Psychology

Psychoanalytictheory1essay11 xPresentationofAcademicSubmissions1 ChildDevelopmentResearchEssayTitles1 StudySkillsday06.02 PsychoanalyticTheory1EssayTitles11 essayquestion1reading1 Theory1_Asecure41 CDR_Asecure31 eESSayq11 essayq2reading1 Essayquestion1reading1 ESSAYquestion1 essayquestion2readings

Please read example essays from previous years CDR A and theory 1 A are all examples. I have also included requirements and critical thinking examples on the study days page. If you scroll down right towards the end is the page titled Theory 1 paper. Those are the CRITERIA that need to be met for the highest marks. I have also attached the presentation style. The referencing needs to be Harvard referencing and citations, please. I have also attached the readings that will be needed. and titled them essay question 1 for all of the readings needed for the first essay and titled essay question 2 for the readings needed for the second essay. Please ensure you follow all these guidelines.

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Tavistockand Portman NHS Foundation Trust

Assessment Front Sheet

ALL written assignments MUST be submitted with this cover sheet. Assignments submitted without this or with an incomplete cover sheet will not be accepted.

Student Number:

1

800481 Course Code: PA7073

Unit Name: Theoretical Perspectives Y1: Strand 1: Psychoanalytic Theory

Unit Number: Unit 3.1 Submission Date:

2

6/04/2021                                    

Word Length (not including appendices and end/footnotes): _______________________________

Essay Title (if applicable): Observing the unconscious – projective processes and defences against anxiety

Confirmation: Please tick the following boxes to confirm:

1. I confirm that the word length falls within the word length tariff for this assignment

2. I confirm that I have taken all reasonable measures to ensure anonymity of all the patients, clients, professionals and institutions referred to in this assignment

3. I confirm that this submission is my own work and the ideas and written work of others has been identified and correctly referenced

Theoretical Perspectives 1: Psychoanalytic Theory

Introduction

Observing the unconscious – projective processes and defences against anxiety

In this essay, I will be demonstrating an understanding of

Psychoanalytic Theory and Infant Development Judy Shuttleworth

· Object relations model as an experience that develops within the individual affecting present in different ways and less directly to do with the past causing the present.

· Klein’s internal world. ‘ baby is pre-programmed to prefer human face and voice above other visual and auditory stimuli to feel comforted’

· Brazelton dynamic interactions’ baby movements smooth and rhythmic for human contact contrasting with jerky movements with a mere object.

·

Klein view – meeting of instinctual needs with an external object not only results in a satisfying experience but initiates beginnings of mental development. The match between infant’s needs and and the object’s capacities, the external world can be brought into the infant’s mental grasp and thought about as well.

Paragraph

2

Paragraph

Conclusion

In your essay, address the following aspects:

1. Introduce the topic in your own words and define the relevant psychoanalytic concepts drawing on the theoretical papers you have studied. (900 words approx.)

2. Illustrate your understanding of the psychoanalytic concepts by explaining their relevance to an example from your observation or work. (900 words approx.)

v1.1 October 2015

1
2

Presentation of Academic Submissions

All academic submissions should be presented in a clear font type such as Times New
Roman, Ariel, Calibri or Verdana and in font size 12. Sentences should be in 1.5 or
double spacing. Pages should be numbered. Footnotes should be used sparingly, if
at all.

All academic submissions should follow the Harvard referencing style. For help with
this please go to the student support page on Moodle.

Any literature quotations should be placed in inverted commas and referenced
appropriately using the Harvard style. If quotations are two sentences or more, these
should be indented from the rest of the text.

‘Observational material’ refers to extracts/quotations of observation that have been
written up and may have been presented in an infant/young child or work discussion
seminar.

Any extracts of observational material should be written in italics. If these are two
sentences or more, they should be indented from the rest of the text. When presenting
an extract of an infant or young child observation, the age of the child and observation
number should be given in brackets following the extract e.g. (10 months, observation
42).

Any identifying details (e.g. name of workplace, child, family, location) must be
disguised. For further guidance please see the Student Support page on Moodle.

The name of the student should not appear anywhere on the paper. Only the individual
student number should be used. Please see the Student Support Page on Moodle for
full details of how to submit assignments on Moodle and to download an Assessment
Coversheet which must go at the front of the submission.

The deadline for all academic submissions on Moodle is 12.00 midday. Late
submissions made within 24 hours of the deadline will incur a 5% penalty deducted
from their grade. Students must ensure they are enrolled on the online submission
page on Moodle where details of academic submission dates are available.

All assignments submitted on Moodle will be analysed by Turnitin, our plagiarism
software. For further details about Turnitin, please see the Student Support page on
Moodle.

ESSAY TITLES (2020-21)

Theoretical Perspectives Year 1
Strand 2: Child Development Research

Please select one of the following Child Development Research topics studied this year:

a) Primed to Relate
or

b) Ruptures and Repairs

In your essay, address the following aspects:

1. Introduce this topic and the range of relevant research you have studied for this subject.
(1000 words approx.)

2. Choose a piece of research, or a study exploring different pieces of research* in the topic
you have chosen. Critically reflect on the scope and limitations of the study/ies described
including how they might/might not address diversity and difference. (800 words approx.)

* Please note, if you choose a study which explores different pieces of research, this cannot be a
chapter from the core syllabus text “Nurturing Natures” (Graham Music).

For full details of the assessment task, please see module description in handbook.

Referencing, paper style, citations
Have a timetable!!!!
What’s involved in writing a paper
Demonstrating that I am learning the outcomes to meet the academic awards
Showing you have grasped something – why you’re writing
Who are you writing for? Someone that’s marking your paper. What will they find helpful? How
can you arrange your writing to make it straightforward for them to look at it and assess
What exactly do you want to write about? Think of exactly what. Condense your material
What do you need to write about?

Clarify the task
– Pay attention to guidance of what the task is, assessment criteria, block of guidance in

handbook

Thinking and planning
– Identify style of approach:
– Plan your time for all papers

Provide a structure
– beginning/introduction
– Middle (that does what the introduction says!)
– Gathering together/conclusions
– Signposting where needed (ie headings)

Illustration and evidence
– Make appropriate use of work discussion/observational material
– Make responsible use of theoretical references (pay attention to assessment criteria)
– Confidentiality of disguising identity
– Respect theoreticians by referencing their work/original concepts

Criteria: this paper is mainly to be observation led and reflection and use theory to help with
guiding yourself towards thinking of material ie suppose to use theory sparingly the theory
should match the observation. Pay attention to criteria to structure. Use theory to demonstrate
that something has come up that you have understood.
This occurs and the theory states i should expect this but i don’t think its relevant? Questioning.

When describing concept: projective identification ie think about giving an explanation a short
one, if referring freud’s transference – actually reference what you’re talking about. Demonstrate
in paper where he discusses this ie Dora case study.

Reviewing your observational material

– Looking through observational material for paper – make the material say as much as it
possibly can to help illustrate and the direction where you’re moving thingsin the paper.

– Expanding on sentences with details in essay paper using a one liner from observation
material for example

– Referencing it as (observation 30, jane is 11 months old) for example.

Critique and proofread
– After paper put together proofread and critique
– Critique: review your writing to see if you can enhance it. To make it better. Create 3

sentences rather than one very long sentence. Notice whether answering question ie
critical reflective skill.

– Reading your writing to check your relevant, your achieving the task, writing is clear,
straightforward and delivers what you need it to deliver.

– Look at the language you’ve used and whether you’ve gone at the top of it. Instead of 4
adjectives use 2? Concise.

– Linking sections to make a point or discuss: need to be clear and straightforward.
Reduced instead of long.

– Proofreading: written english at an academic level

Confidentiality & plagiarism
– For whose benefit are you adding the details; is it relevant? For the marker etc.
– Which details are relevant; put it out initially to flow but go back and have a look to see if

can get rid of/change.

Anonymising your writing – use pseudonyms, not initials (you, families, organisation)
– Don’t give specific details broaden out – not the town/area working in – is it in an inner

city? Rural area? Small town? Area of community affluent? Or deprived?

Sameness and difference – if someone from morocco just say north african/middleeastern
Family: young professional, middle age etc just converting broad details to convey message
Gender – include. In relation to families involved with or clients working with.
What’s the meaning? HOW ARE THESE DETAILS RELEVANT. Similarity of your
culture/heritage and the family you’re observing?

Plagiarism
– Read around the topic and use their reading to write understanding gained

Citation & referencing
– In text citation name the author at the point that you use them in your paper.
– Give date of the book/paper where the author has presented those ideas.
– Referencing: reference list at the end, final list of submission
– Don’t use bibliography – only those referred to in paper.

Reference; in body all ideas correctly referenced but at the end when drawing ideas dont need
to references gain. Only exception if you introduced a new idea in conclusion should be
avoided.
Cite websites name if no author or date

Referencing Harvard style
– All the in text citations need to correspond to reference list – fulll reference listed

following harvard style in alphabetical order. If using same idea again cite again in body
of text but no need in conclusion.

– In text citation: (surname, YEAR)
– (Stark, 2008) if it was a reference from group of people reference the name of

organisation ie (Tavistock & Portman Library, 2010)
– If you have used year or surname in a sentence you can take it out of brackets; in this

1935 article (Rogers) it was noted that…
– Can write Stark (2008)
– Several authors up to 3: all need to be there. (Surname1, Surname2, Surname3, YEAR)
– More than 3 authors (Surname1 et al.,YEAR) et al in italics.

Quotes:
– Lee and kirby (1962, p.6) put in page numbers when quoting something.
– Long quote – still need to put page numbers but don’t need to put quotation marks can

just use indents.
– To cite sigmund freud you need to add information on the edition with the date of

publication of the original text.
– Standard edition (Freud, 1920, SE18, p.45) penguin or pelican (Freud, 1920, PFL11,

p.281) PEP Archive: (Freud, 1920, SE18, PEP Archive, paragraph 7)

Referencing a book:
– Surname, I. (YEAR) Title of the book. Town: Publisher.
– Kamala, K. (2018) How I learned how not to stretch myself.
– If more than 3 authors all need to go in there all 20 etc.
– If this is not a first edition, add the edition number. Goes afte the title – after the dot.
– For collection of published works: add the original year of publication of the paper differs

the year of publication of the book. Year in brackets original publication and the year
underneath for freud etc not in brackets.

Referencing an article
Author, I. (YEARpaper) ‘Title of paper’, Name of the journal, Volume (Issue), webpage,
Website: Author, I. (YEAR) Title pf the page. Available at URL (Accessed: date)

Referencing a powerpoint:
Author, I. (YEAR) ‘Title of presentation’ [powerpoint presentation]. Module code: Module title.
Name of institution. Available at URL of the VLE (Accessed: date)

Email of librarian to ask q’s about referencing : mlubrun@tavi-port.ac.uk

M7 WORKSHOP; WORK DISCUSSION
Due in June. 4000 words not including reference. Material integrated with theories. How has my
work role been impacted by the pandemic. Don’t think its not interesting, or its too obvious.
Assessment criteria very important.

– Show evidence that you’ve thought deeply about your work role, including evidence that
you’ve thought about the emotional impact of you carrying out your work role

– Not Asked to write about therapeutic work but thinking about what it feels like you to
arrive, doing your job, what it feels like for the person you’re working with

– Unconscious processes between workers; violin teacher writing about the unconscious
processes

– Writing about cultural diversity and sameness and difference – evidence you’ve thought
about this. Including cultural identities, language, issues of gender, disability. What does
it feel like, showing your understanding of different perspectives and how they are
enacted in your work role

– Observer role: are you able to use the skills that you’re developing in infant observation
seminar, step back and think from more of a observer perspective – what’s going on
here, what are the processes that are going on for everyone involved.

– Reflections of why am I feeling like that? Make sense of it from observer perspective.
– Gather understanding overtime; not to rush conclusions or make judgements

prematurely. Showing curiosity. Capacity to wonder. Student writing: im not sure what to
make of what’s going on in this interaction but i had some ideas that it might be this or
that. Assessed in quality of thinking and that includes, not sure and some ideas i think it
may be is that.

– Marked on reflectivity.
– Illustrate paper; 1000 words approx, presented tehthe way in work discussions.
– Include few, relevant theoretical texts, ie child development & psychoanalytic theory.

Choose your work discussion write ups carefully ie ideas first, work material and then
pick theories from child development & psychoanalytical theories to bring in and support
your argument.

– Some seminar links will have been made. So you can link to paper,
– Detailed notes: set out your situation, ie only got these 3 moments so drawing material

from those 3 moments due to situation.
– Structure of paper: focusing on adolescents/children. you’re writing about your

experience of your working role. There isnt a set title for this paper. Can just call it work
discussion paper.

– Start with intro, introduce setting, intro to what you’re exploring in the paper. Following
development of child working with? Short term interventions/relationships? Strengths &
limitations of working situation. If you’re trying to make a point think of material which
example will capture the theory or idea. What exactly is it illustrating. Include theory only
when its defo supporting example.

– Should only use between 3-6 pieces of theory that helps support argument and
discussion you’re having.

Workshop Infant Obs 1
3 different tasks for this paper.

Task 1: 12 or more observations both 1500 words.
– Submit a portfolio of 2 infant obs from early and from further on write ups
– Reflective piece of writing based on observational material presented about emotional

experience of baby observed.
– Each one should be about one video scenario.

Content of reflective piece; experience of observing by video. How the video obs ended. The
beginnings, endings, taking thoughtful stance. Thinking of impact of being an observer. Be on
the tightrope of something called an observer stance – think in a way of a mental discipline.
What will the infant experience will be moment to moment and try not to get distracted by whats
going on in the surroundings. Interaction of infant and imagining it as a tightrope – impossible to
be perfectly in an observer role.
Skills will develop. Starting the discipline of noticing when you fall off the tightrope, wat made me
lose focus that i couldn’t concentrate on infant’s experience? Write ups include ….. To think
about why your mind went awol in that moment in your infant obs seminar.
Developing skills as an observer.

– Reflective piece on your own experience. Its not a focus of theoretical understanding.
– Think of a vignette draw your experience of it then link with a psychoanalytic theory.

Focus on your experience and the baby’s experience.
– Think about your development as an observer – first pieces may be more gaps, less

detailed, further on more detail less gaps etc.
1 or 2 themes to gather the material. In depth thinking. Outline of development so far but like to
see thinking in detail about these specific materials that you;ve got in a vignettes or 2 vignettes.

Task 2: delayed and completed less than 12 by submission date
– Portfolio comprising one infant obs from first 12 obs.
– Include reflective piece of writing including broader ideas; attempt to finding suitable

finding, meetings with professionals, potential parents and what you’ve learned.
– Extracts from reflective journal to evidence your reflection
– Experience of early weeks and months, focus on baby’s emotional development and

interactions.
– Reflection: 2300 words. Could talk about experience of covid and how thats affected the

search. Reflect on experience of being part of observation seminar during this time.

Submitting essays
At the front of essay – need to have a cover sheet boxes to tick for confidentiality.
Save as word doc or PDF. When saved save it as student number and the name of essay ie
infant obs 1 or work discussion 1.

Writing an Academic Essay child development
research
1800 words
Assessment criteria
quantitative/qualitative
Specificity/Generalisability
Universal/Culturally specific
sameness/difference
Validity for critical

Critically reflect – can make reference to their acknowledgement of their criticals. Have you
reflected on it? Does it make sense to you? Are they measuring what they’re saying? Or if
you’ve spotted they’ve overlooked something.

Validity – can we say this is beyond urban middleclass families, is it really universal. A lot of
people aren’t looked at or considered. Measuring something that they’re not realising they’re
measuring. All papers are entirely collertive they’ve controlled what they can not as specific a n
animal study so always areas that can slip in that we wouldn’t notice. So what have they
actually measured and the thing that they’re stating is the cause of the outcome.

correlation / causation relationship
Correlation – one thing happens another thing happens at the same time, can’t be sure that A
causes B.
Causation – A causes B.

Quantitative vs qualitative and how does that relate to specificity and generalisability
– One experience can’t generalise but even with quantitative – amount of data you have

and where it comes from to generalise.

Demonstrate knowledge and understanding of CDR -breadth and depth, show that you’re able
to understand the breadth of research.
Demonstrate a clear line of argument – question is always about a specific area and the most
interesting areas make an argument about why those findings are important.
Chronological ideas

Your marker has a marking sheet – read your paper it’s good but we are only allowed to
comment in boxes next to criteria, if you don’t meet the criteria limited to marking.

Theory 1 Paper
1800 words
Understanding of concept supported by relevant primarily and secondary source texts.
Theoretical and links between understanding of it and other modules. Theory paper.
Main focus is the theories.

Keep it tight and to the point with theory and less on examples. Not all background detail
essential with this.

Primary source – core texts, papers by the original authors. Access to more applied papers that
might discuss how those concepts are used clinically in a contemporary context would be
secondary.

Key core psychoanalytic theorists and then the secondary is adding onto their readings,
developing on the core thinkers. Don’t just do secondary read the full primary and secondary.

Assessment criteria
– When you get your first paper back can see markers comments next to other box where

criteria is.
– Evidence that you’ve internalised and understood these ideas so they come out in your

voice. Talk about these concepts with confidence.
– Include reference to questions of diversity in relation to PA framework – understanding of

diversity in when these concepts started and what they’re based on, now how
psychoanalytic concepts can be used with a diverse population. Can these concepts be
applied in cross cultures or can be more cultural specific.

– Specificity and generalisability. Think about your race.
– Critical perspectives; how can the concepts help us understand things projective

processes playing a part in racism etc.
– How does the issue of diversity and difference play into transference?
– Demonstrate understanding of concepts in relation to observational work. Have to bring

something of own experience into this. Only using material to demonstrate
understanding of theoretical concepts.

Introduce topic and define relevant PA concepts 900 words
– Balance, good to adopt a position to argue from a perspective but have to be careful.

Show that you understand the concepts and which are the key papers that are the go to
points. Differences in opinions within a context show that you recognise that.

ESSAY TITLES (2020-21)

Theoretical Perspectives Year 1
Strand 1: Psychoanalytic Theory

Please select one of the following psychoanalytic topics studied this year:

a) Psychoanalysis, cultural diversity, sameness and difference and the Unconscious
or

b) Observing the unconscious – projective processes and defences against anxiety

In your essay, address the following aspects:

1. Introduce the topic in your own words and define the relevant psychoanalytic concepts
drawing on the theoretical papers you have studied. (900 words approx.)

2. Illustrate your understanding of the psychoanalytic concepts by explaining their relevance
to an example from your observation or work. (900 words approx.)

For full details of the assessment task, please see module description in handbook.

118

C H A P T E R T E N

Projective processes:
gangs, bullying, and racism

Groups and gangs

W
hen does a group become a gang? Hamish Canham
(2002) defines a gang mentality as one in which de-
structive forces have taken over. It is paranoid-schizoid

functioning where there is no thinking, only a need to rid oneself
of parts of the personality that might expose the individual (or
group) to feelings of neediness, ignorance, or weakness. Within the
personality, this is achieved by imposing a reign of terror on the
vulnerable parts. In gang behaviour, the reign of terror is directed
towards other groups. A gang is anti-thought, anti-parents, and
anti-life.

Hamish offers a commentary on William Golding’s The Lord of
the Flies and tracks the way in which the boys lose touch with an
idea of parental function and give way to the lure of the gang. He
draws attention to the way in which Ralph and Piggy manage to
impose some structure by making the rule about the conch: in com-
munity meetings, boys cannot speak unless they are holding the
conch. At the beginning of their time on the island, the older boys
are in touch with the idea of rules (which Hamish suggests are a
representation of parental function), and they agree to this arrange-

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119G A N G S , B U L LY I N G , A N D R A C I S M

ment. Later, the rule is cast aside, the conch smashed, and order is
overthrown in an outpouring of paranoid-schizoid behaviour.

Jack, the leader of the choir, represents the pull in the group
away from feeling lonely, afraid and dependent on each other
for survival. The de-personalisation that sets in is represented
by the dyes with which these boys begin to daub their faces.
Jack, in particular, is gripped by an idée fixe which is that their
survival is dependent on killing the pigs which inhabit the
jungle interior of the island. This culminates in a horrific scene
where a sow with a litter of suckling piglets is killed by Jack
and his band of followers.
This action represents most dramatically the gang mentality
at work. Faced with a life without parents to look after them,
vulnerability and loss is projected into the pig family, with
the piglets made into the orphans the boys feel themselves to
be. As those who have read the novel will know, this cruelty
extends to brutal savagery from Jack and his gang towards the
other boys, in particular Piggy, who is killed towards the end
of the book.
Piggy is an overweight, asthmatic boy who has an ability to
see the truth of their situation and to continue thinking about
what needs to be done to ensure the survival of everyone. Pig-
gy’s thoughtfulness and insight is under constant attack from
the gang. They steal his glasses—representing his capacity to
see—and eventually they kill him. Ralph is the character who
struggles most between the lure of the gang and his desire
not to lose the capacity to think. As he is pulled towards the
gang, Golding describes a shutter coming down in Ralph’s
mind. This shutter seems to cut him off from what he knows
he should be doing—keeping the fire going, looking after the
younger children, building shelters and keeping everyone
working together. It represents the temptation for him to for-
get these responsibilities and to join Jack’s gang who seem
to be leading a life free from these worries as they hunt for
pigs.
It is most striking that the only two characters in the book
who make reference to their families in any significant way are
Piggy and Ralph. It seems that it is this ability to keep alive a
sense of helpful, loving parental figures that sustains these two
boys and helps them not to climb into identification with the
parodies of powerful grown-ups as Jack and his followers do.
[pp. 119–120]

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120 T H E L E A R N I N G R E L AT I O N S H I P

Children and young students in schools are not faced with this
kind of ordeal, involving total separation from adult control and
protection. However, there may be times when the experience of
groups or individuals will have some elements in common with
what is described in the novel, and their emotional responses may
be similar.

Hamish Canham summarizes what can be seen as the teacher’s
(or school institution’s) role as follows:

The presence of figures in authority who can maintain a thought-
ful and considerate attitude towards all those for whom they
have responsibility inclines people towards groupings rather
than “ganging”. This may be within a family, the classroom,
work place or in government. The presence of these figures is,
of course, not sufficient in itself, for they will be distorted by the
perceptions of those reliant on them. This relationship is crucial
and is centrally determined by the results of working through
the Oedipus complex in individuals. [p. 125]

The internal world and the gang state of mind

This brings us back to the question of what is going on in the
internal worlds of children and young people who, as Hamish
suggests, distort their perception of external reality such that they
cannot make use of thoughtful, concerned adults. He writes about
a “ganging” within the mind, which drives children towards gangs
in the external world or turns them into nasty, scheming bullies.
“The dominant and destructive parts of the self take hostage what
they feel to be those other parts which would expose them to
feelings of neediness, littleness and ignorance and they do so by
imposing a reign of terror on those other parts.” In this state of
mind, the individual is clinging to the illusion of omnipotence
and omniscience; there is no separation from the object and no
acknowledgement of dependency. The parent in the internal world
is a nasty, narcissistic version, seeking only to rid him/herself of
any awareness of vulnerability or need for others.

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PORTMAN NHS TRUST
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Bullies and victims

The bullies of school stories (e.g., Flashman in Tom Brown’s School-
days, Squeers in Nicholas Nickelby) fit neatly into this psychological
account of extreme splitting and projection. They are unrelenting
in their attacks on their victims and continue with their escalating
cruelty until such time as they get their just deserts. Most of the
time, the situation is much less polarized. If paranoid-schizoid
functioning and the depressive position are seen as states of mind
between which all human beings oscillate, then it follows that
everyone is capable of bullying behaviour of one kind or another.
When interviewed sensitively and encouraged to be honest, most
children admit to having at one time or another bullied a weaker
member of the class, a younger sibling, or an animal. Most children
can also describe interactions or relationships in which they have
been the victims of bullying. They are also able to speak eloquently
about how they understand the motivation behind bullying, seeing
very clearly that the bully is trying to get rid of feelings he does
not want to have.

The cliché about there being a coward inside every bully is,
of course, accurate. However, a psychoanalytic account would
suggest that the perceived threat comes as much from within the
individual as from the external world. If, after an episode of bul-
lying behaviour, the individual is able to get back in touch with
good internal objects and associated depressive functioning, he
will be able to think about his own culpability and to feel some
remorse. If this is not possible, the bully is indeed in a terrifying
world, one in which his hostile projections lodge in objects which
then become all the more toxic and threatening, as the fear of re-
taliation increases. When bullying becomes entrenched, the bully
has to redouble his efforts to make sure that there is no chink in
his armour. Part of this is likely to be to surround himself with a
gang—a group of followers who have their own reasons for stick-
ing close to the bully. The leader of the gang works hard to make
sure that everybody knows it would be dangerous to leave—a
clear projection of his own knowledge that he would be in danger
without them. This is the theme of many books and films as well
as the school stories mentioned above. The Mafia, for example, is

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122 T H E L E A R N I N G R E L AT I O N S H I P

not an organization that people choose to leave or, indeed, where
there is room for independent thought!

Origins of the gang state of mind

In terms of child development and early experience, the lamenta-
ble internal situation of the hardened bully or gang member may
come about in a number of ways. Hamish Canham (2002) draws at-
tention to the kinds of experiences that, in his view, may create the
“gang state of mind”. He refers to the impact of extreme anxiety
and the tendency in human beings to look for someone to blame.
He also identifies deprivation in terms of a deficit in containment
in early life, which he suggests renders the individual less able
to hold on to depressive position functioning and more likely to
resort to projection and splitting. He writes about the impact of
abuse and the way in which children who have been the victims
of abusive treatment often seek to rid themselves of the feelings
of fear, anger, guilt, and shame by passing on the experience, by
vacating the position of victim and putting another in their place.

CASE ILLUSTRATION: ROBERT

Robert was a bully. At 10 years of age, he had a reputation in his
school for terrorizing anyone who was smaller or weaker than
he was. His teachers knew what he got up to but could rarely
catch him at it. If they did see him, for example, leaning over
a younger child against a wall in a corner of the playground,
they would try to intervene, but he would quickly put a posi-
tive spin on what he was doing and his hapless victim would
corroborate his story. He was usually flanked on either side by
boys of physical bulk and low intelligence. They considered
themselves to be highly privileged to have been singled out by
him, and if they ever felt a tinge of discomfort about what they
were seeing, they were very quickly pulled back into line.

Robert seemed entirely comfortable in his position as leader of
his gang. Without actually causing physical hurt, he managed
to provide himself and his followers with extra money, extra

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123G A N G S , B U L LY I N G , A N D R A C I S M

food, the best seats in the dining hall, and first turn on the foot-
ball pitch. He was intimidating. He was also capable of making
his own classmates fall about with laughter, and they looked on
with some satisfaction as he tried out a bit of mockery (verbal
bullying) of an inexperienced supply teacher.

Shortly before he was due to visit possible schools in advance
of secondary transfer, he was accused of going into the girls’
toilets and of looking up the girls’ skirts. A 9-year-old girl
had been upset at home, and her parents came into the school
to complain. The head teacher subsequently spoke to Robert,
who first denied it and then broke down and begged him not
to tell his father. The next day, having received a call from the
head and a letter giving the reasons for a three-day exclusion,
Robert’s father stormed into school. He barged past the recep-
tionist and straight into the head teacher ’s room, demanding
an explanation. Towering over the head’s desk, he shouted that
his boy was innocent and that it was just typical of this school to
pick on an innocent child. He thumped the desk as he said that
if there was any more trouble of this kind, he would make life
miserable for the head, adding that he did not need anyone to
tell him how to bring up his child. If there was any punishment
to be meted out, he would do it himself.

A very much cowed Robert returned to school three days later.
The head spoke to him immediately and suggested he see the
school counsellor. The counsellor continued to see him until
he moved on to secondary school. Sessions were filled with a
great deal of empty bravado, but Robert did manage to talk
more honestly as the relationship developed, and his bullying
behaviour diminished over the last few months of his primary
school career. The counsellor came to understand that Robert
was terrified of growing up. He had very little internal sense
of supportive adults who would help him to do so. He was
sure that he would be bullied in secondary school and that his
father would mock him for it. He was already mocked by his
older brothers for not being more sexually advanced, hence
his exploit in the girls’ toilets. He had no confidence in his
academic ability and so believed that physical strength was his
only way of staying “ahead of the game”. Being “ahead of the

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124 T H E L E A R N I N G R E L AT I O N S H I P

game” seemed to be his version of being able to survive—phys-
ically, emotionally, and psychologically. The counsellor was
convinced that Robert was treated harshly at home, but he was
fiercely loyal to his father and would not give anything away
about his home life.

The way in which Robert fits in with Hamish Canham’s descrip-
tion of the development of a gang state of mind is clear. At 10 years
old, he has a model in his mind which is of needing to make him-
self feel better by making others feel worse. He surrounds himself
with supporters and provides himself with stolen goods to boost
his flagging self-esteem. He cannot dwell on his fears for the future
and is heavily identified with his bullying father. Mockery threat-
ens him from without and from within. It is a hopeful sign that his
counsellor managed to make some contact with a more vulnerable
and honest aspect of Robert, and one would want to think that a
similar resource would be made available for him in secondary
school. The onset of puberty, with all the associated physical, psy-
chological, and emotional changes, could so easily throw him back
into an identification with a gang leader.

Envy and the bully

I want to broaden the discussion about deprivation in the inter-
nal world and make some links with deprivation in the external
world and with the destructive forces of envy. It is absolutely clear
that poverty does not, of itself, breed destructive envy. If there is
a secure internal structure based on experiences of containment
and of having been helped to negotiate separation, the materially
impoverished individual is unlikely to be consumed by envy of
his richer neighbour. However, where internal deprivation of the
kind Hamish describes meets external deprivation, there is fertile
ground for envy and hatred. Poverty and deprivation may then be
used by individuals to justify their membership of gangs which,
they argue, only exist to right the perceived injustice. This is a
particular danger when the impoverished individual is constantly
brought up against the affluence of others. There have been major
changes in this aspect of the external-world context since the early

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125G A N G S , B U L LY I N G , A N D R A C I S M

psychoanalytic theorists were struggling to reach an understanding
of projective processes. This kind of provocation—the provocation
of relative wealth—can be seen in inner cities, where rich and poor
communities live side by side. It can also be seen in communities
where there is widespread poverty and despair but where satellite
television suggests that there is a shiny, exciting world just out of
reach. Envy of what others seem to have acquired without effort is
one of the major determinants of the gang state of mind. Globaliza-
tion, advertising, ideas of instant wealth and fame, and the preoc-
cupation with celebrity all serve to challenge the sense of identity
of the individual, and particularly so if feelings of relative poverty
resonate with an internal picture that is full of deprivation.

Racism

Bullying and racism are different in some important detail but also
have much in common with each other. I do not intend to suggest
that a psychological account of racism can replace a sociological
or political account. As Stephen Frosh (1989) suggests, racism, like
sexism, is deeply embedded in Western society, having its external,
historical roots in economic and political oppression. However, the
question to be addressed is whether a psychological understand-
ing of the internal dynamics of racism can contribute anything of
value to those who are charged with responsibility for managing
the issue in our schools. Frosh makes the point that it is the rac-
ist fear and hatred in the psyche of individuals that perpetuates
institutionalized racism.

This is a debate that is often felt to be too risky to address. Our
language in health, education, and social care is peppered with
phrases that are designed to make everyone feel more comfort-
able—“working with difference”, “anti-discriminatory practice”,
“cultural sensitivity”, and so on. These may be worthy aims, but
they all too easily serve to inhibit thought, in that they sanitize
and oversimplify an area of discourse that is rife with passionate
feelings of love, hatred, and fear. I want to be clear that I am not
dodging the question of how schools can make a contribution to
the anti-racist cause, but, rather, arguing that enhanced under-
standing of the mechanism within individuals must surely make

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126 T H E L E A R N I N G R E L AT I O N S H I P

a contribution to thinking about the curriculum and about whole-
school policies.

The racist individual

On an individual level, racism is another manifestation of pro-
jective processes. The racist targets a particular individual or an
ethnic group, who become the recipients of a cluster of hostile
projections. Thoughts and feelings that the individual does not
want to own get attached to a racial identity. That race is then
hated because of the characteristics that have been attributed to it
and feared because there is an unconscious expectation that there
will be retaliation. The racist has to ensure that he is justified in
his hatred, and this he does—in a similar way to the bully—by
gathering like-minded supporters around him and by justifying
his position with arguments about the way in which the hated
race has brought it on itself. Economic realities such as pressure on
housing or benefits are brought into the argument in the service of
bolstering a system that is actually about generating paranoid fear
and hatred in an attempt to manage internal anxiety. Envy fuels the
racism when the racist thinks he sees the hated group succeeding
where he feels himself to be failing.

Fear of difference and change

It is easy to write or speak about “the racist”. It is much more dif-
ficult to address aspects of fear, prejudice, and intolerance in our-
selves. In the chapter on beginnings and endings (chapter 6), I have
written about the tendency in the human psyche to try to hold onto
the status quo, actively resisting forces that challenge our assump-
tions and threaten our equilibrium. “Working with difference” and
“celebrating diversity” suddenly become much more challenging
notions if we are genuinely open to new experience and really al-
low for the fact that we might need to change our perspective and
that change involves discomfort.

For my own generation, growing up in the 1950s and early
1960s, ignorance was a major part of the picture. The idea of “The

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Commonwealth” was a comfortable cocoon in which to hide from
the realities of inequality, exploitation, and oppression. Childhood
songs, rhymes, and stories were racist in content, but we did not
know it (consciously) and were not called upon to be ashamed
of reciting them. Things have moved on since then, and children
now have the benefit of a more rounded version of history and
first-hand knowledge of other ethnic groups and other cultures.
Schools have played a vital role in educating children over several
generations about each other’s histories and cultural identities,
and this has done much to eradicate some of the stereotyping and
racist assumptions which, historically, were based on ignorance.

The situation in the early twenty-first century is very different.
Mass migration has continued to grow over the past fifty years,
and we now live in much more mixed communities. We are also
subject to the inexorable impact of world news and commentary.
Social divisions are now racialized in a way that can all too read-
ily be used to legitimize the words or behaviour of the racist in-
dividual.

Cooper and Lousada (2005) make some interesting points in
a paper that they call “The Psychic Geography of Racism”. They
suggest that in the last decade or more, there has been a loss of
the “believed-in family”, by which they mean that there has been
a change in the relationship between citizen and state. “Upon
the quality of the relationship between citizen and state depends
the depth or shallowness of social concern” (p. 86). They suggest
that in the past there was a relationship with an idea of the “Wel-
fare State”, which was built on assumptions of benign leadership
where government and those in positions of authority would con-
cern themselves with the needs of all those for whom they have
responsibility. The population now knows much more about the
actual people and institutions who are invested with these respon-
sibilities and so has developed a much more cynical attitude.

Cooper and Lousada’s thesis is that with the loss of the
“believed-in family” comes the loss of a capacity for concern for
the stranger. Acceptance of the stranger gives way to fear of the
stranger and the growth of “nationalism, racial and social indiffer-
ence”. Schools reflect the society they serve, and I would suggest
that there is something one might call the “believed-in” school
institution where there is sufficient containment from the senior

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128 T H E L E A R N I N G R E L AT I O N S H I P

management team for tolerance and concern to hold sway. If the
“believed-in” school is undermined, there is fertile ground for pro-
jective processes (ganging, bullying, and racism) to take hold.

Whole-school policies

Anti-racist and anti-bullying policy statements are important doc-
uments that give a clear message to staff, pupils, and parents as
to what is and is not acceptable in school. Many local authorities
now require that any incidence of bullying or racist behaviour be
recorded. The record becomes part of the annual report from each
school and, in that sense, is a public document. A thoughtfully con-
structed policy can be a genuine indication that a school is aiming
to offer a “believed-in-family” context for learning and teaching. It
can also, in some instances, be used defensively, as if the existence
of a statement can in some way guarantee a tolerant and inclusive
institution. Children and teachers should, of course, be prevented
from speaking or behaving in a racist way. The curriculum should,
of course, be genuinely multicultural, reflecting the experience of
every member of the school community. All this is part of thought-
ful and containing (Bion, 1961) management of the institution.

However, prejudice cannot be managed didactically. Teach-
ing tolerance and understanding is a much more complicated
task. There is a danger that Personal and Social Education (PSE)
becomes infected by unconscious anxiety and unwittingly settles
for teaching “about” diversity, never finding a safe way to explore
some of the more primitive fears and feelings that groups have
about difference. There is also a danger that the teaching takes
up a rather comfortable “us” and “them” position, encouraging
“us” to make space for “them” (the newcomers) and not address-
ing the nature of the minority experience and the feelings “they”
have about “us”. In my view, the very use of the word “minority”
highlights one of the most powerful unconscious forces: the need
to reassure oneself that one is in the “majority”.

A major challenge of the early twenty-first century is how to
understand the way in which international and inter-communal
hatred has resulted in barbaric acts of terrorism in so many parts
of the world. What is it that drives a young man to sacrifice his

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129G A N G S , B U L LY I N G , A N D R A C I S M

own life in order to take the lives of others in the name of nation,
race, or religion, and what impact does this have on the polariza-
tion of religious and political factions? At the time of writing, the
response of the UK government to the London bombings of 2005
has been to introduce legislation to prosecute those who incite
hatred. Again, we see a device to control behaviour, which may be
necessary but which seems to be entirely split off from thinking
about the underlying issues.

These are huge questions, and we do not currently know how
events will unfold, but there is a very simple point to be made
about the importance of education and the vital role of schools.
We neglect issues of racial, cultural, and religious identity at our
peril, and it may be that combining a psychological account with
a socio-political account in relation to human development and
school communities would provide us with new and energizing
perspectives.

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TheOedipus Complex

This essay presents a discussion of the origins of the Oedipus complex, beginning with its Freudian

conception and subsequent Kleinian developments.1 I will give an overview on the evolving

importance of the primal scene (the parental sexual relationship) presenting the argument that the

contemporary understanding of the primal scene as an imagined space allows for an interpretation

of the Oedipal complex that does not succumb to heteronormative bias. I will then compare Freud

and Britton’s differing understandings of the pathogenic potential of the Oedipal complex. Finally, I

will utilise a vignette taken from my work with a three year old boy to demonstrate how an

understanding of the Oedipus Complex can provide insight into a child’s internal world.2

Little Hans and the Freudian Oedipus Complex

Freud situates the Oedipus complex during the phallic phase of psychosexual development, in

which transfer of the libido to the genitals as the main erogenous zone occurs (1905). Freud

demonstrates how the changes associated with this stage can manifest in increasing sexual curiosity

and masturbatory impulses through the depiction of Little Hans’, ‘interest in widdlers’, and

compulsion to ‘touch his member’ (1909, SE10, PEP Archive, p.2). Also ‘typical,’ Freud argues,

‘of the sexual development of children,’ is a growing sexual desire for the Mother (1909, SE10, PEP

Archive, p.2). This is presented as a prominent feature of Hans’s behaviour, he is labelled a, ‘little

Oedipus who wanted to […] be alone with his Mother and sleep with her’ (1909, SE10, PEP

Archive, p30). Freud demonstrates how Hans’s sexual feelings towards his Mother, engenders the

fear of his Father’s retaliation; now his rival by necessity, locating what Segal refers to as the,

1 For the purpose of this essay, I will focus on the male Freudian Oedipus complex, a decision informed by the
abundance of male Oedipalmaterial in Little Hans, and the overwhelming consensus that the phallocentricity of
Freudian understanding of female sexuality is,‘narrow and ignorant’(Klauber, 2019, p.10).

2 All names included have been changed to ensure confidentiality.

‘conflicting impulses, […] anxieties and defences,’ that this engenders as central to the formation of

the Oedipal complex (1989, p.1).

For Freud, this rivalry manifests both as an ongoing castration anxiety that draws its origins in

Hans’s Mother’s threat to ‘cut off your widdler’ (1909, SE10, PEP Archive, p.2) , and his

unconscious ‘death wishes’ towards his father (1909, SE10, PEP Archive, p.30). Crucially, as Hans

also loves his Father ‘deeply,’ (1909, SE10, PEP Archive, p.30), the repression and then

displacement of his negative feelings for his father onto horses, works as a defence, allowing him to

fear and hate a phobic object, without conflict. If Hans’s fear of horses is presented as pathogenic,

the repression of his conflicting emotions surrounding his parents is not. Freud suggests that Hans’s

phobia could even be perceived as advantageous as it ‘directed his parents attention’ to the

‘unavoidable difficulties’ associated with typical Oedipal anxieties (1909, SE10, PEP Archive, p.

34).

For Freud, the resolution of the Oedipus complex ‘would go to its destruction […] from the effects

of it’s internal impossibility’ (1924, p.395). As little Hans discovers, ‘the barrier against

incest’ (Freud, 1909, SE10, PEP Archive, p.8) , necessitates a repression of his sexual desires

towards his mother, which allows for the internalisation and identification with his father, an

indication of a successful resolution of the male Oedipal complex (1924). Hans’s phantasy in which,

‘the plumber came and first he took away my behind with a big pair of pincers and then he gave me

another, and then the same with my widdler’ (Freud, 1909, SE10, PEP Archive, p.25) , is seen as

symbolic of his internalised identification with his father and the resolution of his castration anxiety.

It is pertinent to acknowledge that the presentation of internalised identification as the ideal, betrays

both the heteronormative bias of the social structure contemporary to Freud, and what Wakefield

cites as a phallocentric lack of consideration concerning the role of maternal containment within

Little Hans (2007).

Klein’s Oedipal Situation

Through her psychoanalytic work with infants, Klein reshapes the Freudian Oedipus complex,

alluding to an infantile Oedipal relationship with the parents that occurs prior to the phallic phase,

referred to as the ‘Oedipal situation.’ (Britton, 1989, p. 83). Klein emphasises the importance of the

relationship to the breast, which is experienced as two different part objects, sometimes the loved,

nurturing breast, and sometimes the hated, withholding breast . The manifestation of this state, in

which the perception of the world is split into good and bad, defines what Klein refers to as the

paranoid schizoid phase. Klein states that the aim of this phase, is to work towards acceptance that

the hated breast is also the loved breast, or the depressive position (Fear, 2018).

Klein posits the depressive position as central to the development of the Oedipal situation because

recognition of the Mother as not a ‘sole and permanent possession’ engenders a ‘recognition of the

parental sexual relationship.’ (Britton, 1989, p. 84). In this way Klein connects Freud’s concept of

mourning, where the phantasy version of an ideal world must be surrendered to achieve a realistic

understanding of the world (1917) , with the process of working through the Oedipus complex,

where the infantile version of the ‘ideal’ Mother must be surrendered. However, Klein, also betrays

a heteronormative bias as she corroborates Freud’s theory that Oedipal resolution is ultimately

achieved through identification with the parent of the same sex (Fear, 2018).

The Evolving Importance of the Primal Scene

Fear states that Freud ‘believed the child to have a knowledge of the primal scene’ (2018, p. 16).

However, in Little Hans, it is contextualised as important in relation to the Oedipal complex

predominantly because it reveals Hans’s unconscious knowledge of the sex act, and is utilised as a

means to strengthen the argument that Hans wants to ‘take possession of his mother,’ as his Father

does (Freud, 1909, SE10, PEP Archive, p.8).

For Klein the primal scene features more centrally in the Oedipal situation. What Klein refers to as

the epistemophilic impulse, or desire to know what the parental couple excludes the infant from, is

key in her resolution of the Oedipal situation (Fear, 2018). Knowledge of the primal scene places

the child in the position of the ‘observing third,’ a position that when tolerated, engenders the

understanding that it is possible to be alone but not abandoned, crucial for development and

learning. (Fear, 2018, p.26).

Britton expands on the importance of the primal scene, stating that an acceptance of the link

between the Oedipal couple can lead not only to a crucial understanding of the difference in the

relationship between parents and children, but the possibility of a beneficial perception of parental

intercourse which is not just excluding but creative (Britton, 1989). Britton also refers to the primal

scene as ‘the place where [in it’s perpetual absence] the object spends its invisible existence.’ (2003,

p. 20). Here, Britton presents a configuration of the primal scene that is representative of an

imagined space rather than a literal act, a metaphor that describes the need for infantile recognition

of the mother or primary carer’s existence outside of the mother-infant dyad. Crucially, this does not

rely on a heteronormative familial configuration, or even an Oedipal couple. Therefore, Britton

shifts the centrality of the Oedipal drama away from heteronormative ideals and gender

identification, towards the separation anxiety of the infant and the ability to tolerate being alone.

Pathological potential

Freud emphasises the enduring affects of the Oedipal complex in the phallic stage, as an ‘infantile

trace’ that helps determine an individual’s sexuality in adolescence (1905, p. 363), arguing that the

‘finding of an object’ in puberty (1905, p. 357) is heavily influenced by the Oedipal complex, ‘this

first and most significant of all sexual relations’ (1905, p. 358). Freud therefore signposts the

‘detachment from parental authority’ (1905, p. 361) at adolescence as an essential factor in

preventing ‘disturbances of psychosexual development’ (1905, p. 362).

However, Freud states that at ‘every stage in the course of development […] a certain number are

held back’ (1905, p. 361), individuals who regress, or remain fixated on their childhood libido

object choice may experience a pathogenic expression of their Oedipal complex during later life

(1905). While Freud’s pathology of sexual inversions, such as homosexuality proves controversial

for the contemporary reader, his understanding of the Oedipal complex’s crucial role in adulthood

neurosis paved the way for developments in contemporary psychoanalytic thought.

Britton disagrees with Freud in that he argues, ‘each new life situation, at each stage of

development, and with each major addition to experience or knowledge’ requires a re-working of

the Oedipus complex (1992, p. 38). This is not presented as pathogenic in itself, but as essential to

development. However, Britton also cites the importance of the Oedipal complex in relation to

neurosis, referring to Oedipal illusions as ‘defensive organisations’ that seek to ‘deny the psychic

reality of the parental relationship’ (1989, p. 99). Britton utilises Bion’s concept of containment to

discuss when an unresolved Oedipal complex becomes pathogenic, arguing if the mother has an

‘existing precarious status’ as a container, the further threat of acknowledging the relationship with

the father could ‘spell disaster’ (1989, p. 90).

Oedipus complex within a Nursery setting

To further elucidate an understanding of the Oedipal complex, I will look in detail at a moment

from my work in a Private Nursery with a 3 year old, ‘Tom.’ I have been working with Tom for

eight months. This vignette is taken from the week in which Tom was informed that his Mother is

five months pregnant with her second child. Tom’s parents are a married heterosexual couple.

Extract:

‘What are you going to draw?’ I ask Tom. ‘My house!’ he says, reaching for a crayon and

drawing a large connected circle. ‘Next, he draws a small stick figure inside the circle.

‘This is Tom and Mummy!’ He draws a much larger stick figure next to the Tom figure.

‘What are mummy and Tom doing in the house?’ I ask. ‘Resting on the sofa!’ says Tom.

‘What about Daddy?’ I ask. ‘In the garden!’ says Tom, and he draws a stick figure outside

of the circle. ‘He loves digging up the plants!’

I found the symbolic potential of Tom’s drawing illuminating. The placement of his figures, with

him and his Mother inside the house, and his father outside seemed suggestive of an Oedipal

phantasy; the desire to be alone with his Mother and remove his Father. In light of his Mother’s

recent pregnancy, the large containing circle could be symbolic of a womb-like space. If Britton’s

suggestion that, ‘each new life situation,’ requires a re-working of the Oedipal complex (1992, p.38)

is considered, it could be argued that Tom is demonstrating an unconscious desire to regress to the

Mother-infant dyad as a defence against the Oedipal anxieties engendered by the prospect of a

sibling.

Tom’s depiction of his Father’s digging could be indicative of Tom’s unconscious knowledge of his

role in the primal scene. More likely, I feel that it represents the way in which Tom may have

unconsciously attributed the perceived destruction of his family to his Father. Tom may be

projecting his anger into his Father; perhaps as a regressive form of splitting that acts as a defence

against the knowledge that his Mother has decided to have another child, and therefore does not

solely belong to him. By attributing the blame to his Father, the ‘good mother’ is protected. It seems

that Tom is working through his Oedipal anxieties through the medium of symbolic play, playing

out his unconscious phantasies.

The concept of the OedipalComplex can therefore be beneficially utilised as a way to understand

childhood behaviour. While the resolution of both the Freudian and Kleinian Oedipus Complex

focus perhaps detrimentally on gender identification, by bringing childhood and infantile

unconscious phantasy about the parental couple into the forefront, their theories paved the way for a

contemporary understanding of the Oedipus complex as a means to understand separation anxiety

and how to be tolerate being alone. These issues are crucial to the development of the mind, both in

childhood and adulthood.

Bibliography

Britton, R. (1992). ‘The Oedipus situation and the depressive position’ In R. Anderson (Ed.), New

library of psychoanalysis, 14. Clinical lectures on Klein and Bion (pp. 34-45). New York, NY, US:

Tavistock/Routledge

Britton, R. (2003) Sex, death and the Superego. London: Karnac Books.

Britton, R. (1989) ‘The missing link: parental sexuality in the Oedipus complex’ in R. Britton,

Feldman M and O’Shaugnessy, E (1st ed.) The Oedipus complex today. Clinical implications.

London: Karnak Books, pp. 83-101.

Fear, R. (2018) The Oedipus complex : solutions or resolutions?. London: Routledge

Freud, S. (1909) ‘Analysis of a Phobia in a 5 year old boy (Little Hans)’ , in The standard edition

of the complete psychological works of Sigmund Freud. vol.10. Viewed on PEP Archive [online]

via EBSCOhost (authenticated resource) , pp.1-42

Freud, S. (1905 ) ‘Three essays on the theory of sexuality’ in The essentials of Psychoanalysis

Sigmund Freud London:Vintage, 2005, pp. 277-375.

Freud, S. (1924 ) ‘The Dissolution of the Oedipus complex ’ in The essentials of Psychoanalysis

Sigmund Freud London:Vintage, 2005, pp. 395-401

Klauber, T. (2019) ‘The Oedipus Complex (and touching on the super-ego). Introducing the

concept of the Oedipus complex and developments in thinking about it since Freud’ , M7:

Working with children, young people & families: a psychoanalytic observational approach. The

Tavistock and Portman NHS Foundation. Unpublished.

Wakefield, J. (2007) ‘Little Hans and Attachment Theory: Bowlby’s Hypothesis Reconsidered

in Light of New Evidence from the Freud Archives’, The psychoanalytic study of the child,

62(1), pp. 61-91

A reasonably coherent presentation that follows an argument or line of
thinking.

1

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2

Attachment Theory

Introduction

Attachment theory encompasses a broad body of research over several decades. In the first part of

this paper I will introduce the topic and the range of relevant research I have studied. In the second

part I will focus on a journal article by Juliet Hopkins, “Overcoming a child’s resistance to late

adoption: how one new attachment can facilitate another” (2000). I have chosen this topic as in my

work with looked after children, particularly adolescents moving towards leaving care, I find myself

confronted often with the power of the predictive reach of attachment theory yet simultaneously

questioning whether these patterns of attachment established in early life can be altered.

Introduction to Attachment theory and range of relevant research studied

Attachment theory offers us a profound understanding of the importance of early relationships and

how they impact on child development. From its initial conception by the psychiatrist and

psychoanalyst John Bowlby (1969), attachment theory has become an important area of research

over the last fifty years, particularly in relation to child development. Whilst not forgetting his roots

in psychiatry and psychoanalysis, Bowlby was also influenced by the science of evolutionary theory

and what drives the human biological instinct to survive (Music, 2017). To begin with Bowlby

focussed his attention on how young children responded to separation from their parents by

observing their behaviours, what emerged was that not only did young children require their basic

physical needs to be met such as food or shelter, but they also have, “a biological need for a

protective attachment figure, the absence of which causes serious psychological difficulties” (Music,

2017, p. 62). Attachment began as a need from an infant for proximity to their primary care giver,

most importantly during moments of distress or alarm.

3

The parent or primary care giver serves as what Bowlby termed a ‘secure base’ to which the infant

can return to when in a state of fear or anxiety. Attachment is relational, the child attaches to the

parent and the parent attends to the child’s physical and emotional needs, Bowlby referred to what

happens between them as affectional bonds (Music, 2017). It is important to say that these

affectional bonds can be formed with more than one individual, attachments can be made to several

significant figures in an infant’s life, and indeed throughout their life into childhood and beyond. It is

often however, the caregiver with whom an infant spends the majority of their time in the first

twelve months of life to whom the most significant attachment is made. This raises the question of

those infants who have had multiple care givers. This may be for cultural reasons, or in more

unfortunate circumstances there may have been multiple placements if parents or families are

unable to provide adequate care in the home.

Security of attachment and how it is measured

Following on from Bowlby’s research which focussed more on proximity of a child to their care giver,

there was more of an emphasis placed on the quality of the mother’s availability when she is with

her child, meaning how sensitive and responsive she is to their needs. If an infant comes to know

that their mother will consistently, not only be physically but also emotionally available in times of

distress, then they will develop a sense of safety and security (Hopkins & Phillips, 2009). It was Mary

Ainsworth (1978) a colleague of Bowlby’s who devised a test to measure the security of the

attachment formed between a mother and their twelve month old infant, this is known as the

Strange Situation Test, Hopkins and Phillips summarise this well,

“In this standardised test the infant is left briefly alone in a strange room and then reunited

with his mother: his reactions on reunion are considered indicative of the nature of his

security with his mother, since they reveal the expectations he has developed about her

physical and emotional availability when he is afraid.” (2009, p. 40).

4

Four categories emerged from the analysis of the infant’s reactions, secure attachment, insecure-

avoidant attachment, insecure-ambivalent attachment and disorganised attachment. Securely

attached infants become upset when left alone. They seek out and settle with their mother on

reunion and then seek to be put down and continue their play with toys that are available in the

room. These children have a trust that their mother can be relied upon to respond in a predictable

and timely manner to their distress. Those classified as insecure-avoidant become anxious during the

separation (displayed by their increased heart rate) but tend not to show this distress to their care

giver. On reunion they ignore the caregiver, do not seek comfort and can actively avoid it when

offered. These children may also surreptitiously watch the care giver and perhaps approach them,

but not display any negative affect. This behaviour suggests that these care givers can usually

manage their infant’s positive emotions but struggle when they display negative emotions. (van

Rosmalen, van Ijzendoorn & Bakermans-Kranenburg, 2014). Those classified as insecure-ambivalent

become markedly upset during the separation and display ambivalent behaviour when reunited with

their care giver. They cry loudly and seek immediate contact with the caregiver but do not settle and

appear conflicted between wanting to be held but also wanting to express their anger and

frustration at being left. This clinging but simultaneous pushing away can suggest that this infant’s

experience of soothing from their caregiver has been inconsistent. We can think of these three

classifications as organised coping mechanisms for staying in contact, both physically and

psychologically with one’s primary caregiver.

The final classification, disorganised attachment, was identified some years after Ainsworth’s initial

research (Main & Solomon, 1986). On reunion these infants can display contradictory behaviours

such as approaching but doing so backwards or another example is freezing completely when the

caregiver enters the room. Such a child has not been able to develop an organised strategy which

can suggest that their experience of their caregiver has been confusing, unpredictable and even

frightening. Disorganised attachment is often synonymous with abuse or neglect where the

caregiver has been both the source of the fear whilst also being the source of the care or security.

5

What the Strange Situation Test shows us is the human capacity to assess and predict the safety of

situations is firmly established by the time an infant has reached just twelve months of age.

Attachment behaviours change or adapt depending on the environment, the child forms predictions

about the world and how to respond to it in order to achieve a desired sense of safety. The patterns

of behaviour that emerge lead us to Bowlby’s concept of ‘internal working models’. This is a place

where psychoanalysis and attachment theory meet, Music describes these as, “a non-conscious

model in their minds, an internal representation of themselves in relation to others.” (2017, p.66).

Fonagy et al. (1993) found that the security of an infant’s attachment with both their parents at

twelve and eighteen months could be predicted based on assessment of the parents own

attachment styles (as assessed by the Adult Attachment Interview (Main et al., 1985)) before the

baby is even born. This confirmed Fraiberg’s (1980) hypothesis that a person’s own childhood

conflicts can resurface when one has their own children. However, this predictive reach of

attachment through the generations must also be explored with caution. It is important to consider

when thinking about children who may have suffered early abuse or neglect, whether changes in

patterns of attachment can happen with thoughtful, consistent and attuned attention from care

givers, and when required, therapeutic intervention from professionals as discussed below.

There is also debate as to how applicable attachment theory is across cultures having been

formulated in western society. This is also discussed below in the context of the chosen paper.

Critical reflection on ‘Overcoming a child’s resistance to late adoption: how one new attachment

can facilitate another’ Hopkins, J. (2000)

The reason I chose this paper is that often with disorganised attachment in children who have

suffered severe abuse and/or neglect there can be little hope. In the context of my work with

adolescents transitioning from care to independent living, Hopkins offers some insight into the

6

potential successes of psychotherapeutic interventions informed by attachment theory. After a brief

summary of the paper, I will firstly address the scope and limitations of case studies. Secondly, I will

highlight the absence of cultural and/or racial context given in the paper, examining the challenges

this bring in interpreting the paper more generally, particularly in the context of my own work with

predominately Black, Asian and Minority Ethnic (BAME) young people.

The paper addresses some of the challenges that can arise for late-adopted children in their ability

to form an attachment to their new parents. Hopkins uses the lens of attachment theory to examine

the psychotherapy of a nine-year-old boy named Max, over the course of two years. She explores

how a disorganised pattern of attachment can have its roots in early neglect and trauma. We get an

insight into the intervention with Max which helps him work through early negative attachment

models and their connected feelings of ‘fright without solution’. The defensive strategies established

which were useful in frightening or unpredictable circumstances have become not only redundant

but also disturbing and obstructive to the formation of new attachments to his adoptive family.

While ultimately a successful intervention I will examine the case study in more detail below.

Case studies and qualitative research more generally play an integral role in highlighting

psychoanalytic concepts, consider for example Freud’s seminal paper detailing a fragment of analysis

of Dora which led to the emergence of the concept of transference (1905). Hopkins describes a

successful intervention showing a causal link between therapy and Max’s newly earned attachment

to his adoptive parents. The rich context provided in the paper is hugely informative. However, case

studies are limited for the very same reason. They highlight a very specific context and set of

circumstances, some of which may be transferable, but others less so. In contrast quantitative

studies (e.g. Fonagy et al., 1993), attempt to highlight the predictive power of attachment theory

more generally. Ultimately a full description of the predictive power of attachment theory requires

both qualitative and quantitative research.

7

This paper offers great insight into successful therapeutic intervention but lacks description of Max’s

cultural or ethnic background and what consideration was given to this, if any, at the time of

adoption. Significantly culture has been shown to play an important role in the quality of

attachments formed (Erdman, 2010). In a similar vein, the paper could have offered a broader

understanding if consideration had been given to the similarity or difference of ethnicity within the

therapeutic relationship. In my own experience as a white woman working with majority BAME

young people it has been valuable to name any racial or cultural differences and to explore any

impediments to the work that may accompany them. Equally if there are many similarities it can be

helpful to acknowledge them and what they might bring.

What Hopkins offers is a rich example of how, with therapeutic support, children who have

experienced trauma can overcome extensive difficulties in forming attachments. Hopkins mentions

that Max’s adoptive parents are receiving support in parallel to Max, however a deeper

understanding of Max’s intervention may have been gained by expanding on this work.

Conclusion

The extensive body of work around attachment theory continues to give us a way to understand the

behaviour of young children not merely as a reaction but an intelligent and highly adaptive response

to their environment from infancy. Whilst it’s predictive reach is strong it is by no means unalterable

as we have seen in the case of Max above. Attachments can continue to be formed throughout the

life cycle which offers some hope for those children that have had negative early experiences.

8

References

Ainsworth, M.D. (1978) Patterns of Attachment: A Psychological Study of the Strange Situation. New

Jersey: Lawrence Erlbaum.

Bowlby, J. (1969). Attachment and Loss. Vol. 1: Attachment. London: Hogarth.

Erdman, Phyllis jt. editor, & Ng, Kok-Mun jt. editor. (2010). Attachment. Expanding the cultural

connections. New York: Routledge.

Fonagy, P. Steele, M. Moran, G. Steele, H. and Higgitt, A., 1993. ‘Measuring the ghost in the nursery:

An empirical study of the relation between parents’ mental representations of childhood

experiences and their infants’ security of attachment.’ Journal of the American Psychoanalytic

Association, Volume 41(4), pp.957-989.

Fraiberg, S. H, Adelson, E, & Shapiro, V. (1980). Ghosts in the nursery: A psychoanalytic approach to

the problem of impaired infant-mother relationships. Clinical studies in infant mental health. The

first year of life. (pp. 164–196). London: Tavistock Publications.

Freud, S. (1953) ‘Fragment of an analysis of a case of hysteria (’Dora’)’, in The standard edition of the

complete psychological works of Sigmund Freud, Vol. 7. 1901-1905. A case of hysteria. Three essays

on sexuality. Other works. London: Hogarth Press. (pp. 1–123).

Hopkins, J. (2000) ‘Overcoming a child’s resistance to late adoption: How one new attachment can

facilitate another’, Journal of Child Psychotherapy, Volume 26(3), pp. 335-347.

Hopkins, Juliet, & Phillips, Gail. (2009). Some contributions of attachment theory and research. The

handbook of child and adolescent psychotherapy. Psychoanalytic approaches. London:

Routledge. (pp. 38–50).

Main, M. Kaplan, N. and Cassidy, J., 1985. Security in infancy, childhood, and adulthood: A move to

the level of representation. Monographs of the society for research in child development, pp.66-104.

9

Main, M. and Solomon, J. (1986) `Discovery of an insecure disorganized/disoriented attachment

pattern’, in T. Brazelton and M. Yogman (eds) Affective Development in Infancy.New Jersey:

Norwood, pp. 95-124.

Music, G. (2017). Nurturing natures: Attachment and children’s emotional, sociocultural and brain

development. 2nd edn. Routledge.

van Rosmalen, Lenny, van Ijzendoorn, Marinus H., & Bakermans-Kranenburg, Marion J. (2014). ABC+

D of attachment theory. the Strange Situation procedure as the gold standard of attachment

assessment. The Routledge handbook of attachment. Theory (pp. 11–30). New York: Routledge.

Fraiberg, Selma H.

Ghosts in the nursery: a psychoanalytic approach to the problem of
impaired infant-mother relationships

pp. 164-196

Fraiberg, Selma H. (editor), (1980) Clinical studies in infant mental health. The first year of life,
London: Taylor & Francis Ltd

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Course of Study: M7 Y1 Theory – Theoretical Perspectives Year 1. Strand 1: Psychoanalytic
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Title: Clinical studies in infant mental health. The first year of life

Name of Author: Fraiberg, Selma H. (editor)

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Tronick, EZ;

The mutual regulation model: The infant’s self and interactive regulation
coping and defensive capacities

pp. 177-194

Tronick, EZ;, (2007) The neurobehavioral and social-emotional development of infants and
children, New York: W. W. Norton & Co

Staff and students of Tavistock & Portman NHS Trust are reminded that copyright subsists in this
extract and the work from which it was taken. This Digital Copy has been made under the terms of
a CLA licence which allows you to:

access and download a copy;•
print out a copy;•

Please note that this material is for use ONLY by students registered on the course of study as
stated in the section below. All other staff and students are only entitled to browse the material and
should not download and/or print out a copy.

This Digital Copy and any digital or printed copy supplied to or made by you under the terms of this
Licence are for use in connection with this Course of Study. You may retain such copies after the
end of the course, but strictly for your own personal use.

All copies (including electronic copies) shall include this Copyright Notice and shall be destroyed
and/or deleted if and when required by Tavistock & Portman NHS Trust.

Except as provided for by copyright law, no further copying, storage or distribution (including by e-
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neither staff nor students may cause, or permit, the distortion, mutilation or other modification of
the work, or any other derogatory treatment of it, which would be prejudicial to the honour or
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Course of Study: CDR – Child Development Research/Developmental Science

Title: The neurobehavioral and social-emotional development of infants and children

Name of Author: Tronick, EZ;

Name of Publisher: W. W. Norton & Co

Freud, Sigmund

Case history and analysis

pp. 22-100

Freud, Sigmund; Strachey, James; Freud, Anna; Richards, Angela, (1955) The standard edition of
the complete psychological works of Sigmund Freud, London: Hogarth Press

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This Digital Copy and any digital or printed copy supplied to or made by you under the terms of this
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Course of Study: M7 Y1 Theory – Theoretical Perspectives Year 1. Strand 1: Psychoanalytic
Theory

Title: The standard edition of the complete psychological works of Sigmund Freud

Name of Author: Freud, Sigmund; Strachey, James; Freud, Anna; Richards, Angela

Name of Publisher: Hogarth Press

Shuttleworth, Judy

Psychoanalytic theory and infant development

pp. 22-51

Miller, Lisa; Rustin, Margaret; Rustin, Michael; Shuttleworth, Judy, (1989) Closely observed
infants, London: Duckworth

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extract and the work from which it was taken. This Digital Copy has been made under the terms of
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stated in the section below. All other staff and students are only entitled to browse the material and
should not download and/or print out a copy.

This Digital Copy and any digital or printed copy supplied to or made by you under the terms of this
Licence are for use in connection with this Course of Study. You may retain such copies after the
end of the course, but strictly for your own personal use.

All copies (including electronic copies) shall include this Copyright Notice and shall be destroyed
and/or deleted if and when required by Tavistock & Portman NHS Trust.

Except as provided for by copyright law, no further copying, storage or distribution (including by e-
mail) is permitted without the consent of the copyright holder.

The author (which term includes artists and other visual creators) has moral rights in the work and
neither staff nor students may cause, or permit, the distortion, mutilation or other modification of
the work, or any other derogatory treatment of it, which would be prejudicial to the honour or
reputation of the author.

Course of Study: M7 Y1 Theory – Theoretical Perspectives Year 1. Strand 1: Psychoanalytic
Theory

Title: Closely observed infants

Name of Author: Miller, Lisa; Rustin, Margaret; Rustin, Michael; Shuttleworth, Judy

Name of Publisher: Duckworth

i
Nurturing
Natures
This new edition of the bestselling text, Nurturing Natures, provides an indis-
pensable synthesis of the latest scientific knowledge about children’s emotional
development. Integrating a wealth of both up- to- date and classical research
from areas such as attachment theor y, neuroscience, developmental psychol-
ogy and cross- cultural studies, it weaves these into an accessible, enjoyable text
that always keeps in mind children recognisable to academics, practitioners and
parents.
It unpacks the most significant influences on the developing child, includ-
ing the family and social context. It looks at key developmental stages from life in
the womb to the pre- school years and right up until adolescence, covering impor-
tant topics such as genes and environment, trauma, neglect or resilience. It also
examines how children develop language, play and memor y and, new to this edi-
tion, moral and prosocial capacities. Issues of nature and nurture are addressed
and the effects of different kinds of early experiences are unpicked, creating a
coherent and balanced view of the developing child in context.
Nurturing Natures is written by an experienced child therapist who has
used a wide array of research from different disciplines to create a highly read-
able and scientifically trustworthy text. This book should be essential reading
for childcare students, for teachers, social workers, health visitors, early years
practitioners and those training or working in child counselling, psychiatr y and
mental health. Full of fascinating findings, it provides answers to many of the
questions people really want to ask about the human journey from conception
into adulthood.
Graham Music is a Consultant Child and Adolescent Psychotherapist at The
Tavistock and Portman NHS Foundation Trust and an adult therapist in private
practice.

ii
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iii
Nurturing Natures
Attachment and Children’s Emotional,
Sociocultural and Brain Development
Second Edition
Graham Music

iv
This edition published 2017
by Routledge
2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN
and by Routledge
711 Third Avenue, New York, NY 10017
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2017 Graham Music
The right of Graham Music to be identified as author of this work has been
asserted by him in accordance with sections 77 and 78 of the Copyright,
Designs and Patents Act 1988.
All rights reser ved. No part of this book may be reprinted or reproduced or
utilised in any form or by any electronic, mechanical, or other means, now
known or hereafter invented, including photocopying and recording, or in any
information storage or retrieval system, without permission in writing from the
publishers.
Trademark notice: Product or corporate names may be trademarks or registered
trademarks, and are used only for identification and explanation without intent
to infringe.
First edition published 2011 by Psychology Press
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Librar y
Library of Congress Cataloging in Publication Data
CIP data has been applied for.
ISBN: 978- 1- 138- 10143- 2 (hbk)
ISBN: 978- 1- 138- 10144- 9 (pbk)
ISBN: 978- 1- 315- 65693- 9 (ebk)
Typeset in Times
by Out of House Publishing

v
This book is dedicated to my dad,
who I loved deeply and miss dearly.

vi
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C
o
n
te
n
ts
vii
vii
Contents
ACKNOWLEDGEMENTS xiv
1 Introduction: the blind men
and the elephant 1
NATURE AND NURTURE 2
MULTIPLE PERSPECTIVES 3
UN- NURTURED AND FERAL CHILDREN 6
THE CHAPTERS 7
Part I
BEGINNINGS OF EMOTIONAL
AND SOCIAL DEVELOPMENT 11
2 Life begins: from conception
to birth 13
OBSERVING THE UNBORN BABY 15
WHERE DOES PARENTAL INFLUENCE START? THE
MEETING OF BIOLOGY AND PSYCHOLOGY 16
LASTING EFFECTS, SOCIAL EFFECTS 18

C O N T E N T S
viii
viii
BEING BORN 20
KEY POINTS 21
3 Born to relate 23
IMMATURITY 24
BONDING: HUMANS ARE NOT GREY- LAG GEESE 25
INFANT IMITATION AND CONTINGENCY 28
ATTUNEMENT, AFFECT REGULATION AND MARKING 29
MATERNAL INSTINCT QUESTIONED: ABANDONMENT AND INFANTICIDE 30
ENTRAINMENT, CULTURE AND BECOMING ONE OF US 31
KEY POINTS 33
4 Infant coping mechanisms, mismatches
and repairs in relating 35
IT TAKES TWO TO TANGO: BLIND BABIES, PREMATURE BABIES
AND SENSITIVE BABIES 37
EARLY EMOTIONAL DEFENCES 39
MISMATCHES AND DODGES 40
THE EFFECT OF MATERNAL DEPRESSION AND OTHER MENTAL
HEALTH PROBLEMS 43
KEY POINTS 46
5 Empathy, self and other minds 47
EARLY PRECURSORS OF UNDERSTANDING OTHER MINDS 48
DEVELOPMENTAL LEAPS FROM NINE MONTHS AND ONWARDS 50
THEORY OF MIND 53
MIRROR NEURONS AND RIZZOLATTI’S MONKEYS 54
EXCEPTIONS: NEGLECTED, MALTREATED AND AUTISTIC CHILDREN 55
KEY POINTS 57
Part II
OVERARCHING BODIES OF IDEAS 59
6 Attachment 61
ATTACHMENT THEORY’S SECOND PHASE: AINSWORTH’S
STRANGE SITUATION TEST AND CRITTENDEN’S DYNAMIC
MATURATIONAL MODEL 63

C O N T E N T S
ix
ix
ATTACHMENT INSIDE US 66
TRANSMISSION OF ATTACHMENT 68
ATTACHMENT THEORY AND CULTURE 70
ATTACHMENT AND DISORDERS 72
KEY POINTS 73
7 The importance of culture 75
SOME DIFFERENCES 77
SOCIOCENTRIC AND EGOCENTRIC, DYADS AND GROUPS 79
WHAT IS UNIVERSAL OR NATURAL? BREASTFEEDING AND EMOTIONS 82
CULTURAL VARIATIONS IN DEVELOPMENT 84
CULTURES FRAME OUR THOUGHTS, PHYSIOLOGY AND BRAINS 85
KEY POINTS 86
8 Biology and the brain 89
BRAIN BASICS: NEUROPLASTICITY AND NEURO- GLIA 90
BRAINS, NERVOUS SYSTEMS AND BODIES 92
EVOLUTION AND BRAIN AREAS 95
HORMONES AND OPIATES 98
EMAPTHY, CEREBRAL HEMISPHERES, ATTENTIONAL AND
CREATIVE NETWORKS 100
MALTREATMENT 102
HOPE OR HOPELESS? 103
KEY POINTS 104
9 Epigenetics, evolution and how
nature meets nurture 107
EPIGENETICS AND EVOLUTION 108
NURTURING NATURE IN ACTION 109
ORCHIDS AND DANDELIONS 111
SINS OF THE FATHERS AND LAMARCK 112
GENES AFFECT BEHAVIOURS IN SELF AND OTHERS 113
GENE ENVIRONMENT INTERACTION AND CAUTION 114
KEY POINTS 115

C O N T E N T S
x
x
Part III
DEVELOPMENTAL CAPACITIES AND STAGES 117
10 Language, words and symbols 119
PARENTESE AND INFANT- DIRECTED SPEECH 122
CULTURE AND LANGUAGE 123
INTERSUBJECTIVITY AND LANGUAGE LEARNING 124
LANGUAGE AND BRAINS 126
LANGUAGE AND EMOTIONAL PROCESSING 128
LANGUAGE ABILITY AND SOCIAL ADVANTAGE 129
KEY POINTS 130
11 Memories: learning who we are and
what to expect 131
THE BRAIN AS PREDICTOR OF THE FUTURE 132
MEMORIES OF EVENTS AND FACTS 134
EPISODIC AND AUTOBIOGRAPHICAL MEMORY 136
TRAUMA, MEMORIES AND FORGETTING 138
KEY POINTS 141
12 Play: fun, symbolising, practising
and mucking about 143
EARLY PLAY 145
PLAY IN OTHER SPECIES AND ROUGH AND TUMBLE 146
DIFFERENT KINDS OF PLAY, DIFFERENT KINDS OF LEARNING 147
PLAY AS A WINDOW INTO THE PSYCHE 149
PLAY, PRETENDING, SYMBOLISM AND GROWING MINDS 151
KEY POINTS 153
13 Boys, girls and gender 155
SOCIAL LEARNING 157
DIFFERENT CULTURES, DIFFERENT GENDERS 158
UNCERTAIN GENDERS 159
A WEAKER SEX? GENDER AND THE IMPACT OF EARLY EXPERIENCES 162
VENUS AND MARS: LANGUAGE AND DIFFERENT PLANETS 163
GENDER PREFERENCES 164
DIFFERENT GENDERS, DIFFERENT PSYCHOLOGICAL PRESENTATIONS 165

C O N T E N T S
xi
xi
TESTOSTERONE AGAIN, AND OTHER HORMONES 166
KEY POINTS 167
Part IV
NOT JUST MOTHERS 169
14 Nonmaternal care and childcare 171
ADOPTION IS COMMON IN SOME SOCIETIES 173
PURCHASED NONMATERNAL CHILDCARE: NURSERIES 174
NURSERIES, NANNIES, GRANNIES AND CHILDMINDERS 178
KEY POINTS 180
15 Middle childhood, siblings, peers
and group life 181
SIBLINGS AND EARLIER INTERACTIONS 183
SWITCH POINTS: PEERS, PARENTS AND ATTACHMENT 184
POWER OF THE GROUP 186
PEERS: ARE THEY MOST IMPORTANT? 189
TEMPERAMENT 190
KEY POINTS 192
16 The place of fathers 193
BIOLOGICAL PRIMING 195
CHILDREN WITH A FATHER AND A MOTHER 197
CHILDREN WITHOUT A BIOLOGICAL FATHER PRESENT: SINGLE
MOTHERS, LESBIAN PARENTS AND STEP- FATHERS 199
PRACTICAL LESSONS FROM RESEARCH ON FATHERS 201
KEY POINTS 203
17 Moving towards adulthood 205
THE ADOLESCENT BRAIN 208
SCREENS, THE CONNECTED WORLD AND OTHER ADDICTIONS 211
BECOMING LESS ATTACHED 214
SEX AND ROMANCE 216
RISKS, PROBLEMS AND RESILIENCE 217
KEY POINTS 219

C O N T E N T S
xii
xii
Part V
CONSEQUENCES OF EARLY EXPERIENCES 221
18 Trauma, neglect and their effects 223
NEGLECT 224
MALTREATMENT, TRAUMA AND ABUSE 227
DISORGANISED ATTACHMENT 229
LONG- TERM EFFECTS 231
KEY POINTS 232
19 Resilience and good feelings 235
POSITIVE EMOTIONS AND HEALTH 237
OPTIMISM IS NATURAL IN CHILDREN 239
RESILIENCE 240
AMBIVALENCE AND EMOTIONAL COMPLEXITY 243
HAPPINESS: EUDEMONIC AND HEDONISTIC 245
RESILIENCE, INTERVENTIONS, AND PROXIMAL AND DISTAL IMPACTS 247
KEY POINTS 249
20 Moral development, antisocial and
prosocial behaviour 251
PRIMED FOR GOODNESS 252
ATTACHMENT AND EMPATHY 253
HOW STRESS MAKES US LESS PROSOCIAL 255
IMPULSIVENESS, SELF- CONTROL AND AGGRESSION 256
AGGRESSION: HOT AND COLD BLOODED KINDS 257
EMOTIONS AND REASON 259
GENES 261
EVOLVED TO BOTH COOPERATE AND COMPETE 262
THEM AND US 263
KEY POINTS 264
21 Conclusions: earlier experience
and its longer- term consequences 267
PSYCHOLOGICAL EFFECTS OF EARLY EXPERIENCES 269
ADVERSE EXPERIENCES AND THE BODY 271

C O N T E N T S
xiii
xiii
WHAT CHANGE IS POSSIBLE? 272
CONCLUSIONS 275
GLOSSARY 279
REFERENCES 285
INDEX 356

xiv
xiv
Acknowledgements
A book like this inevitably owes its existence to lots of people. Probably my great-
est debt is my patents, clients and super visees who have forced me to constantly
rethink what I need to know in order to help. Equally important are the inspira-
tional writers, researchers and teachers who have led the field and paved the way,
who I hope I have sufficiently acknowledged in the text.
Many have generously helped me with this book, particularly in reading
sections and giving their thoughts. I would like to thank Liz Anderson, Lindsay
Barton, John Cape, Colin Campbell, Robert Chapman, Ginny Clee, Geraldine
Crehan, Hilar y Dawson, Martin Doyle, Simon Edwards, Rich Faulding, Amanda
Glass, Danny Goldberger, Paul Gordon Jeremy Holmes, Juliet Hopkins, Sally
Hodges, Rob Jones, Krisna Catsaras, Andy Metcalf, Helen Odell- Miller, Nick
Midgely, Graham Puddifoot, Jane O’Rourke, Asha Phillips, Sara Rance, Roz Read,
Michael Reiss, Janine Sternberg, Allan Sunderland, Annie Swanepoel and Helen
Wright. A  special thanks to Teresa Robertson and Lawrence Dodgson whose
illustrations bring alive the neuroscience chapter.
I am particularly grateful to all the students I have taught who have forced
me to get my thinking straight and who have been so inspiring in their enthusiasm.
Big thanks too to the editorial team at Psychology Press, notably Lucy
Kennedy and Michael Fenton.
Last but certainly not least I am most grateful to Sue and Rose, for putting
up with me and my foibles, and for still being there after my too frequent and
lengthy disappearances into the land of computers, cyberspace and heavy tomes.
Some words and concepts might not be familiar to readers, I  have included a
glossar y at the back of the book. Words that appear in the glossar y are written in
A note on the text

A C K N O W L E D G E M E N T S
xv
xv
bold when they are first used. Also, for want of finding a better term, I have used
the word ‘Western’ a lot throughout the text to denote the social, cultural and
economic influences derived primarily from European and American societies,
as well as the intellectual traditions within which most academic thinking, such
as in psychology, has been situated. I am ver y aware that this word cannot do the
huge job asked of it.
newgenprepdf

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1
1
C h a p t e r   1
Introduction: the blind
men and the elephant
Nature and nurture 2
Multiple perspectives 3
Un- nurtured and feral children 6
The chapters 7
newgenprepdf

I N T R O D U C T I O N
2
2
This book is about how a human baby, a tiny bundle of biological inherit-
ances, develops into a particular psychological, emotional and social being.
I  describe many recent increasingly rigorous yet exciting research find-
ings. This is a big complex subject and our understanding of how people
develop from an infancy with multiple potentials into a unique adulthood,
how early beginnings affect later functioning, has grown beyond all meas-
ure. The fast and relentless march of new research has led to the need for
this second edition. Although there is so much written on these subjects,
this is mainly scattered in a vast array of scholarly books, chapters and
journal articles, and my aim has been to distil such research into a digest-
ible form that can provide a sound knowledge base, and a jumping off point
for further exploration.
The question of the relative importance of nature or nurture is a theme that runs
throughout this book. Whether people arrive with ready- formed personalities,
or are primarily influenced by nurture and experiences, has been debated as
far back as records begin. In the post- war period many argued that humans are
‘blank slates’ who could be moulded by parents and others (Pinker, 2002). An
opposing view is that genes rather than parents are the main influence on chil-
dren’s development (Harris, 2009). Both views are too simplistic and we now
know that neither nature nor nurture is dominant. Children are born with differ-
ent temperaments and genetic endowments, and if 100 children are subjected
to similar influences then each will respond in different ways. Yet we will still see
common patterns emerge. For example, children reared in poor- quality orphan-
ages, who receive little human contact, are less likely than most to develop good
language skills, to build secure attachments, or to have a strong understanding
of the minds and emotions of others.
Throughout this book I keep in the foreground the fact that humans always
develop within a context. The psychoanalyst and paediatrician Winnicott (1958)
famously stated that there is no such thing as a baby, by which he meant that we
can only ever understand a baby in relation to the important people in its life.
Similarly systemic thinkers have long argued that an individual is only under-
standable in relation to his or her context (Bateson, 1972). I tr y to bear in mind
the way human development needs to be understood from a bioecological per-
spective (Bronfenbrenner, 2004), taking account of biological inheritance, but
also the various systems children are nested in, whether microsystems such as
family, school or neighbourhood, or larger societal macrosystems.
We are increasingly aware of the complexity of contexts and the non- linear
ways in which development takes place. From the moment of sexual intercourse,
and indeed before, there are trains of influences. At conception there is straight
away a genetic inheritance from both parties. The newly conceived foetus car-
ries all kinds of biological predispositions but is interacting with, influencing, and
Nature and nurture

I N T R O D U C T I O N
3
3
being influenced by its environment. Depending on one’s culture the developing
foetus will hear and remember different sounds in utero, will imbibe different
smells, and be subject to different rhythms. Some foetuses share the womb with
a twin, which again is a different experience. If the mother’s state of mind is
highly anxious then stress hormones cross the placenta and affect the unborn
baby. Genetic inheritances alongside prenatal influences can lead some babies
to be labile and hard to soothe, and others more robust or calm. Parents too can
be more or less competent, and live in more or less stable or supportive environ-
ments, and the meeting of each mother– baby pair results in unique relationship
patterns and potentials.
This book will examine what makes personality development understand-
able and even predictable. So much can influence later outcomes. Are there older
siblings in place who affect an infant’s development? Is the baby raised in a cul-
ture where there are nearly always many adults around, like in hunter- gatherer
societies, or with an isolated, inexperienced, and unhappy mother? Is this baby
born into a culture that believes infants should be carried all the time, or one
that believes that babies should be placed at the end of the garden in a pram? Is
the baby long awaited and desired, or the result of an accident? If the mother is
not ver y confident then is there an experienced father, or friend or grandparent
around? Are the parents relatively affluent, or living in poverty or amidst urban
degradation or violence?
Our understanding of such trajectories has increased hugely. However
development rarely follows a linear path where X always causes Y, and research
these days often follows a more ‘fuzzy’ logic (Kosko, 1993). One can no longer
straightfor wardly ask, for example, if non- parental childcare is a good thing for
young children. We have to ask what kind of childcare (whether nurseries, nan-
nies, or childminders), of what quality, for what kind of children with what genes,
from which kinds of background, at what age, and how each form of childcare
might affect either cognitive, social, or emotional development. Each factor
added into the equation adds further complexity while also aiding understanding.
The first edition suggested that the controversies of the nature/ nurture
debate were now less relevant, and in the last few years burgeoning epigenetic
research has left us in no doubt that our genes are expressed quite differently
depending on the kinds of experiences we have. Despite massive hopes for the
human genome project, we now know that biological inheritance, while extremely
influential, by no means holds all the cards, and this will become evident in many
of the chapters to come.
So many perspectives are now needed to really understand human development.
I liken the subject to the ancient Indian fable of the blind men and the elephant.
In this, each blind man touched a different part of the elephant’s body, such as
the tusk, trunk or leg, and each disagreed about what the elephant was really like.
Multiple perspectives

I N T R O D U C T I O N
4
4
One blind man felt the elephant’s leg and insisted it is like a pillar, while another
felt its ear and knew that the elephant was like a hand fan. The same can happen
when thinking about children’s development. We now understand much more
about neurobiology and how different experiences affect brain development. Yet
this knowledge is only one small part of the stor y. Anthropologists and historians
can teach us how childrearing varies across cultures and epochs, and other vital
perspectives such as attachment theor y, developmental and social psychology,
mother– infant interaction, psychoanalytic and systemic theor y, behavioural and
cognitive science, genetics and evolutionar y theor y, all illuminate other aspects
of the mythical elephant.
I at times cite research on animals such as rats or monkeys. Because
something is true of another animal does not mean that it is also true for
humans. Typical is the misinterpretation of research about bonding; grey- lag
geese might bond with the first creature they see after bir th but humans do
not. Yet animal research can illuminate human development, par ticularly as so
many of our biological and brain systems are shared with other species. Typical
is how humans use similar biological and brain systems to most mammals in
stress or terror.
Lack of space stops me describing in detail the various research meth-
ods used in the studies I  quote. I  hope it will become clear how researchers
use extraordinar y ingenuity to devise experiments, and for those interested in
the detail of research methodology I  would point to more specialist texts (e.g.
Breakwell, 2006; Coolican, 2009). For example, even though babies cannot
speak, researchers can work out what infants prefer, such as that they favour
human faces, and we learn this by watching which pictures babies look at most,
or by physiological tests such as measuring heart rates. Some kinds of research
look at the fine grain of childhood experiences, such as examining the physical
response in babies who unexpectedly lose their mother’s attention. Much of this
is qualitative, looking at people’s experience, using obser vation and interpreting
meanings. Other research is more ‘macro’ and quantitative, often examining
huge samples of data using complex calculations in longitudinal studies, for
example looking at a huge birth cohort to tease out the effect of experiences
such as maltreatment.
Some research is in naturalistic settings, perhaps seeing how language
develops in family homes, while other research is undertaken via artificial experi-
ments in laboratories, maybe looking at what parts of the brain light up when
people are shown alarming pictures. Each form of knowledge can add something
extra to the overall picture. We can tr y to understand particular experiences,
such as that most one- year- olds cr y when their mothers leave them on their own.
We also need to understand how this links to broader understandings, such as
why it is that not all one- year- olds cr y when left. We might find that some babies
are born temperamentally prone to cr y more than others, but also that some
babies become used to being alone and learn not to cr y out. From here one can
look at samples, maybe of the non- cr ying babies, and find out if similar early
experiences generally have a similar long- term effect. Each kind of research

I N T R O D U C T I O N
5
5
has its strengths and flaws. Microstudies are often too small to generalise from,
but huge meta- analyses, such as the effect of emotional neglect across differ-
ent cultures, do not necessarily compare like- for- like phenomena. I  have relied
heavily on published peer reviewed articles, some of which could be critically
‘deconstructed’ methodologically, while others might in time be superseded or
reinterpreted. Hopefully, on balance the research quoted in this book illuminates
important aspects of experience and is as reliable as possible.
Expectations and unconscious biases of researchers can also influence
results. An early and classic example is how experimenters were told (wrongly)
that the rats they were using for experiments were bred to be good with mazes.
These rats ended up navigating mazes far better than similar rats labelled as bad
at mazes (Rosenthal and Fode, 1963). The obser ver often affects the obser ved,
especially when the obser ved is alive and sentient. Another early experiment
(Rosenthal and Jacobson, 1968) exemplifies this point. Teachers were told that
the children in their class had been tested and some were predicted to have a
learning spurt. In fact there was no truth to this, the children had been randomly
labelled. The labelling had such an effect on the teachers’ non- conscious expec-
tations that these particular children showed a huge rise in their achievement
levels. Because such subtle biases can creep into research practice, a degree of
caution is always sensible.
It is also possible to do research using the wrong assumptions. A  good
example was early research in America in the 1950s which supposedly ‘proved’
that having a father present in a boy’s life made him more masculine (Leichty,
1978). The evidence seemed to be there. Researchers developed a measure for
masculinity and found that sons whose fathers spent time with them had more
of these masculine traits. These days boys whose fathers spend more time with
them are often more socially skilled and take on less rigid gender roles (Barker
et al., 2004). Children of course like to emulate those they love and admire, and
in America in the 1950s the role model was often a tough masculinity that has less
purchase today. The original researchers maybe answered the question as best
they could but used the wrong assumptions. Burman (2007) in particular has
helpfully urged a critical approach to developmental research and has cautioned
against normative and moral assumptions hidden in it. Ideas about what is ‘nor-
mal’ all too often hide cultural and other biases.
It is never helpful to uncritically accept research methodologies, and I would
always encourage reading with a critical eye. I  take it for granted that beliefs
about what is true can change over time and that scientists might only be able see
one version of reality (Kuhn, 1970), often a culturally dominant one (Feyerabend,
1993). I  also agree with Popper’s (1959) idea that we ‘should’ always be test-
ing our ideas and that good scientists are always prepared to be proven wrong.
I work on the assumption that one can honestly seek to get nearer what seems
truer, according to the definitions of truth we currently use. Our knowledge is
always provisional; we are all like the blind men groping in the dark. However,
I am more interested in seeing what we can learn from the research rather than
aiming to critically deconstruct as many findings as possible. In these exciting

I N T R O D U C T I O N
6
6
times we have much information from different fields that helps us grope for an
increasingly reliable view with more assurance.
There are areas I  have inevitably had to leave out of this book. Due to
space I do not describe, except peripherally, children’s cognitive development, a
subject I believe is more than adequately dealt with in most traditional develop-
mental psychology texts. Similarly, this book is not about physical development
and milestones. I have attempted to keep the emphasis primarily on emotional,
social, and psychobiological issues.
From conception the developing human is influenced by and is influencing its
environment. Some children receive loving, attuned care, while others suffer
violence or abuse, and a few other children receive little human input and are
left much to their own devices. Humans have sur vived and expanded across the
planet so successfully through extraordinar y versatility in adapting to differ-
ent environments. Just as people thrive in Arctic snow, in oxygen deprived high
altitudes and in Saharan deserts, so too can humans sur vive and develop while
receiving loving, empathic care, or strict and regimented care, or even abuse or
neglect. The developing brain will grow differently in each of these situations.
This is called experience dependence, which suggests that brain development
differs depending on the kinds of experiences one has.
There is also something called experience expectance, which refers to
input that humans are primed ready to receive, and without which certain more
usual, traits do not come online. Food, water and oxygen are the obvious physi-
ological examples. A kitten needs light for its visual capacities to come on- stream
and if blindfolded at a critical time in its development it will never see normally
(Hubel and Wiesel, 1970). Human infants similarly need certain experiences in
order for capacities like language to come fully online. This did not happen for
some children who tragically were neglected in the worst institutional orphan-
ages (Rutter et al., 2007). I will later describe research showing how only some
of these ‘caught up’ with their peers, while others fell behind in language, social
abilities, and physical development. As we will see, we need particular experi-
ences for capacities like empathy or altruism to come online.
This gives the lie to the idea of ‘noble savages’ (Rousseau, 1985) who thrive
untainted by the influences of civilisation. It also suggests that particular experi-
ences are needed to make people ‘properly’ human, whatever we mean by this. The
absence of expected human contact can have devastating consequences. Many
such children are described as wild or ‘feral’, which often means something like
‘without civilising influence’, ‘subhuman’ or ‘like animals’. Such children lack what
most experience from the first moments of life, such as basic care and actively learn-
ing from close relationships. Children imbibe and become part of cultural rules and
ways of being, what the social theorist Bourdieu (1977) calls the habitus. However,
some children have meagre experiences of human life to adapt to and learn from.
Un- nurtured and feral children

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Over the centuries descriptions have abounded of ‘wild’ children, suppos-
edly reared without human input, some reportedly even living alongside animals.
Although such stories are more anecdotal than scientific, there are enough of
them to put together some consistent themes. A typical example is Peter the Wild
Boy, found in woods near Hanover in 1725. Descriptions of him were rife with
statements about whether he was ‘human or beast’. He climbed trees, gorged
himself on meat with bare hands, had no sense of morality, no ability to speak,
and no capacity to take seriously another’s point of view. Similarly Kamala and
Amala were purportedly found living in a wolves’ den in India, and other famous
accounts include Caspar Hauser, or Viktor the Wild Boy of Aveyron, who was
described as ‘a disgusting, slovenly boy, affected with spasmodic, and frequently
with convulsive motions … indifferent to ever ybody, and paying no regard to
anything’ (Itard, 1802, p.17). Although the accuracy of each and ever y one of
these stories cannot be guaranteed, putting them together with recent evidence
about highly neglected children suggests that there is a consistent effect when
children do not receive the experience expectant inputs needed to develop into
cultural and social beings. Such children often never use language fully, despite
huge efforts on the part of educators, and have only a rudimentar y sense of their
own and other people’s feelings. Many steal and are quite without remorse. Such
stories reveal that human development can take many forms, but that without
certain kinds of experiences children fail to thrive. Exactly what is ‘necessar y’
for someone to become human is controversial, and much that people assert is
‘necessar y’ can be based on cultural beliefs or prejudice. Such questions will be
at the heart of this book.
These findings raise another central theme of this book. To become a ‘per-
son’, with what is often called a sense of self, requires large amounts of input
from other people early in life, and an experience of ourselves as reflected back
through the eyes and minds of those around us (Winnicott, 1996). Thus, ironi-
cally a person’s sense of self arises from the experience of being in the minds
of others, without which it simply does not develop. Central to this book is the
idea, illustrated by much of the research that I describe, that one’s sense of self
is socially and co- constructed. Rochat (2009, p.8) puts it well when he writes ‘if
there is such a thing as a self, it is not just interior to the individual but rather also
at the intersection of the individual as he or she transacts with others’. Much of
the book teases out this central idea in more detail.
This is a new edition and I felt it was needed because so much new research has
come out in the last five years. Each chapter has been updated and edited and has
more recent references. Some chapters have been more substantially re- written,
such as those on neurobiology, epigenetics and adolescence, and I  have also
added one entirely new chapter on the roots of moral development and prosocial
and antisocial behaviour.
The chapters

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The first few chapters describe key elements of early development. Our
journey begins with prenatal life, and the birth process. We will see what an
active being a foetus is, learning and interacting, already a character forming,
but also affected by the mother’s state of mind. I  next describe the new- born’s
pre- wired abilities to relate to other human beings, adapting and responding to
the particular emotional environment it arrives in, whether loving or cold, happy
or depressed. In Chapter  4 I  describe the strategies even young infants must
resort to when coping with difficult experiences such as neglect, using defensive
states that can sometimes become character traits. We see that such strategies
always occur within relational processes, that different parenting affects children
in different ways but similarly the kind of child one is can affect the parenting one
receives. Then, Chapter 5 describes how empathy and the capacity to understand
other minds develop, what helps and hinders this, and particularly how having
adults interested in one’s feelings and thoughts affects how a child makes sense
of their own and others’ emotions.
The next four chapters examine a subject which provides a lens through
which much research in this book can be viewed. First, in Chapter 6, attach-
ment theor y is described, as well as they ways in which dif ferent kinds of
parental sensitivity give rise to children who form dif ferent kinds of attach-
ments. Next, in Chapter 7, culture is given attention, and like attachment, an
understanding of cultural dif ferences is necessar y in its own right but also
is central in thinking about most topics. I examine the huge variation in chil-
drearing practices across societies, in par ticular between more collectivist and
individualistic cultures. In Chapter 8 neurobiology is formally introduced; this
body of thought has exploded in recent years, and here I  focus in par ticular
on how the brain’s development is af fected by experience, and the impact of
trauma and stress on neuronal architecture, ner vous systems, and hormonal
programming. Next, in Chapter 9, new for this edition, the bourgeoning field
of epigenetics is described, and the complex interplay between genes and
environment.
The next chapters each describe a further fundamental aspect of develop-
ment. Chapter 10 focuses on language and how it is intertwined with emotional
and social development. I  outline the precursors of speech in the musicality of
mother– infant communications, and how language acquisition and theor y of
mind skills are closely connected. In Chapter 11 I look at how the past affects
later experiences, and outline different kinds of memories, both consciously
recalled and habitual embodied ways of being, as well as the controversial ques-
tion of repressed memories and how memor y can be notoriously unreliable.
I look at play in Chapter 12 and what play signifies about a child’s development,
as well as how playing spurs development. I look at symbolism as well as enjoy-
ment and ‘fun’, examining how play reveals much about a child’s psychological
states. The final chapter in this section takes up another somewhat contentious
area, that of gender differences, teasing out the relative roles of biological and
social influences in determining gender identity, and how boys and girls develop
both similarly and differently.

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There is a danger in a book like this that mothers are focused on too much,
particularly as so much research about children focuses on how mothers interact
with their infants. This can lead to blaming of mothers and criticism of parenting.
Chapters 14– 17 redress this by focusing on people other than mothers who are
important in children’s development. Attention is paid to how humans evolved to
rear children in groups, with alternative carers, sometimes called alloparents,
such as grandparents and adolescent girls. The impact of different kinds of child-
care such as nurseries is also assessed. Next, in Chapter 15, I describe how chil-
dren are influenced by peers and siblings, particularly as they move into middle
childhood. I outline the psychological and neurobiological developments of this
age, as well as describing the importance of group processes and membership.
Chapter 16, keeping the focus off mothers, discusses fathers, cultural variations
in fathering and whether there is anything distinctive about what a father offers
to children. Adolescence is considered next, again a time when parents generally
are becoming less central in a child’s life. We see how adolescence relates to ear-
lier childhood as well as being a distinctive phase, and how the adolescent brain
is developing fast. An addition to this edition is now research about the effects of
the internet and screens.
As the book nears its end, I ask what impact early experiences really have
on later life trajectories. Chapter 18 takes on the less pleasant topic of how trauma
and neglect affects children and the implications for later development. A distinc-
tion between trauma and neglect is outlined, and some variants, such as disorgan-
ised attachment, are focused on. Chapter 19 then moves on to examine positive
experiences, resilience and what can foster emotional well- being. Chapter 20 is
new to this edition, looking at moral development, the roots of being prosocial or
antisocial, and the extent to which moral life is based on emotional or cognitive
capacities. In the final chapter I  sum up and revisit the question of the longer-
term effects of early experiences.
Reporting research is central to my task, and so this book needs to be
accurate and reliable. However, the research I examine can rarely be read neu-
trally. Thinking about infancy, early childhood, parenting, or the birth process
means raising issues that evoke intense passions and strong opinions, which stir
up memories, wishes, regrets and hurts, and inevitably makes it harder to read
about these subjects purely factually. Although I have my own biases, conscious
and unconscious, I tr y not to take sides about what are good or correct practices.
This is less out of a belief in scientific neutrality and more from understanding
how transient and fleeting scientific and moral certainties can be. I rather hope
that the findings discussed here can illustrate the huge range of potential psycho-
logical and emotional development that an infant and child is capable of.
The questions posed in this book are not just academic ones. When politi-
cians argue, for example, that fathers should spend more time with their children
and that single parent families are not a good idea, we can examine the data and
see whether such ideas have solid foundations. Similarly, research can illuminate
the effects of childcare practices, or ways of working with children, which can
then inform parents and professionals. Although this is not a ‘how to’ book and

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does not give direct advice, I  hope that the research will inform people’s work
with children and families, and in how ser vices for them are organised. My place
of work is the Tavistock and Portman Clinics in London, which for many decades
have combined high- quality psychotherapy ser vices with research and training
for thousands of professionals. Bowlby founded and developed attachment the-
or y there, and it was a place that first developed trainings in child psychotherapy
and family therapy in Britain. The kind of research quoted in this book funda-
mentally informs how professionals like myself approach our work.
Strong feelings are an inevitable part of learning about these aspects of
human development. We have all been treated in a variety of ways by parents or
caregivers, have all suffered upsets, disappointments, and in some cases, terrible
losses or horrible experiences. Many readers are parents, some whose own emo-
tional histories have affected how they have acted with their own. Some come
across this learning late and wish wholeheartedly that this knowledge was avail-
able when they were being parents, or being parented, wistfully wondering how
different things might have been.
Neuroscience and psychology research teaches us that we absorb things
best when we are neither over- nor under- aroused, and my hope is that the reader
will be sufficiently emotionally stimulated to be interested to learn, and neither
be stirred up too little or too much. I have aimed to give as clear a picture as I can
of the findings available that can help us in our lives and work. Such understand-
ing can change how we interact with, respond to and think about children and
families. Research can also fuel discussion about the practices and policies we
adopt, areas where passions and strong feelings can have an outlet. My aim is to
convey an understanding of recent research that has illuminated how the human
child develops in its context. In the end my main hope is that the reader might
feel inspired to understand children and family life a little differently.

11
P a r t   I
Beginnings of Emotional
and Social Development

12
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13
13
C h a p t e r   2
Life begins: from
conception to birth
Observing the unborn baby 15
Where does parental influence start? The meeting of
biology and psychology 16
Lasting effects, social effects 18
Being born 20
Key points 21

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Many aspects of life before birth, processes that might seem purely physi-
ological, can also be thought about from a psychological, social and neu-
robiological perspective. The growth of the human from an embr yo into
a foetus, and the journey until birth, is a complex, almost miraculous pro-
cess. After a successful conception, the fertilised egg, at this stage called
an embr yo, moves slowly along the fallopian tube and settles in the lining
of the mother’s womb, constantly dividing and growing. By seven weeks
the embr yo is only 10  mm long but already the heart, lungs, brain and
face are forming. We start to call it a foetus, literally meaning ‘young one’,
by about eight weeks. By 14 weeks it has a strong heartbeat, its internal
organs are formed, as are hair, eye lashes and other details. Each foetus
is subject to myriad influences; each develops inside a particular mother,
has specific genetic inheritances, and is living in a unique intrauterine envi-
ronment. Across the placenta nutrients and oxygen pass into the foetus’s
bloodstream via the umbilical cord, as can drugs, alcohol and various hor-
mones. This chapter tries to unravel some of the pre- birth influences that
can affect the growing child.
The foetus is its own being, with its own rhythms, urges and biological expec-
tations. Its arrival partly transforms the mother’s body into its host, and once
plugged into the uterine wall it basically fiddles with its mother’s control mecha-
nisms, leading some to liken it to a cosmonaut in charge of a spacecraft. The
foetus determines which way it will lie in pregnancy and present for the birth,
and indeed the timing of birth. It has feeling, responds to painful stimuli by turn-
ing away (Goodlin and Schmidt, 1972), demonstrating a surprising capacity for
choice. The foetus can actively seek food (Bradford and Maude, 2014), and indeed
as early as 1937 experiments (Bradley and Mistretta, 1975) showed that when
saccharin was added to the amniotic fluid foetuses swallowed more, whereas
foetal drinking rates crashed after the injection of bitter substances. Foetuses
get used to initially unner ving stimuli, and, for example, on first encountering a
vibrating stimulus might move, but on subsequent occasions tend to pay it less
attention (van Heteren et al., 2001). By 8 to 10 weeks it is moving its limbs. Rather
than being an inert cell collection blissfully bathing in amniotic fluid, a foetus is
active and responsive.
It is nonetheless profoundly influenced by its milieu. It responds to musi-
cal signals, moving in synchrony to rhythms (Sallenbach, 1993). Foetal facial
expressions actively respond to music by 16 weeks (López- Teijón et  al., 2015).
As early as the first trimester the foetus will jump if touched by an amniocentesis
needle and turn away from a doctor’s foetal stethoscope (Goodlin and Schmidt,
1972), and foetal heart rates increase when pregnant mothers smoke cigarettes
(Lindström et  al., 2013). Ultrasound video has shown foetuses responding to
both cigarette smoking and loud noises by what looks like cr ying (Bellieni, 2012;
Gingras et al., 2005). Already we see nature– nurture interaction; the foetus is its
own being but also is being socialised. It learns to recognise sounds that it will
prefer after birth (Krueger and Gar van, 2014), while culturally influenced tastes

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are also being picked up, so that for example, if the mother eats garlic during
pregnancy, the new- born will show less aversion to it (Mennella et al., 2011).
When a small acoustic/ vibrational sound stimulus is placed against a
pregnant mother’s stomach ultrasounds reveal higher heart rates in foetuses of
depressed mothers than non- depressed. After wards foetuses of depressed moth-
ers took 3.5 times longer to return to their normal baseline as foetuses of non-
depressed mothers. The latter both reacted more responsively, and also calmed
down more quickly than the foetuses of depressed mothers (Dieter et al., 2008).
This is uncannily like chronically anxious or stressed older children and adults
who tend to recover more slowly from alarming stimuli, suggesting some prena-
tal adaptation to the world they are experiencing.
Neither foetuses nor children are primed to live in a world of perfect
mother– infant harmony. Conflict is engrained in human nature and, as psycho-
analysts and evolutionar y psychologists such as Trivers (2002) showed, a par-
ent and child, sharing only half their genes, have conflicting as well as common
interests. It is in the interest of the foetus, not the mother, to transfer as many
nutrients as possible across the placenta. The foetus sends hormones into the
mother’s blood stream that can raise maternal blood pressure, sometimes giving
rise to symptoms ranging in seriousness from swollen calves to preeclampsia,
all to increase its own supply of nutrients. The foetus re- models the mother’s
arteries, stopping her constricting the vessels that supply the embr yo without
star ving herself. In effect the foetus establishes control of the territor y to ensure
its growth. A  mother’s body develops its own response to foetal demands, so
that a complex mutually regulating process occurs, which usually works well.
Sometimes, though, this balance is disturbed, such as when a pregnant woman
contracts diabetes after placental hormones increase glucose (Hrdy, 1999).
The foetus and maternal body’s relationship is replete with such fine- balanced
‘tugs- of- war’.
The foetus itself is the locus of innumerable conflicts, maybe the best doc-
umented of which is that between the male and female genome. Haig (2004)
studied genetic imprinting, whereby the same gene will express itself differently
depending on which parent it comes from. In an extraordinar y experiment with
mice, the paternal and maternal instructions were alternately rendered inactive,
and thus only one parent’s genome was ‘in charge’ of a foetus. In foetuses where
the mother’s genome ruled, babies were born smaller but with larger brains,
especially the parts to do with intelligence and complex emotional responses,
whereas those born by rule of the father’s genome were brawny and less clever!
Even in pregnancy conflicting interests are engrained in our ver y genes and cell
structure.
With the advent of ultrasound technology we have gained a new window on foetal
life. We see foetuses yawn, move about, grimace with pain, undergo rapid eye
Observing the unborn baby

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movement (REM) sleep, and male foetuses having erections. By 12 weeks a foe-
tus will grasp when its palm is stroked, will suck when its lips are stimulated, and
squint when its eyelids are touched.
Scans and careful obser vations of twins have allowed obser vers to witness
what looks like personalities forming in utero. For example, we can see a twin
kick another who flinches and moves away, or in other pairs the kicked twin will
instead retaliate and push back. There have been several examples of twins show-
ing similar personality traits well into postnatal life, such as a seemingly more
placid and conciliator y twin in utero showing similar behaviour with their more
aggressive twin in later childhood. The Italian psychoanalyst Piontelli (1992)
adapted an infant obser vation method originally developed at the Tavistock Clinic
in London in the 1940s by Bick (1968). She obser ved foetuses via ultrasound and
found that the intrauterine environment is quite different for each twin in a pair.
One for example might claim more space and resources, growing at the other’s
expense. Twins clearly do not have identical environments before birth, despite
what some longitudinal twin studies suggest. Some twins recoil from contact
while others actively seek it. She documents affectionate twins who stroked each
other’s head through a membrane, and after birth they stroked each other simi-
larly, using a curtain as the membrane. Other twins were violent in the womb,
seemingly hitting out at each other, interaction patterns that persevered as they
grew older. Was this just due to the twins’ temperament or was the intrauterine
environment affected by a mother’s emotional states, such as of stress or anger,
and the accompanying release of hormones that cross the placenta? Piontelli’s
accounts may seem anecdotal and open to interpretation but they suggest that at
least some aspects of personality are developing in the womb. As ever, nature and
nurture, physiology and psychology, are hard to disentangle. Such research asks
important questions about continuity between pre- and postnatal life.
A central theme of this book is how carers affect a child’s psychological and
emotional development, and interestingly a pregnant mother’s states of mind
is predictive of an infant’s behaviours a year or more after birth. In a fascinat-
ing experiment undertaken by Howard and Miriam Steele (Fonagy et al., 1991)
pregnant first- time mothers were given the Adult Attachment Inter view (AAI)
which measures an adult’s capacity to process their emotional histories. The
mothers’ inter views predicted with surprising accuracy the future attachment
status of their as- yet unborn child. Similarly we know that pregnant mothers who
are securely attached tend to be more attuned to their infants after birth (Sohye
Kim et al., 2014), while mothers with more worr ying trauma- related attachment
styles (Bernstein et al., 2014) are less able to accurately read their infants’ facial
expressions. Typically an adult who produces a coherent narrative and self- reflec-
tive stor y tends to have a child who at a year is classified as securely attached.
Where does parental influence start? The meeting of
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Mothers whose stories are more chaotic or inconsistent, or who are emotionally
cut- off, tend to have insecurely attached children. Thus, extraordinarily, the psy-
chological capacities of a pregnant mother predict how their unborn child will
react to stressful situations a year after birth. It is a parent’s sensitivity to emo-
tional life, her own and others, that seems to lead to this effect.
Such findings imply that people who are sensitively reflective about emo-
tions might also be sensitive to their baby’s psychological states, and also that
there is likely to be continuity between a mother’s states of mind during and after
pregnancy.
However, prenatal experiences have lasting influences in themselves, irre-
spective of a mother’s state of mind after birth. A well- known example comes from
the Second World War, where a cohort of Dutch mothers were literally star ving
and even resorted to eating tulips (Lumey et al., 2007). The foetuses of the star v-
ing mothers grew into children and adults with ‘thrifty’ metabolisms who stored
more fat, despite the food shortage no longer existing after their births. Such
research describes what is called ‘foetal programming’, whereby unborn babies
learn lessons to prepare for life later, which in this case would have been that food
is scarce and needs conser ving. Thus a bodily strategy developed that in fact was
not necessar y in post- war Holland and also led to physical and psychiatric issues in
many of this sample. A similar effect was found in China. Mothers whose foetuses
were affected by their malnutrition in The Great Leap For ward had offspring who
comparatively struggled in junior secondar y school entr y (Seonghoon Kim et al.,
2014), and here again it was the prenatal influences that were decisive.
Prenatal factors like birthweight are predictive of illness right into adult-
hood. Being born of low birthweight is hugely predictive of all kinds of diseases
in adult life, such as coronar y heart disease or type 2 diabetes, and indeed even
of early death, when other factors such as genes or socioeconomic circumstances
are screened out (Barker, 2013).
However, seemingly physiological matters such as birthweight often have
psychological and emotional aspects. There is consistent evidence that high
stress levels in pregnancy increase the likelihood of both birth complications
and low birthweight (Wadhwa, 2005), as well as affecting a foetus’s capacities
for memor y and habituation, and that such effects persist after birth. Cortisol,
probably the best- known stress hormone, crosses the placenta, affecting foetal
development. When a mother becomes fearful her heartbeat alters, often leading
to reduced oxygen flow to the foetus as well as constricted arteries, which might
affect birthweight (Monk et al., 2000). There are correlations between maternal
and foetal cortisol levels (Glover, 2015) and a link between high cortisol levels
and low birthweight (Bolten et al., 2011). Intrauterine stress predicts health out-
comes and cell expression right into adulthood (Entringer et al., 2011). Prenatal
stress impacts the immune system and tell- tale signs of this can be seen in exam-
ining the placenta (Lan et al., 2015).
Other known and less surprising dangers to the foetus include maternal
use of alcohol and both legal drugs such as anti- depressants (Huybrechts et al.,
2014) and anti- psychotics (Kulkarni et  al., 2014), and illegal drugs (Ross et  al.,

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2015; Yip et  al., 2014), all affecting the developing brain and ner vous system.
Clinicians who have worked with heroin addicted new- borns have described how
their jerky desperate movements make excruciating viewing (Emanuel, 1996).
However by far the most recreational pernicious drug for the developing foetus
is alcohol, which can have a devastating effect on the growing ner vous system.
Some children develop full- blown foetal alcohol syndrome (Mohammadzadeh
and Farhat, 2014), with its classic set of dysmorphic facial features and shocking
effect on emotional and psychological life. Other infants escape the facial features
but suffer with ‘fetal alcohol spectrum disorders’ (Riley et al., 2011). Their lives
are often profoundly affected by this condition, as for such children the brain
areas involved in both memor y and impulse control often are profoundly affected
(Kodituwakku and Kodituwakku, 2014; Rangmar et al., 2015).
The effect of maternal stress, anxiety, or depression on foetal development
has been shown to hold up even when other factors such as biological inheritance,
social class, diet, or smoking are screened out (Glover, 2015). Once again there is
nature– nurture interplay. One study examined the effects of prenatal stress with
mothers either pregnant with their own genetic child or one conceived via in vitro
fertilisation (IVF) that lacked her genes (Rice et al., 2010). Prenatal stress had a
clear effect on later behavioural problems, but a slightly greater one on the moth-
er’s genetic child. In other words, some later behaviour was influenced by genetic
inheritance, but not all, genes and environment both playing a role.
However, because maternal stress leads to low birthweight and other issues,
we can on no account blame stressed mothers for the physical and emotional
health of their offspring. This research takes us far beyond the responsibilities of
the individual parent. Stress, anxiety, depression and other psychological issues do
not occur by chance or in a vacuum; such stress is more likely if one is socially and
economically marginalised, particularly if poor in an unequal society (Wilkinson
and Pickett, 2009), or is the victim of racism (Hilmert et al., 2014) or of domestic
violence or abuse. There are exceptions to this, such as otherwise ordinarily well-
functioning pregnant women who are present at traumatising events such as 9/ 11
(Yehuda et al., 2005), or traumatic events like hurricanes or ice- storms (Currie and
Rossin- Slater, 2013; Walder et al., 2014). Pregnant mothers who experienced post-
traumatic stress symptoms had children with altered stress responses and cortisol
levels. However generally social causes of stress such as poverty or interpersonal
trauma are the most prevalent, and one can argue that maternal stress levels are
a signifier of social, political, economic and cultural issues. If responsibility lies
anywhere it is with society as a whole rather than individuals.
Maternal stress and anxiety influence birthweight and are a precipitating fac-
tor in birth complications and prematurity (Glover, 2015; Sanchez et  al., 2013).
Indeed stressful adverse experiences such as trauma in a pregnant mother’s
childhood are predictive of giving birth prematurely (Christiaens et  al., 2015).
Lasting effects, social effects

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Thus, blaming mothers will not help; but if we want to alter trajectories then we
cannot downplay what the research finds. High stress levels can alter the foetus’s
brain structure and functioning, contributing to later mood and anxiety disorders
(Talge et  al., 2007; Wyr woll and Holmes, 2012) and lower the baby’s immune
functioning (O’donnell et  al., 2009). Low- birthweight babies born to ver y anx-
ious mothers are likely to have higher cortisol levels throughout their lifespan
and a permanently altered stress response system (Phillips, 2007). Adults who at
birth were of low birthweight are more susceptible to the physiological effects of
stress caused by factors such as poverty and unemployment (Barker et al., 2001).
It is as if the unborn baby is tr ying to work out what kind of world to prepare for.
Indeed research is suggesting that continuity between the prenatal and postnatal
environments often gives rise to better mental and psychomotor outcomes, even
if this environment is a depressed mother (Sandman et al., 2012).
Severe antenatal stress affects levels of hormones that regulate mood,
such as dopamine and serotonin, and has been increasingly linked to a range
of childhood emotional and behavioural problems (Beijers et al., 2014) such as
ADHD, and to problems right into adolescence and adulthood (Bosch et  al.,
2012). Such influences hold firm after screening out factors such as gender,
parental educational level, smoking in pregnancy, birthweight, and postnatal
maternal anxiety. While we still do not know, for example, about how and why
stress in pregnancy has different effects depending on which trimester the stress
is in (Van den Bergh et  al., 2007), we do know that prenatal stress often but
not always has profound effects. Of course, its impact can be increased by liv-
ing with equally stressed parents later on, but stress in pregnancy has its own
impact. Such research bolsters arguments for providing psychological and social
support for pregnant mothers. Indeed inter ventions such as the Family Nurse
Partnership, which includes visiting mothers pre- and postnatally, have shown
profound long- term benefits (Olds, 2012).
Some stress can derive from one- off rather than chronic experiences,
such as a mother experiencing bereavement during pregnancy, and then if good
support is available the impact on the infant will be lessened by later positive
influences. More tragic are overdetermined causative factors such as a highly
stressed mother born into poverty, who is the victim of violence and has little
social support. She might be more likely to have a low- birthweight baby and
have birth complications, which in turn can lead to difficulties in bonding. If one
then adds the probability of intrusive medical attention, a decreased likelihood of
breastfeeding, less attuned interaction, poor housing, little support, then a baby’s
prognosis exponentially worsens.
Social forces, biology and psychology surprisingly interlink. For exam-
ple a teenage girl is more likely to reach puberty earlier, and indeed to become
pregnant, if she had a stressful or traumatic early life (Ellis and Essex, 2007),
while a close relationship with one’s father seemingly predicts later puberty
(Maestripieri et al., 2004; Belsky 2012). Evolutionar y theorists (Sieff, 2014), sug-
gest that a stressful upbringing, where conditions are tough and infant sur vival is
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the best chance of passing on one’s genes. The forces that lead us to act as we do
are often hidden from our view.
While this chapter primarily focuses on prenatal life, aspects of the birth pro-
cess are also fundamentally linked with psychological processes. Human birth
is more hazardous and painful than in most species, due to a combination of the
relatively large size of our brains, and the small pelvises that developed several
million years ago when our forebears became bipeds (LaVelle, 1995). It is prob-
ably in response to these factors that human infants are born relatively immature.
Cultural practices concerning birthing differ, and those thought of as ‘natu-
ral’ in one era might seem alien in another. Until recently the use of stirrups for
birthing was de rigeur in Western hospitals, acupuncture is often used in China
for pain relief (Y. Chen et al., 2014), across the Western world caesarean section
is on the increase, while many women also espouse natural births, often with
fathers present (until recently males attending births were almost unknown).
Ideas about what birth means var y hugely across cultures and historical
eras. For example, the Beng of West Africa (Gottlieb, 2004) believe that babies
come from a place of spirits called wrugbe, and are reincarnations of ancestors.
Gottleib described a Beng woman having a difficult childbirth who summoned
a diviner who stated that the baby would only come out when she called the
particular name the baby had had in wrugbe. When the mother did this, the
anthropologist witnessed that the birth proceeded speedily. This might seem
inexplicable to us, and I  do not want to make such ideas out to be primitive or
exotic, but simply to point out that odd practices in one culture can seem normal
in another. Although throughout this book I  tr y to use the latest research to
understand children’s development, I also aim to be ver y aware of cultural differ-
ence and bias. What we think of as cutting- edge knowledge today can tomorrow
seem a quaint superstition, and views based in different cultural worldviews can
be a particular challenge to us.
Psychological factors such as stress have an impact on the quality of a birth.
Pregnant mothers with little support often have higher levels of cortisol, and are
at more risk of earlier and more difficult births as well as postnatal depression
(Yim et al., 2015). The presence of a supportive empathic, and experienced per-
son can ease births and reduce the risks of complications (Hodnett et al., 2005).
Klaus and Kennel as early as the 1970s piloted schemes in which supportive
women stayed with the mother throughout the birth, and the result was quicker
births and fewer complications (Klaus et  al., 1993). In one study 240 first- time
mothers were randomly assigned either to a control group whose births were
managed ‘as normal’, and another group who were assigned to a continuous
supportive companion called a ‘doula’. The supported mothers had babies with
fewer caesarean sections, less meconium staining and foetal distress, and were
less likely to be hospitalised in their early months. Indeed research suggests
Being born

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that continuous midwife care shortens labour and reduces birth complications
(Sandall et al., 2013). Having a supportive partner and being in a mutually secure
attachment relationship is linked to less pain (Krahé et al., 2015). The importance
of psychological support begins ver y early.
The release of oxytocin is probably central, as we release it when we bond
with someone, feel good, make love and also during labour. It enhances immune
responses and protects against physical pain and we produce greater doses
when feeling supported and cared for. Many other chemicals are also naturally
released such as adrenaline and noradrenalin, and beta- endorphins, all of which
protect against pain and make the birth process more manageable.
The quality of the experience of birth can have a knock- on effect on mother–
child relationships, as research on post- traumatic stress symptoms following
birth testifies (Andersen et al., 2012). Traumatised mothers often feel rejecting
of their babies and the mother– infant relationship can struggle to recover (Ayers
et al., 2006; Kendall- Tackett and Barnes, 2014). As we will see, a good start is not
essential to a child’s mental health but it certainly helps. A good birth increases
the chances of a better emotional start, and the chances of a smooth birth are
enhanced by having good support. Equally the capacity to bond well with a baby
is increased when mothers feel emotionally safe and cared for, which reduces the
risk of other problems such as postnatal depression (Sockol et al., 2013).
Of course sometimes bad luck intrudes into the birth process and there are
physiological complications. However, generally the research suggests that psy-
chological, social and biological factors interact; reducing stress levels through
emotional support leads, on average at least, to healthier pregnancies, easier
labours, fewer birth complications, and seemingly better outcomes generally. As
we will see through much of this book, the research in this chapter demonstrates
the importance of psychological and emotional support. It also suggests that
there is much that can be done to make the experience of pregnancy and birth
better for mothers and babies.
• Psychological life begins well before physical birth.
• The foetus is an active being, with its own tendencies, and is already
responding to its environment and learning from it
• The biological mother’s emotional health and capacity to process emotions
has a profound effect on the developing foetus, including via the transmis-
sion of stress hormones and more noxious substances across the placenta.
• The foetus can be ‘programmed’, for example by such stress hormones and
be born prone to be reactive to stressors.
• Emotional support for mothers makes both pregnancy and the birth pro-
cess easier, showing the importance of psychological well- being from the
ver y beginning of the life cycle.
Key points

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C h a p t e r   3
Born to relate
Immaturity 24
Bonding: humans are not grey- lag geese 25
Infant imitation and contingency 28
Attunement, affect regulation and marking 29
Maternal instinct questioned: abandonment and infanticide 30
Entrainment, culture and becoming one of us 31
Key points 33

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The human infant is born extremely immature and can do little unaided in
its first months. Its sur vival requires fairly constant physical and emotional
care. In this chapter I  look at how babies are pre- wired with impressive
capacities for social interaction. They tr y to elicit the human responses
they need to sur vive and thrive, and have a striking ability to respond to
the social environments they find themselves in. Babies arrive with wide-
ranging temperamental and genetic potential, while the ways in which
adults respond to babies also varies enormously. A  human life develops
from the delicate interplay of nature and nurture, the meeting of a bundle
of inherited potentials and the cultural, social and personal influences of
the adults in an infant’s life.
Such two- way meetings are seen immediately after birth. Klaus (1998, p.1244)
described the new- born’s astonishing capacity, moments after birth, to crawl
towards its mother’s breast and find the nipple, inching slowly for ward with its
legs, pushing on its mother’s abdomen, and eventually coming ‘close to the nip-
ple, he opens his mouth widely and, after several attempts, makes a perfect place-
ment on the areola of the nipple’. Most babies can do this if they are not washed
after birth nor born with too much medical inter vention. Smell is central; if one
washes the right breast then infants crawl to the left one, and vice versa, and if
both breasts are cleaned, the infant crawls to the one with the mother’s amniotic
fluid on it.
Babies are born primed to recognise their mother’s smell. In one classic
early experiment new- borns were placed in cots, and the scent of their mothers’
breast milk was blown through breast pads on their left side of the cot while
the scent from another mother was blown through the right side. The babies
turned, straining towards their own mother’s scent, and when the breast pads
were swapped over, then their efforts were re- directed in the new direction
(Macfarlane, 1975).
Such instinctual movements illustrate the infant’s ability to adapt to its
situation and its active desire to stay close to its mother. In skin- to- skin con-
tact a mother’s body maintains an unclothed baby at just the right tempera-
ture, forming a two- person homeostatic system. When mothers breastfeed,
oxytocin is released which can induce feelings of love, and also lower pain.
Encouraging more contact between mothers and babies reduces the risk of
abandonment. In mothers who are at risk of parenting disorders, just increas-
ing the time babies spend with their mothers by a few hours a day can lead
to a fivefold reduction in abandonment, abuse, or neglect (O’Connor et  al.,
1980). For some parents bonding is not straightfor ward, and a helpful nudge
makes a huge dif ference. Research shows that when mother– infant bonding
is facilitated, such as via suppor ting breastfeeding, then child abandonment
greatly reduces (Dumas et al., 2013). Suppor t for new mothers can be crucial
(Olds, 2012), aiding physical closeness, triggering the release of hormones
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like vasopressin and oxytocin, leading to better feelings for the baby, and also
better feelings in the baby.
There has been a misconception that bonding must occur immediately or irrevo-
cable damage is done, an idea popularised by ethological animal studies. For
example grey- lag geese bond with and follow around the first creature of any
species that they see, and sheep imprint on their lambs’ smells and reject woo-
ing from lambs lacking the right scent. Humans are different though and do not
have a critical period just post- birth when bonding must occur. Humans have the
potential to bond with most babies, not just their own, and such bonding rarely
happens immediately but rather normally takes time to develop. Bowlby (1969),
the founder of attachment theor y, found that it is consistent care and closeness
over time which gives rise to what he termed ‘affectional’ (meaning emotional)
bonds’.
Maternal commitment is by no means certain, and human bonding is a two-
way and generally gradual process, and one that can be helped along by support.
This can be seen in pregnancy when mothers often become more committed
to their babies after seeing scans (de Jong- Pleij et  al., 2013), particularly when
development is going well. Babies’ chances of sur vival increase by being primed
to gain attention from carers, hence neonates are often born with attractive fea-
tures. The mitered leaf monkey infant, for example, is born dazzlingly white with
a dark stripe from head to toe. Most of us think human babies are adorable, and
these feelings can extend to other baby- like creatures, such as seals with big
wide eyes.
Breastfeeding facilitates bonding and lowers women’s reactivity to psycho-
logical stressors, probably partly through oxytocin release (Johnson and Young,
2015). It also provides many immunological benefits for the baby, particularly
from collostrum, the rich fluid that arrives before ordinar y milk. Of course
breastfeeding is not exclusive to birth mothers. In aristocratic medieval Europe
sur vival rates for infants fed by wet nurses were as good as with maternal nurs-
ing, and facilitated both increased fertility and infant sur vival. In France wet nurs-
ing was endemic across all classes by the mid- eighteenth centur y (Fildes, 1988),
it and is still common in some parts of the world.
Breastfeeding gives rise to the release of other helpful hormones, such as
prolactin which increases protective feelings and attentiveness. Indeed breast-
feeding mothers have been found to be more aggressively protective (Hahn-
Holbrook et  al., 2011), the so- called ‘mama- bear’ effect. Prolactin levels even
increase in fathers before and after birth as well (Gettler et al., 2012). Oxytocin
is present only in mammals, more in monogamous ones, and helps attachments
form. It can even induce positive feelings that can blind us to the faults of others
and make us too trusting! Mothers with higher levels of oxytocin tend to be more
sensitive to their babies, bond better, form closer attachments, demonstrating
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more positive gaze and affectionate touch (Galbally et al., 2011). The common,
almost obsessive kind of love that mothers often have for their babies has similar
features not only to falling in love, but also to obsessive– compulsive symptoms.
Leckman (1994) suggests maternal vigilance, such as constantly checking a cot
to ensure their infant is still breathing, has similarities with obsessive– compulsive
patients checking whether the oven is left on. There is even a link between high
anxiety, oxytocin, and what is often called ‘love- sickness’ (Clark- Polner and Clark,
2012). Generally, though, oxytocin is involved in good feelings, not anxiety, and
high levels in infancy leads to more oxytocin receptors, programming the body
to produce and use more of it later in life.
With luck, time spent with an infant after birth stimulates closeness and
strong feelings of mutual affection, and infants are soothed by touch (Fairhurst
et  al., 2014) and being carried, which regulates heart rate and blood pressure
(Esposito et  al., 2015). Mothers who stroke their infants seem more protected
from depression (Sharp et al., 2012). Of course some mothers struggle to form
close bonds, whether for social reasons, such as living in extreme poverty, or
psychological ones, such as being depressed or being a victim of violence. Indeed
oxytocin seems to promote bonding only when a context seems safe rather than
dangerous (Bartz et  al., 2011; Olff et  al., 2013), and of course amidst violence,
severe economic pressure, or personal mental illness, for example, the likelihood
of bonding is reduced. This is about more than oxytocin, and we are learning that
ver y different parts of the brain’s cortico- limbic circuitr y are active depending
on the quality of mother– infant relationships (Swain et al., 2014). Particular brain
regions are activated when viewing one’s own as opposed to a stranger’s baby
(Wan et al., 2014), and researchers have been identifying which brain networks
are activated in mothers who have bonded well with their infants (Feldman, 2015).
Babies actively attempt to elicit care in adults, and are primed to relate to
people and faces. Not so long ago people believed that infants were born blind,
but in fact they see from birth, albeit from a distance of about 30 centimetres
(von Hofsten et al., 2014), about breast to face distance. Many of an infant’s earli-
est perceptual abilities are geared to becoming social beings. Several decades
ago Brazelton (Brazelton and Tronick, 1980) showed how babies are pre- wired
to relate differently to humans and inanimate objects, something that recent
research has confirmed (Baker et  al., 2014). Infants were filmed as a toy mon-
key moved almost within reach, suspended on a wire. Babies responded to the
toys with excitement, but as something to explore, touch and grasp, while they
responded to their mothers totally differently, as a person to interact with, look-
ing for a response, smiling, looking back and away. Infants generally show pref-
erence for looking at faces over inanimate objects (Kwon et al., 2013), although
babies who later become autistic are often an exception (Jones and Klin, 2013).
In the first minutes of life an infant’s attention can be drawn to a black and white
drawing of a face, but not to fuzzier less distinct variants. Mothers and babies
often seek out each other’s eyes after birth, and new- borns prefer pictures of
their own mother’s face to a stranger’s (Wagner et al., 2013). Indeed, maybe wor-
r yingly, by three months they even prefer faces of their own race (Gaither et al.,

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2012). They prefer looking at pictures of faces with eyes open rather than closed,
faces the right way up (Dobkins and Harms, 2014) and look longer at face- like
shapes, such as lines resembling eyes, mouth and a nose. Such face recognition
can elicit positive caregiving responses.
Such capacities for facial recognition are innate, but become blunted
without attuned input. Sighted infants of blind mothers look at eyes less (Senju
et al., 2015), while children reared in emotionally depriving orphanages have
far less capacity to recognise faces (Nelson et  al., 2013) and less activity in
corresponding brain areas (Moulson, Fox, et  al., 2009). Infants, though, are
born with huge innate potential for emotional recognition and social learning,
especially via sound and faces. If you show babies pictures of many faces, and
later just two faces, one they had seen before and one they had never seen
before but which is an ‘average’ of the previously seen faces, they are most
interested in that ‘average’ one (Walton and Bower, 1993). Babies generalise,
although, interestingly, emotional expressions are more likely to be recog-
nised if that expression is first seen in a parent (Walker- Andrews et al., 2011).
Such skills can be actively used in making sense of who to trust or be open to.
Indeed seven- month- olds can detect complex emotional states such as fear via
changes in sclera, the whites of eyes (Jessen and Grossmann, 2014). Younger
babies even recognise emotions in others just by watching body movements,
when faces are hidden (Zieber et al., 2014).
New- borns can recognise both their father’s and mother’s voices but show
clear preferences for their mother’s (Lee and Kisilevsky, 2014). Foetal heart rates
reduce when hearing tapes of their mother’s voice as opposed to a stranger’s
voice (Kisilevsky et al., 2009), as does an infant’s (Rand and Lahav, 2014), demon-
strating both impressive capacities to know and reach for what it needs. A baby’s
brain waves are different when listening to their mother’s voice as opposed to
another female voice, even if outsiders often can barely distinguish between the
sounds. Field (1984), though, suggests that such capacities are dimmed in both
foetuses and neonates of depressed mothers, who show inferior performance in
face and speech discrimination tests. Thus different experiences will turn these
potentials on or off.
In one fascinating early experiment DeCasper and Spence (1986) worked
out infants’ normal sucking rates, as babies characteristically suck at different
rates. They then piped recordings of their mother’s voice through a speaker, but
only when babies were sucking at a lower or higher rate than usual. When suck-
ing at their usual rate they heard another woman’s voice. Sure enough these
almost new- borns could deliberately suck on the teats at the higher or lower
speeds that brought alive their own mother’s voices, changing their behaviour to
be closer to their mothers. Babies were even able to discriminate between their
mother reading a Dr. Seuss stor y that they had heard while in the womb, ‘The
Cat in the Hat’, and another Dr. Seuss stor y with similar style and rhythm, but
different words. Such skills might well play a role in infant sur vival, helping to
locate and elicit interactions from their mothers, which in turn might reinforce
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Infants who are only weeks old have highly developed capacities to learn.
They can translate experiences received in one sensory modality (such as sight)
into another (such as touch). In an early experiment (Meltzoff and Borton, 1979)
blindfolded babies were given pacifiers with differently shaped nipples, some with
spherical shapes and others with protruding nubs. Babies got to know them, via the
touch and feel in their mouths, and then the blindfolds were removed. Incredibly
the infants looked longer at the nipple they had just sucked, which means they rec-
ognised something using sight that they had only previously experienced through
a different sense, touch and sucking. Something similar is seen with other sensory
modalities, such as sound and shape (Ozturk et al., 2013). Similarly tiny new- borns
prefer watching stroking of other babies faces if their own is being stroked to the
same rather than a different rhythm (Filippetti et al., 2013). Infants can integrate
different experiences, making life predictable and understandable. Unlike some
early psychological accounts, the infant knows that the thing seen (such as the
breast) is the same as the thing that is felt (such as the ‘sucked breast’). Infants
have extraordinary capacities to make sense of the human world.
Infants are born with the potential for interpersonal skills that require attuned
interactions to develop. For example infants can imitate adults only minutes after
birth (Meltzoff, 2007). In experiments parents stick out their tongue and babies
watch carefully and after a lot of effort stick out their own tongue. A 10- minute- old
baby does not know it has something called a tongue, but is somehow translates
what it sees into a physical gesture. Babies only two days old can imitate a range
of facial expressions such as smiling, frowning, or showing surprise, although
the capacity to do this is strongest in the earliest days. Some recent research has
challenged the idea that infant imitation is innate and not learnt (Oostenbroek
et al., 2016), even if the fact of infant imitation is not in question.
Research has shown that infants are definitely communicating when they imi-
tate (Nagy et al., 2013), actively responding to deliberate tongue protrusions, and not
imitating involuntary movements such as sneezes. Heart rates increase as they imi-
tate adult gestures, and interestingly, when they provoke an adult to imitate them, then
their heart rates slow, suggesting a different intent (Trevarthen and Aitken, 2001).
Soon babies can also imitate sounds and gestures. In the first few months babies
smile just enough to elicit their mother’s smile and no more (Ruvolo et al., 2015).
Amazingly babies of a year are less likely to imitate seemingly unreliable
adults (Poulin- Dubois et  al., 2011). Slow- motion films show how babies move
their limbs in time to adult sing- song baby- talk, and through this what we call
entrainment develops, whereby babies and mothers acclimatise to each other’s
rhythms. This becomes a form of mutual resonance, with each party a sounding
board of the other, but also a facilitator of the next exchange. Thus, an infant
experiences physiological and emotional regulation as well as learning about the
interpersonal world. Being sung to is especially effective in this (Trehub et al.,
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2015a), and music can trigger all manner of reward processes and communica-
tive skills (Wang, 2015). Some babies of course have parents who cannot attune
to them, but even these are learning quickly what they can or cannot expect of
the adults in their lives.
Such imitative skills are more than reflex reactions or superficial copying.
Babies engage in conversational cooing exchanges within weeks, feeding off the
rhythm of the other. Infants learn who they are through the gestures and facial
expressions of the other. Mothers respond to their infant’s gestures as quickly as
in a sixth of a second, and the infant in turn within a third of a second (Beebe and
Lachmann, 2002), more like one interactive system than two separate individuals.
Infants produce more speech- like sounds when their mother is smiling, especially
when the smile is of a genuine Duchenne kind (Hsu et al., 2001), and infants of more
attuned mothers gaze, vocalise and smile more positively (Markova and Legerstee,
2006). In the early months, of course, much energy is expended on physiological
regulation, sleeping a lot for example, but between two and six months infant socia-
bility increases fast, with more vocalisations and interactive gazing.
Through imitation and having signals responded to infants learn that they
can have an effect on others, and thus develop a sense of their own agency.
Making things happen is enjoyable. A two- month- old kicks more when their kicks
have an effect, such as making a mobile move, but show less enjoyment when the
mobile moves but it is not of their doing (Ramey and Watson, 1972). Similarly,
when their acts have been responded to contingently but then this stops, infants
protest. Infants like to feel they are having an effect.
Early on babies prefer almost perfect contingency (Fonagy, 2004); they
might stick their tongue out and another might copy this immediately and they
are happy. Imitation is perhaps not the best word as both parties always slightly
var y their pitch, tone and expression. By about three months they like less per-
fect contingency, and become increasingly attracted to novel interactions that
provide high but less perfect synchrony. Indeed too- perfect contingency is seen
as a sign of less sensitivity (Bornstein and Manian, 2013), even of anxiety or
trauma (Beebe et al., 2012). In less- perfect contingency a parent might make a
sound that the infant responds to, and the parent then slightly varies the pitch
and this becomes a game. People are enjoyed as interactive partners: the start of
mutual ‘dances’, which leads to the capacity to tease and muck about later in the
first year. Reddy (1991) describes eight- month- old infants teasing, pretending to
offer an object and then whisking it away, able to both understand and confound
the other’s expectations in fun. Babies similarly can spot when someone is acting
out of character (Liberman et al., 2014), but need an attuned interactive partner
in order to fully develop such complex fine- grained interpersonal skills.
In many early experiences, from nappy- changing to being fed or bathed, to being
calmed in readiness for sleep, parents tr y to understand their child’s emotional
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and physiological states and also show their babies that they have understood.
The psychoanalyst Bion (1977) called this containment, the process whereby
a mother might take in, process and modulate an infant’s experience and then
give it back in a digestible and receivable form. Parents read an infant’s cues and
respond to these, often verbally (e.g., ‘oh now you seem a bit twitchy, I wonder
what’s wrong’). Infants who are quickly responded to, without too much parental
anxiety, learn to trust that the world is a safe, reliable place. The young baby
needs an adult to comfort and regulate it, and those who receive this soon expect
that comfort is available when needed.
When a baby is upset a carer often empathically shows they understand
by making noises rather like the infant’s. Gergely and Watson (1996) have called
this marking, which is a slightly exaggerated reflection of an infant’s feelings,
almost hamming it up, conveying a sense of an emotionally attuned mind along-
side them, bearing their feelings and reflecting them back. This is also central in
therapeutic work with children (Music, 2005). Marking, like containment (Bion,
1977), conveys that an emotional state, such as anger or sadness, has been under-
stood and is not over whelming. In empathy or marking we might sigh in the way
a distressed baby is sighing, making sounds that match theirs, moving in time to
their gestures. This is not just mirroring, as just having one’s distress reflected
straight back could make a baby feel worse rather than better. However, when
one’s distress is understood and managed by another, it becomes less frightening.
Distressed babies who are picked up and soothed in their first year cr y
less than others after a year (Hubbard and van Ijzendoorn, 1991). They experi-
ence their emotions being managed, contained and modulated, and learn not
to be over whelmed by experiences. They also learn to manage their own feel-
ings, suggesting parental capacity being internalised. Such early experiences of
being understood by another facilitate the development of self- understanding.
Subjectivity and self- awareness only develops if emotional awareness is received
from another. Some babies never receive this, such as tragic cases of severely
neglected or abused children who often do not develop many self- reflective or
interpersonal abilities. Many of the children who show up on the worr y- lists
of professionals have lacked the kinds of nurturing interpersonal experiences
described here.
In many adults, brain areas specialising in reward (e.g. the medial orbitofrontal
cortex) respond within a seventh of a second to unknown infant faces, but not
adult faces (Kringelbach et al., 2008). This suggests something like a maternal
instinct, but it is important not to be sentimental about this. In most primate spe-
cies parents, particularly mothers, have to take tough decisions about whether
to invest the huge amount of time, energy and devotion that bringing up a child
requires. Hrdy (1999) reports many examples of primate and human females
sacrificing their own offspring. For example coroner reports for five years in
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nineteenth- centur y England listed 3900 deaths, mostly new- borns, and over 1100
at inquest were deemed to be murder. This is a difficult topic, as our values define
such acts as immoral. Yet Hrdy is convinced that infanticide has been a common,
even adaptive behaviour. In hunter- gatherer societies where conditions might
only support one birth ever y four years, infants born too quickly were often
killed, as were one of twins (Sieff, 2014). Hrdy writes ‘many millions of infant
deaths can be attributed directly or indirectly to maternal tactics to mitigate the
high cost of rearing them’ (p. 297).
In one foundling hospital in fifteenth- centur y Florence about 90 babies a
year on average were abandoned, but in the year of famine 961 babies were left.
Sur vival rates are rarely good in such homes. In Russia over 1000 were admitted
in 1767 and 91 per cent failed to sur vive the year. In contemporar y Greece child
abandonment increased massively during the economic recession and austerity
(Carassava, 2014). Scheper- Hughes (1992) studied Brazilian shanty towns with
high infant mortality, disease and dire economic conditions, and obser ved moth-
ers distancing themselves from babies who were unlikely to sur vive. Mothers
described some babies as ‘strong’ and others as lacking the will to live. The latter
were often allowed to die in a way that might seem cruel to Western eyes.
Timing is often crucial; a mother might abandon a child when circum-
stances are not propitious for childrearing, yet can lovingly and devotedly care
for another child born in more hopeful times. Younger mothers in poor circum-
stances are more likely to abandon offspring, perhaps feeling confident that they
will have other chances, and we know that neonaticide is more commonly com-
mitted by young, poor mothers who have received little support (Friedman et al.,
2005), presumably an argument for early inter vention rather than blame.
Hrdy’s point is that most mothers in human histor y have not had the lux-
ur y of loving ever y child that is born. Some evolutionar y theorists (Hagen, 1999)
have even argued that the propensity for postnatal depression, with its particular
hormonal release, is nature’s way of allowing a mother to step back from her
bonding with this particular infant at this particular time. There might be good
reasons to invest in children only when resources or support systems are better
or when there is less danger, a challenging idea for people working with parents
and children.
Babies in the earliest weeks and months are acclimatising and adapting to the
world they find themselves in. For example they learn quickly to adjust to the
day– night cycle of their parents and entrain their heart rates and breathing to the
adults around them. Infants separated from their mothers for a few days and then
returned still quickly entrain to their mothers’ sleep– wake cycle within days,
although boys seemingly take longer (Sander, 2007).
Biological potentials interact with cultural and family expectations to give
rise to different interaction patterns. Infant cr ying is a typical area where the
Entrainment, culture and becoming one of us

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biological and social are inextricably linked. Cr ying is an inbuilt signal, but one
that is only effective with a sensitive listener. Babies might not know what they
are distressed about, and carers often need to work out whether a cr y is due
to teething, hunger, or an appeal to be picked up, for example. Parents tr y to
learn about their particular baby and babies also learn to adjust to their particu-
lar parents. While securely attached infants cr y when distressed and learn to
expect helpful responses, others realise that cr ying does not bring a comforting
response, and so learn not to cr y.
Cr ying might be a common primate signal, but it also can be unbearable for
some parents. In the West babies are often diagnosed with colic, although often
what counts is not the amount of cr ying as much as the impact of cr ying on a par-
ent and on their capacity to soothe a baby (Barr et al., 2014). Protective factors
against colic include having a supportive partner, less stress during pregnancy,
and less social isolation. Increasing the amount of time mothers hold their infants
after feeding reduces cr ying considerably, compared with control group babies
who cr y the same amount. Colic is rarer in non- Western societies (Lee, 2000),
and cross- cultural research suggests that babies begin to cr y in similar propor-
tions, whether Dutch, American or !Kung San, but what differs is how long they
cr y for and how quickly they are responded to. Culture of course interacts with
biology. American carers are more likely to ignore about 46 per cent of infant
cr ying episodes in the first three months of life, while mothers in some cultures
put babies to the breast within 15 seconds of starting to cr y (Ainsworth and Bell,
1977). Nonetheless we should not underestimate the terrible distress that can be
caused by infant cr ying, often leading to child maltreatment (Barr, 2014).
Cr ying evolved for infants to communicate distress and is mostly biologi-
cally adaptive, but not when it drives a parent away. Temperament plays a role,
and some babies are born fussier and harder to sooth. Cr ying evokes different
responses depending on cultural expectations and parental states of mind. Many
adults prefer ‘good’ calm babies, but not all. In a bad drought in the 1970s some
Maasai babies were labelled either ‘difficult’ or ‘easy’, based on how adaptable,
calm, or manageable they were (Wermke and Friederici, 2005). A  researcher
identified the ten easiest and most difficult babies, but when he returned three
months later the drought had worsened. He re- found thirteen infants and of
these seven already malnourished ones died in the coming months, but interest-
ingly only one of the seven was in the ‘difficult’ group. The fretful cr ying babies
maybe demanded more attention, or more milk, and showed more fight, and this
possibly saved their lives. In the study by Scheper- Hughes (1992) of Brazilian
Shanty towns with high infant mortality rates, it was the babies labelled as ‘fight-
ers’ who received the attention and sur vived. Hrdy (1999) similarly narrates an
anthropological account from the Eipo people in New Guinea, a culture that has
used infanticide as one means to keep the population down. One mother had
stated that she would not accept another girl, and prepared herself to abandon
her new- born. She wrapped her in fern leaves laced with a rope, while the infant
screamed. The mother left, but did not throw the bundle into the bush as would
be usual. Two hours later she returned, cut the umbilical cord and took the baby

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with her, apparently explaining that her daughter was ‘too strong’. Sometimes it
makes sense to cr y and such signalling is typical of how infants are active, com-
municative and social beings from birth onwards.
• Infants are wired to relate, and to recognise and actively respond to their
mother’s smells, voice and gestures from birth onwards.
• They actively adapt to their social environment, learning both what to
expect from it and how to actively influence it.
• Bonding is gradual and not guaranteed, and rejection of infants is not uncom-
mon. Some infants receive attuned attention and contingent responses, but
by no means all, depending on levels of parental support and a parent’s own
histor y.
• New- borns maximise their attractiveness to sur vive. Many features of
‘babyness’, such as large heads, big eyes, round faces, prominent fore-
heads, induce positive and protective feelings and deter aggression.
• Babies are able to recognise faces, smells and sounds and become accul-
turated, whether to the rhythms of an African hunter- gatherer tribe or a
Western European middle- class family.
• A baby can be like a sponge for emotional, psychological, or cultural atmos-
pheres, picking up and adapting to moods and emotional expectations.
• Infants ‘entrain’ to the rhythms of their environment, and in microsecond
encounters are learning expectable behaviour patterns, whether a highly
interactive or a more socially withdrawn one
• All infants are learning to sur vive and thrive in the particular world in
which they find themselves, using the hugely varied stock of responses
with which evolution has endowed them.
Key points

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Infant coping
mechanisms, mismatches
and repairs in relating
It takes two to tango: blind babies, premature babies and
sensitive babies 37
Early emotional defences 39
Mismatches and dodges 40
The effect of maternal depression and other mental
health problems 43
Key points 46
C h a p t e r   4
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Infants are ver y sensitive to the moods and intentions of their interactive
partners. Beebe and Lachmann’s research (2002) has shown that a mother
can respond to an infant’s gesture just a sixth of a second after the infant
has begun to make the gesture, and an infant nearly as quickly, indeed
faster than one can even see in real time, requiring slowing down video
footage to fractions of a second. Tronick (2007) described such interac-
tive ‘dances’ in terms of a mutual regulation model in which both parties
actively regulate each other. I now discuss research that demonstrates the
fine- grained manoeuvres an infant resorts to in order to maintain equilib-
rium in the face of stressors.
Infants have limited capacity for self- regulation and resort to clear coping mecha-
nisms when distressed. One well- known method for obser ving this is the ‘still-
face’ procedure, developed by Tronick (2007) and replicated all over the world.
In this a mother is asked to interact ordinarily with her infant, who is normally
between three and six months old. Then the mother is signalled to hold a still
and expressionless face for up to two minutes. Infants generally are surprised
and perplexed by this, with a sense that ‘this is not what is meant to happen’.
Some infants work hard to tr y to re- initiate the interaction, others display more
negative expressions, such as grimacing, and still others use both kinds together.
Many babies manage by looking away, cutting off or self- soothing.
In such circumstances infants generally tr y to regulate themselves by
getting the other person to interact with them. Ordinarily if a parent suddenly
becomes preoccupied an infant might frown to communicate dissatisfaction
or smile broadly to regain the attention. If such interactive ploys fail then they
often focus inwards, turning away from relationships temporarily, and ‘holding
themselves together’ (Bick, 1968). Some will avert their gaze or focus on objects
around them, and distressed infants often self- soothe, maybe stroking them-
selves or clasping their hands together. These are all attempts to self- regulate in
response to a stressful situation and can become standard responses that they
use when similar situations arise.
The first examples, such as smiling beseechingly or cr ying out, are signal-
ling manoeuvres, attempts to remain in communication with the other in order
to feel regulated, whereas the self- soothing strategies are more a ‘giving up on
the other’, at least for now, tr ying to self- regulate instead. The ‘still- face’ places
infants in situations that they have to cope with anyway in ordinar y life. Tronick
(2007) has shown that even the best mother– infant dyads are matched only about
30 per cent of the time, and in ever y relationship there is mismatching and mis-
cueing. More sensitive mothers have babies with higher expectations of being
responded to, and these babies are more likely to actively signal rather than turn
away when their mother puts on a still- face. If a baby’s signals are habitually
not responded to, then what starts as a momentar y coping mechanism, some-
thing seen in all infants, can turn into an ongoing defensive strategy. Such infants
might automatically turn away from even friendly and empathic adults. Infants

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are aiming to avoid negative and uncomfortable experiences and optimise their
chances of experiencing regulation of their affects and emotions (Music, 2001).
Interactive mismatches and awkward relationships are by no means just due to
maternal insensitivity. Babies are not all born the same, and parents might not
always understand the baby they have in front of them. A classic example comes
from the work of Fraiberg (1974) who in the 1970s worked with blind babies and
their sighted mothers. She found that many blind babies became emotionally cut-
off. When these mothers used their natural ways of communicating, such as smil-
ing, they did not receive the feedback they expected or yearned for. The babies’
eyes did not light up in response to their mothers’ faces, and some mothers felt
rejected or inadequate. Fraiberg noticed how many then detached from their
babies and the babies then coped by turning in on themselves. This could become
a vicious circle, whereby the mothers felt even more helpless, interacted even less,
and the babies had no choice but to withdraw further. Fraiberg sensitively showed
the mothers that sometimes infants responded to their vocalisations by wiggling
their toes or hands in an expressive way, as if in a rhythmic retort. On realising
this, mothers gained confidence that their babies were responding to them, and
suddenly they felt that they were valuable as mothers. They responded with more
energy and life, and interactive dialogues and affective matching could begin.
These mother– infant pairs were hauled back from unrewarding relationships that
other wise could have led to a serious stymieing of their babies’ development.
This work with blind babies provides an important lesson. Parents must
adjust to the baby they actually have and vice versa, and there are all kinds of
babies and mothers, with all kinds of predispositions and temperaments. Another
example comes from studies of postnatal depression. Murray (Murray and
Cooper, 1999) recruited a large cohort of mothers who were at risk of becom-
ing depressed. Babies at birth were assessed using the Brazelton Neonatal
Behavioral Assessment Scale (Brazelton and Nugent, 1995) to work out how sen-
sitive, irritable or hard to soothe the new- borns were. The results were startling
as, despite the sample being only of healthy babies with no neurological prob-
lems, mothers whose babies were more irritable were over three times more
likely to become depressed than other mothers in the study. Having a hard to
soothe baby can be the ‘final straw’ that pushes a mother into a depression she
might other wise avoid. This effect was found irrespective of whether the babies
were ‘perceived’ as difficult by their mothers, and was a result of the interac-
tion between objectively measurable factors (infant temperament) and maternal
mood. Luckily if help was offered early then a recover y was likely, but other wise
a downward spiral could ensue. Other studies have shown similar results (Sutter-
Dallay et al., 2003). A difficult to engage baby makes its mother more vulnerable.
It takes two to tango: blind babies,
premature babies and sensitive babies

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These are clear examples of the two- way nature of interactions and how the kind
of baby one has makes a big difference to a parent’s ability to cope, while a moth-
er’s poor sense of self- efficacy can also lead them to see a baby as more difficult
(Verhage et al., 2013).
Premature babies are another group who often find themselves in uneasy
interactions. Partly because of improvements in medical care, many sur vive after
little more than 20 weeks gestation. Prematurity often gives rise to difficulties,
the more so the more premature the infant. By school age premature babies
are likely to show more behavioural problems, and have a greater likelihood of
mental health, emotional, attentional and peer problems (Gardner et  al., 2004;
Potharst et al., 2015), issues that persist into adolescence and beyond (Burnett
et al., 2014). Premature babies tend to be more demanding and distractible and
harder to soothe. Ordinarily competent parents struggle more with a premature
infant than a full- term baby, often showing less confidence and more anxiety,
possibly compounded by being separated from their infants at birth. Mothers
find premature infants’ cries harder to understand or bear (Frodi et  al., 1978)
and are more likely to withdraw from their cries than those of full- term new-
borns (Stallings et al., 2001), even more so if less emotionally secure themselves
(Schoenmaker, Huffmeijer, et  al., 2015). The human infant is not biologically
primed to communicate via cr ying before birth. Preterm babies are also less able
to recognise and so be soothed by their mothers’ voices after birth (Key et al.,
2012; Therien et al., 2004), potentially increasing communication difficulties.
Despite this, the quality of the parent– child relationship and of family func-
tioning counts for a lot, and for example predicts the likelihood of later behavioural
problems (Minde, 2000). Interestingly Field (2007, p.51) showed that preterm
infants rated by nurses as more attractive were more likely to thrive, gaining
more weight and leaving hospital earlier, again demonstrating the dynamic inter-
action between infant and carer characteristics. Children born with a disability
can be even more at risk, as parents can, despite themselves, struggle to engage
lovingly with a baby they had not expected (Reichman et al., 2008), and in addi-
tion, children with disabilities require considerably more emotional, social and
financial resources, and indeed the more parents have those resources the more
resiliently they respond (McConnell et al., 2014).
As with other relationships, the more time a mother spends with their pre-
mature infant the better the relationship. Skin- to- skin contact between mothers
and their premature babies has positive effects on physiological and cognitive
development ten years later (Feldman et  al., 2014). The level of engagement
with premature babies in hospital predicts how frequently mothers interact with
their babies on returning home. Parents of premature babies also have less con-
trol, often having to defer to medical specialists, which might lower confidence.
Premature babies in units with excellent medical care often suffer conditions
inimical to social and emotional development, such as constant bright lighting,
intrusively painful medical inter ventions, and constant changes of nursing staff
(Cohen, 2003). Organising environments to minimise discomfort helps, such as
by providing soothing sounds and softer lighting.

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Meta- analyses show that inter ventions to suppor t mothers can really
help (Benzies et  al., 2013). Well- researched inter ventions such as ‘kangaroo
care’ help reduce mor tality and morbidity (Green and Phipps, 2015), as can
using music therapeutically (Ettenberger et al., 2014). In kangaroo care, pre-
mature infants are carried upright under their mothers’ clothes. This stabilises
hear t rate, temperature and breathing, increases weight gain, decreases cr y-
ing, improves sleep, and its ef fects on emotional regulation and cognitive skills
can be seen ten years on (Feldman et  al., 2014). Hear t rate improves even
more when mothers sing to their babies (Arnon et  al., 2014). Mother– infant
interactions are more positive after such care, with better adaptation to infant
cues, more touch and better mutual attunement. Premature infants can seem
less responsive but in fact are ver y sensitive, so it is easy for mothers to mis-
read cues and excessively stimulate infants who then withdraw or become dys-
regulated (Forcada- Guex et al., 2006). Ver y premature infants are more likely
to be withdrawn and have autistic traits as they grow up (Er yigit- Madzwamuse
et al., 2015).
Such matters are always overdetermined (Rahkonen et  al., 2014).
Prematurity is linked with high stress levels in pregnancy, and mothers who are
highly stressed during pregnancy might also be stressed after the birth and less
able to interact easily with their babies. Other factors also have an effect. Minde
(2000) reports that mothers’ fantasies about their new- born tend to become
ver y rich from roughly four months and then become vaguer after about seven
months, allowing a child to be born into an atmosphere where there are less
predetermined expectations, a shift that premature babies do not benefit from.
I have focused on premature babies and blind ones, but other issues and
disabilities can also have a profound effect. For example mothers whose babies
have congenital heart problems are more likely to suffer depression and anxi-
ety (Dale et al., 2013). It always takes two to tango and some dance partners are
harder to attune to, whether due to disability or temperament (Mer win et  al.,
2015). Good relationships breed good relationships. For example the quality of
interaction between mothers and premature infants is better when family rela-
tionships are good, and also when parents of premature babies are well sup-
ported (Browne, 2003). Yet even taking this into account, the more ill the infant,
the less attuned and positive interactions between mothers and babies tend to
be, irrespective of these other factors. While good relationships might generally
breed good relationships, it is not so easy to have a good relationship with a baby
we do not understand, or did not quite expect, such as a blind or ver y physically
disabled one, a ver y sensitive one, or one that arrives before it’s time.
Fraiberg (1982), whose work with blind babies I  described above, was one of
the first to take really seriously infants’ responses to painful or unmanageable
situations. Her work showed that under stressful situations infants develop
Early emotional defences

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exaggerated coping mechanisms that can become entrenched behaviour pat-
terns, used even when situations seem not to require them. Fraiberg’s sample
was of children aged about 18 months who were referred after ongoing neglect
or abuse. These babies rarely sought eye contact or exchanged gazes with their
mothers, rarely smiled in response to their mother’s voice or face or crawled in
her direction.
Their most obvious strategy was active avoidance, mainly of their moth-
ers, such as by turning their bodies away. This was an extreme group, suffering
particularly bad experiences. Of course avoidance is something all infants resort
to at times. If a parent comes too close, or shouts too loudly, then infants will turn
their heads or bodies away. This becomes a pattern if it happens repeatedly.
Another common response to fear is freezing. Like all mammals, humans
resort to primitive fight, flight and freeze mechanisms to aid sur vival. Fraiberg
(1982, p.622) described ‘complete immobilization, a freezing of posture, of motil-
ity, of articulation’ in babies as young as five months old. Many infants who wit-
ness violence adopt this evolutionarily inherited freeze response.
The children in Fraiberg’s sample suffered an unusual degree of depriva-
tion and poor early care. By the end of their second year the ‘fight’ response
had been added to their range of responses, and they were often described as
‘stubborn’ or ‘monsters’. Research shows how such externalising behaviour in
children is exacerbated by harsh, non- attuned parenting (Lorber and Egeland,
2011). These children were not simply ‘naughty’ or lacking discipline, but resort-
ing to desperate measures to manage fear, upset and high anxiety. They had no-
one reliable or capable of helping them to self- regulate. Over time such children’s
aggression might be focused outwards towards others, or re- directed inwards in
self- harming behaviours.
Other defences that Fraiberg discussed included how infants manage pain-
ful affects by turning them into something positive. One baby was hungr y but its
mother excruciatingly ‘teased’ him by putting a bottle into his mouth and then
removing it, and allowing drops of the milk that he craved to fall into her own
mouth. This baby looked perplexed and upset initially, but then seemed to change
his response into pleasure, by starting to kick and laugh, in effect indulging in
almost sadomasochistic actions. This at least allowed the baby to remain in con-
tact with the mother who was so needed. Fraiberg’s obser vational work allowed
people to see how early such defensive patterns develop, and also allowed impor-
tant therapeutic inter ventions to take place. Fraiberg’s clinical accounts suggest
that she had great success in helping such worr ying mother– infant pairs find a
way of becoming more healthily ‘on- track’ together.
Even when things are going ver y well, mutual synchrony and attunement is by
no means ever perfect. Beebe and Lachmann (2002) found that mothers and
babies rarely matched each other’s moods exactly, and when things were going
Mismatches and dodges

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well both parties were moving ‘in the same affective direction’; when excitement
is rising in one, the other will respond but not exactly in sync. Both match each
other’s bodily rhythms and affects, but not perfectly. Adult strangers who match
each other’s rhythms tend to like each other more (Siegman and Feldstein, 2014).
Feeling attuned with others and having similar rhythms is a ‘feel- good’ factor. As
Tronick found, the best functioning mother– infant pairs were in an attuned state
less than one might expect, from 28 per cent of the time at three months to 34 per
cent of the time at nine months. This might reassure parents who worr y that they
should be ‘perfect’ rather than ‘good enough’.
There is a lesson here. Mismatches induce stress in infants who respond
by resor ting to a variety of coping mechanisms. In much ever yday mother–
infant interaction the infant is attempting to get an interaction back ‘on- track’,
or in other words to repair a mismatch. Typical is the infant in the still- face
experiment who musters all its charm to regain its mother’s attention. An
infant thus learns that a bit of mis- cueing between people can be repaired and
is not disastrous. In Tronick’s samples 34 per cent of initial mismatches were
repaired to a matched state by the next phase of the interaction, and 36 per
cent of the remaining mismatches were then repaired by a second step. For
example, a baby who wants to be picked up might sigh, but its mother might
be momentarily preoccupied and this might lead the baby to feel dishear tened
and look away, this being a first mismatch. A mother then might tr y to regain
the baby’s attention but come too close too quickly, and the baby might look
aside and place its thumb in its mouth, this being a second mismatch. The
mother, realising what has occurred might talk soothingly while stepping
back to a manageable distance, and the baby might then look into its mother’s
face and smile. This would be a mismatch repaired on the third attempt. Such
‘dances’ are subtle and leave plenty of scope both for repair, and for things to
fur ther deteriorate. Through repairs of mismatches infants develop resilience,
a sense of agency, and confidence that they can actively change an interaction
for the better.
Daniel Stern, another early pioneer of infancy research, examined mother–
infant attunement using video analysis, in particular looking at mis- cues, mis-
timings, and what he evocatively termed ‘missteps in the dance’ (1977, p.133). He
found that mothers and infants are exquisitely sensitive to each other and, ironi-
cally, when mothers were most controlling and intrusive then, counter- intuitively,
both partners were even more aware of the other. Any baby will occasionally
find the intensity of an interaction too much, and need some respite, such as via
turning its head away to the side. Field (1981) found that an infant’s heart rate
increases about five seconds before it turns away, its body signalling a need to
take a break from contact. If a caregiver is sensitive enough to notice this, they
too take a step back from the interaction, allowing the infant its needed respite,
and the infant will in its own time return to the interaction, its heart rate return-
ing to normal. Stern (1977, p.136) described interactions he called ‘chase and
dodge’, effectively cases of ‘mother- chase and infant- dodge’, in which less sensi-
tive mothers seemed threatened or even rejected when their infants turned away.

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These mothers came up close to their babies, forcing a response, and the babies
learnt to ignore their own needs to placate their mothers.
When an infant’s mood shifts, from being relatively happy to suddenly
upset, this can be taken as a signal to ‘back- off’, but more intrusive parents tend
then to escalate the intensity and almost force the infant to attend to them. This
might regain the infant’s attention, but at a cost, as such infants often give up tr y-
ing to signal to their caregivers in order to get regulated. With such experiences
infants learn not to trust their own bodily signals of discomfort, such as their
increased heart rates, and begin to override them.
Paradoxically, to be intrusive and controlling you need enough sensitivity
to pick up signs of another’s wish to withdraw, which is when such parents can ‘up
the ante’. There is an increased likelihood of ‘chase and dodge’ with premature
babies, who are ver y sensitive and whose mothers often want to ‘haul’ them back
into interactions before the babies can cope. When parents are taught to imitate
and adjust to their baby’s rhythms the infants look longer at their mothers, and
with more positive affect (Cusson and Lee, 1994). In effect such parents learn
about the real- life baby they have in front of them, not the one in their minds.
There can be a misconception that perfect attunement is possible or even
necessar y. Researchers such as Beebe argue (Beebe et  al., 2012) that in good
mother– infant interactions there is a ‘mid- range’ mutual attunement. Here moth-
ers are aware of their infants but not ‘over- aware’, both parties giving each other
space. However, when there is a likelihood of danger, as seen in children who have
been traumatised or regularly intruded upon, then children can become hyper-
vigilantly attuned, needing to pay extreme attention to what might happen next.
Stern (1977) describes interactions between a mother and her twins that
illustrate this. The mother found things easier with one twin, Mark, who she
felt was more like herself, and she had less rapport with the other twin, Fred.
Through video analysis Stern discovered that, although things were not ver y
easy between mother and Fred, they still moved in synchrony with each other.
When mother approached Fred he then withdrew, and when Fred approached,
she withdrew. Ironically they were more sensitive to each other than the other
dyad of mother and Mark, who could move in and out of synchrony without wor-
r ying about the other, an easier thread joining them. Fred was always monitoring
his mother, even when he was seemingly not even looking at her. Mother was
more likely to allow Mark to avert gaze without reacting, but when Fred averted
his gaze, she would move closer to him, as if to force contact. Paradoxically Fred
and mother never really got together much, spending little time being close, yet
in another way they were indivisible, keeping a ver y close eye on each other.
Intrusive interactions are not based on reciprocity, and when one party con-
sistently violates the other’s wishes, then Tronick (2007) suggests that an infant
experiences a form of ‘learnt helplessness’ in which their physiological regula-
tor y systems become over whelmed. In many cases Tronick noted effects such
as infants who ‘turn away, had dull looking eyes, lost postural control, orally self-
comforted, rocked and self- clasped’ (p. 171). We see different forms of mismatch
with depressed withdrawn mothers, and less effective repair (Reck et al., 2011).

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An infant’s determination to regain its mother’s attention in still- face experi-
ments demonstrates just what strong expectations some three- month- old babies
have built up about how other people are likely to respond. It is the challenge
to their already formed expectations (‘my mother doesn’t normally do this!’),
not the silence that disconcerts them. Other forms of perturbation do not have
such a dramatic effect. A related experiment asks mothers to interact with their
infants, and then the interaction is disrupted by a stranger who comes and talks
to the mother (Murray, 1998). In these cases the infants’ positive affect lessens
and they become quiet, but they do not protest, as in the still- face, and they con-
tinue looking at her. Such interactions are disrupted but in an understandable
and expectable way.
In another kind of perturbation experiment designed by Murray (1998)
infants and mothers interacted via video link. Surprisingly this worked fairly
smoothly, with both able to engage fluently, albeit with the infant watching its
mother’s face carefully. This changed when a slight time- lag was artificially intro-
duced between the mother’s actions and what the infant saw on the screen, so
that the mother seemed out of sync with the infant’s communications. The infants
then became disconcerted, looking away and back at the screen anxiously frown-
ing, and self- soothing by touching their clothes and bodies. There was less pro-
test than in the still- face experiments, and Murray suggests that these infants
were more puzzled and confused than anything.
As one might expect, the kind of parenting an infant has had will alter how
they react to such experiments. Infants who have been responded to less sensi-
tively recover less quickly from such experiences, showing more negative affect
and turning away from their mothers more. When heart rates were monitored in
six- month- olds during the still- face experiment, infants of more responsive moth-
ers showed more ability to recover (Mesman et al., 2009), to regulate their heart
rates and manage negative affect (MacLean et al., 2014). Field (2002) used the
still- face procedure with infants of depressed mothers. Their infants reacted less
than other babies, seemingly accustomed to a flatter response, having less expec-
tation of being responded to contingently, already having an idea of what they can
and cannot expect from relationships.
The mental health of parents impacts on the psychological development of even
new- born babies. This is not to blame mothers or parents and caregivers, especially
those already beset by often crippling psychological worries, these in turn often
compounded by issues such as domestic violence or poverty (da Fonseca, 2014).
Indeed mothers are often diagnosed with mental health issues such as general-
ised anxiety disorder when poverty is the main issue (Baer et al., 2012). The risk of
blaming mothers is not helped by the fact that the research is nearly all about moth-
ers and babies, leaving out not only fathers, but also social and economic factors.
The effect of maternal depression and
other mental health problems

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Nonetheless this research remains relevant, not least in thinking about how to
target help. For example, the research by Murray (1992) on the effects of mater-
nal depression on infants showed that screening for this, and putting appropriate
therapeutic help in place, made a huge difference to mother– infant pairs, and to
how these infants developed later in childhood and adolescence. Lessons about
the importance of screening are being put into place in many countries, such as
China (Siu et al., 2012).
Researchers such as Murray ask about the impact on infants of being in the
company of a depressed adult for many hours a day. Even we adults know how
being with someone flat and cut- off is ver y different from being with someone
who is attuned and sensitive, and that again is different from spending days in the
presence of someone who is intrusive and unpredictable. Offspring of depressed
mothers, as one major meta- analysis found (Goodman et  al., 2011), have more
sleep problems, temper tantrums and separation issues, and worse peer relation-
ships. Perhaps most strikingly, they have a more passive sense of themselves,
and show less belief in being able to influence events. Boys particularly are more
likely to have behavioural problems. Some of Murray’s initial cohort of infants
are now past adolescence and there are disproportionate levels of depression
and anxiety disorders in the girls, and higher levels of stress reactivity (Barr y
et al., 2015).
Studies of mothers and babies can help to make sense of how such later pat-
terns take root. Mothers who are depressed or anxious, are less able to read their
baby’s signals. Depressed mothers tend to be unresponsive, showing less activity
in brain areas central for relationships (Laurent and Ablow, 2012). Their babies
can respond by cutting off, dulling themselves down and tr ying to self- regulate.
In most still- face experiments infants are tr ying to reinstate normal interactions,
but infants of depressed mothers expect less from interactions. This is mirrored
in the physiology, brains and bodies of mother– infant pairs, with both depressed
mothers and their neonates showing lower levels of dopamine and serotonin, an
indicator of less positive emotional states, and higher cortisol levels, a marker for
stress (Field et al., 2004).
Different kinds of depression have different effects. Field’s research (2006)
distinguished between mothers whose form of depression was more intrusive
(for example mothers who might insensitively loom too close to their babies),
as opposed to depressed mothers whose interactive patterns were more with-
drawn. Of the two groups, Field found that the infants of the withdrawn, less
interactive mothers did worse, having lower dopamine and serotonin levels and
by only one month old they had more activation in the prefrontal right sides of
their brains, an area dominant for negative feelings, and this remained in follow-
up three years later.
Infants of intrusive mothers spent 55 per cent of their time watching their
mothers, whereas those of withdrawn mothers watched their mothers less than
five per cent of the time, spending much time staring into space. This is possibly
because there is little point looking at someone who is not going to respond, but
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them. Such adaptations can quickly become character traits. By only one year,
infants of withdrawn depressed parents in Field’s sample were less explorator y
than their intruded upon counterparts, by three years old they were showing
little empathy, and were more passive and withdrawn, different to the aggres-
sive lack of empathy seen in children suffering intrusive parenting. The intruded
upon infants even did better cognitively. Inconsistent and intrusive stimulation is
at least stimulating.
Maternal depression is just one psychological condition that can impact
on infants, and others include anxiety disorders, high levels of stress (Sturge-
Apple et  al., 2011), borderline personality and eating disorders. A  common
feature in all of these is less attunement to an infant’s pace and wishes. Stein
(2006) researched mothers with eating disorders interacting with their infants
at mealtimes, in play and other settings. They were generally more controlling
of their infants at a year, and not surprisingly this was most evident at mealtimes
when there was more conflict. Interestingly there was also more marital conflict
in these families, suggesting again that mothers are not the ‘sole cause’ of these
matters.
Understanding these issues can help make a difference, and Stein has had
success helping mothers with eating disorders using video- feedback inter ven-
tions. When mothers in his sample realised the impact of their interactions on
their infants then the relationships improved, and the infants became more con-
fident and autonomous.
Hobson (2005) undertook similar research at the Tavistock Clinic with
mothers with borderline personality disorder. He videotaped interactions with
their infants and used the still- face experiment, and also the Adult Attachment
Inter view, which measured the mothers’ capacity to reflect on their own experi-
ences. These mothers were more intrusive and insensitive than control groups,
had more trauma in their backgrounds and were less aware of their infants’ men-
tal states. Not surprisingly, the infants showed signs of disturbance such as not
recovering well from stressful situations, being more cut- off in still- face experi-
ments, being less positive with strangers, and were far more likely than the con-
trol groups to be insecurely attached. This makes sense in terms of the themes of
this book. These mothers showed enmeshed/ preoccupied thinking about their
early relationships, their thought processes showed troubled features, they often
self- harmed and struggled generally with relationships. It is hard to imagine that
this would not impact on how they interacted moment- by- moment with their
infants. The impact of their unresolved and troubled early lives remained power-
fully alive in the way they approached relationships. Without understanding such
processes and inter vening, it is likely that such patterns would get passed on to
the next generation.
Such patterns can be handed down in subtle ways. Babies are like barom-
eters of emotional climates, and stress literally seems to be transmitted body- to-
body from mother to baby (Waters et al., 2014). Murray (2012, 2007) researched
mothers with social phobia and their infants. Interactions between them seemed
ordinar y enough when no one else was present. However, in a stranger’s presence

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the mothers became fearful and phobic, and this anxiety was transmitted to their
infants, who learnt that strangers are to be distrusted, a learning that they then
took into other situations. Infants born with more sensitive temperaments were
even less likely to interact positively with strangers, but learning from their moth-
ers had the biggest effect. Other studies of mothers with severe anxiety disorders
demonstrate ill- timed responses, intrusiveness, overprotection and insensitivity
(Kaitz and Maytal, 2005) as well as worse bonding (Tietz et al., 2014). Infants of
mothers with issues such as depression, eating disorders, social phobia, person-
ality disorders and other issues tend to feel less attuned to, recover less well from
disruptions, and develop less confidence that their emotions will be regulated by
others, or that it is safe to explore the world with openness and curiosity.
What all such examples have in common is the crucial impor tance of
emotional sensitivity and attunement and how infants develop understand-
able strategies for coping with dif ficult experiences that can become traits
over time.
• An infant is born emotionally immature and needs an adult carer to help
them feel emotionally regulated.
• They develop coping strategies when interactions are uncomfortable, such
as avoiding contact, self- soothing, fussing.
• Different infants, such as those born blind, premature or hard to sooth, can
elicit different parental responses.
• Perfect parental attunement is neither possible nor desirable, and in interac-
tions there is a constant sequence of matching, mismatching and repairing.
• When a parent is able to be sensitive to an infant’s states of mind then the
infant learns to be an active interactive partner.
• Infants who develop a belief that they can actively repair a mismatch
develop a stronger sense of agency and resilience.
• Even when infants need to develop complex defences to manage unbear-
ably painful situations, we need to take care not to blame parents.
• Issues such as postnatal depression or anxiety disorders are more common
if one lives in poverty, in deprived areas, has had bad early experiences, has
suffered a trauma, or has less social support.
• It is possible to inter vene to break potentially damaging intergenerational
cycles if we take seriously what happens in the fine grain of moment- by-
moment interactions between infants and their carers, however painful.
Key points

47
47
Empathy, self and
other minds
Early precursors of understanding other minds 48
Developmental leaps from nine months and onwards 50
Theory of mind 53
Mirror neurons and Rizzolatti’s monkeys 54
Exceptions: neglected, maltreated and autistic children 55
Key points 57
C h a p t e r   5
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This chapter examines empathy and the understanding of other minds, a
crucial developmental skill, centrally linked to secure attachment, emo-
tional regulation and a range of interpersonal skills. We have seen how
the human infant is born prepared for social interaction, with abilities like
imitating, recognising their mother’s voice, and preferring human faces.
I  explain how more sophisticated interpersonal skills develop from these
early experiences to enable children to become increasingly aware of their
own and other people’s minds. There has been a sea change in recent years
in developmental psychology with more emphasis on the role of emotion
rather than just cognition in understanding mental states. I describe how the
ability to empathise with and make sense of others’ feelings and thoughts
develop from the first months through to four or five years old, when the
capacities, often denoted by the term theor y of mind, are normally in place.
From birth children are learning about the intentions, feelings and expectations
of people around them. Interactive gestures such as imitating are not simply cop-
ying, but show a rudimentar y yet definite awareness of another person’s feeling
states and intentions. Infants resonate and respond to those around them, smil-
ing broadly to laughter, or looking sad when others are upset.
Infants are constantly appraising the social world and its subtle nuances.
If a parent responds to an infant’s gesture, such as a startled judder or a sad cr y,
by ‘marking’ (Gergely and Watson, 1996) the gesture, perhaps saying ‘oh what a
huge shock that was, that big door slamming’, then not only has the infant’s affect
been regulated, but he or she has been pulled into a world of meaning by another
person. This is what Meins (2003) has called mind- mindedness, describing a
parent’s acknowledgement of a child’s mental states. Children of mind- minded
parents develop empathy and understanding of minds sooner than others, as do
infants who are securely attached at a year. Having siblings also makes a differ-
ence, and singletons and oldest children on average develop such skills more
slowly than those with older siblings (McAlister and Peterson, 2006), presum-
ably because they have fewer minds to practise interacting with.
Mind- mindedness and ‘marking’ link with affect regulation, whereby a
child’s emotional and physiological states are regulated by an adult attuned to
them. Trevarthen and Aitken (2001) rightly caution that the concept of regula-
tion privileges difficult emotions and underestimates positive social interactions.
Parents not only regulate an infant’s affects, such as monitoring the amount of
excitement, but become what Trevarthen has called a ‘companion in meaning
making’. Attunement describes someone being in touch with both positive and
negative mental states, a form of biosocial feedback (Gergely and Watson, 1996)
that leads to trusting that one’s feelings and thoughts can be accepted and under-
stood. If a cr ying infant’s state of mind is understood, and he or she calms down
following soothing input, then its affect state has been regulated. Over and above
Early precursors of understanding other minds

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this the infant has gained an understanding through the eyes of the other of what
they were feeling, and their state of discomfort has thus been made meaning-
ful. This in turn leads to the development of an internal representation of one-
self as seen through another’s eyes, which also enhances the ability to regulate
one’s own emotional states and to develop capacities for executive functioning
(Carlson, 2009).
Some babies and children have an experience that is rather like looking
into a kind of fairground version of a distorted mirror, and what they see or hear
reflected back increases their difficult feelings and leaves them unable to pro-
cess them, often giving rise to distorted self- understandings. For example if a
child shows fear on hearing a loud noise and the father shouts ‘don’t be such a
wimp, pull yourself together’, then the child probably will struggle to make sense
of such scared feelings in themselves, or to be sympathetic to such feelings in
another.
Yet empathy is more than just having one’s feelings reflected back. If an
infant cries and an adult responds with a pretend cr y which is too much like the
baby’s cr y, that infant might remain upset, feeling that now there are just two
upset people present. Fonagy (2004) described mothers taking babies for their
first injections. The babies who recovered best were those whose mothers empa-
thised with them, but also knew when to distract them. The mothers who tried to
too cheerfully distract the babies too soon did not soothe their babies, but nor did
those who seemed too empathic, as the babies then just had their own emotions
of terror and upset reflected back at them rather graphically. This again is what
Bion (1977) describes as the containment of emotions, in which another person,
often the mother, takes in the emotional experience of the baby, modulates it
inside themselves, and conveys understanding of these emotions in a ‘digested’
form. Contained or marked emotions lose their dangerousness, as if ‘detoxified’,
making them less over whelming.
By two months one can see rhythmic proto- conversations between
infants and parents, both as active partners, each watching the other ‘thought-
fully’ and working out how to respond. These are sophisticated skills that help
infants negotiate with other infants by only six months. Positive mutual affect is
central here. Being with someone one loves and cares about us increases oxy-
tocin which in turn increases the ability to understand other minds (Domes et al.,
2007) and be empathic (Abu- Akel et  al., 2015). Indeed, artificially giving doses
of oxytocin leads to paying more attention to faces and eye regions (Guastella
et al., 2008).
In these early months babies can already understand that they are the
object of another’s attention (Reddy, 2008), and this soon transforms into more
sophisticated awareness of being attended to. Such awareness is ‘experienced’
and known emotionally rather than cognitively. The two- month- old can smile with
pleasure when they know an adult is looking at them, or be uncomfortable and
turn away; they know the difference between an attentive adult and an uninter-
ested one. By three months infants are able to ‘call’ an adult, not just when they
are in distress but also to share positive feelings. Infants both know that they are

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being attended to, and also what it is in them that is being attended to, such as a
deliberately funny face. Psychological and emotional understanding about one-
self in relation to others develops apace through such processes.
By three months many infants are becoming interested in objects not just
to look at but also to play with, touch and explore, and they can ‘lead’ their ‘com-
panion in meaning- making’ towards areas of interest. By six to eight months
many infants are capable of complex game playing, including what Reddy (1991)
has described as teasing and mucking about. An infant might offer something
and as its partner makes a grab for it, the infant might take it away and smile at
the fun of this game. This demonstrates sophisticated understanding of others’
wishes and intentions. By six months an infant can clown about and show off,
and to ‘clown’ a baby needs a sense of how they are perceived by others. They
can also by this age show self- consciousness or coyness when they know they
are the focus of attention, and indeed Reddy has detected this as early as two to
three months. They are starting to seek praise and beginning to know how to get
others to react as they wish, all requiring some understanding of another’s mind.
Such research challenges those who argue that there cannot be self-
consciousness in the early years, before people traditionally thought there was
something one could call a self. Rudimentar y self- awareness is possible much
earlier, and can be viewed as a socio- emotional not a cognitive skill, linked with
awareness of oneself as seen through another’s eyes. Infants generally love the
mutual understanding seen in musical play and ‘tricky’ games in which one needs
to predict timings and the gestures of others. This requires skills and capacities
that are precursors of later ‘fully- blown’ theor y of mind skills.
At around eight or nine months most infants develop exciting new abilities. They
move around, explore, become aware of danger, and want to get close to an
attachment figure if a stranger comes close. By now they have become sophisti-
cated enough to check out whether their caregiver thinks a situation is safe by
reading facial expressions. A famous test which demonstrated this is the ‘visual
cliff’ experiment (Sorce et al., 1985).
In this a sheet of clear plexiglass is placed over some fabric so that the
fabric appears to form a drop that an infant might fall into. In one version moth-
ers are on the other side of a ‘bridge’, and are trained to pull faces, such as sad-
ness, anger, joy, or interest. As the infant crawls along the plexiglass and reaches
what appears to be a drop, the mother is told which face to pull. The infants look
up at and ‘reference’ their mothers, and if the mother shows pleasure or inter-
est, then they tend to cross and if a mother shows fear or anger they generally
stay still. This shows how acutely aware infants are of the emotions and wishes
of others and how carefully these are interpreted as cues. One might say that
the world is being interpreted through the eyes of the mother, and an infant’s
world changes in response to their mother’s expressions. Infants are particularly
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responsive to negative emotions (such as anger), paying more heed to these in
moments of uncertainty. Such negative associations between a situation and the
accompanying emotion are quickly inscribed in brain pathways for future refer-
ence (Car ver and Vaccaro, 2007). For example mothers with severe social pho-
bia give signals that severely inhibit their baby’s desire to interact with others
(Murray et al., 2007).
To read such signals infants must already be adept at recognising states
of mind like happiness or worr y, and also understand what the state of mind is
about. For example, a fearful expression in the partner might refer to a snake
nearby or a hazardous drop. Infants are generally capable of this kind of shared
attention by about nine months. If a child points at a toy in the presence of an
adult who then fetches it, then the infant knows it can get the adult to pay atten-
tion to a third object. This is called proto- imperative pointing. There is also
a more sophisticated capacity developing at this time called proto- declarative
pointing. This requires what Trevarthen and Hubley (1978) called secondar y
intersubjectivity and describes how an infant might see something they find
interesting, such as a colourful flower, and point to this with an expectation that
the other person will also appreciate what they are seeing. In such joint atten-
tion both parties know that both of them have the same object in their minds.
Joint attention is more likely to be accompanied by mutual pleasure, unlike the
visual cliff and other social referencing experiments, which are more likely
to be triggered by fear or danger. Both require an understanding of what is in
Figure 5.1 visual cliff

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another’s mind. This is a central developmental milestone that most children
achieve in the latter part of their first year.
Toddlers who do not manage joint attention or pointing proto- declaratively
are likely to struggle with understanding others and empathising. Children on
the autistic spectrum are particularly likely to struggle with joint attention. The
leaps in understanding at this age are huge. At eight months an infant can work
out another’s emotion but it is normally only several months later when they
can infer a person’s next action on the basis of the direction of their gaze or
their emotional expression (Phillips et al., 2002). Developments henceforth con-
tinue apace. During the latter part of the second year most infants show increas-
ing awareness of mental states. Many show some empathy for another’s distress
by about ten months, and exhibit clear altruistic behaviour, such as approach-
ing others in distress and showing helping (Warneken and Tomasello, 2009).
Not all children will do this. Infants are more prosocial and kind after being
attuned with and mimicked (Carpenter et al., 2013), and of course children are
more likely to feel empathy if they have been empathised with (Music, 2014b).
Furthermore the capacity for empathy and emotional connection turns off in the
face of stress and anxiety (e.g. Martin et al., 2015).
Infants by only six months watch someone do an action and remember and
perform it several days later (Schneider and Ornstein, 2015). Indeed infants can
even infer someone’s intention by watching them failing at an action, later suc-
ceeding in the same task (Meltzoff, 1988), and it is the recognising of intentions
that is central here (Reddy, 2015). A classic example is that 18- month- olds were
asked to give an experimenter some food, and they worked out what the experi-
menter liked, this being inferred by clear signals such as lip smacking and other
gestures. More immature 14- month- olds just gave the experimenter foods that
they themselves liked, such as sweets (Repacholi and Gopnik, 1997)! Similarly
infants by 18 months will baulk at adult reactions which seem incongruent, such
as looking sad after getting a sought after object, whereas most 14- month- olds do
not (Chiarella and Poulin- Dubois, 2015).
Soon they can work out what another person intended to do, even if the inten-
tion is not carried out, showing by 13 months impressive capacities to understand
adult intentions (Choi and Luo, 2015). For example (Dunfield and Kuhlmeier, 2010)
21- month- old infants had seen an exciting new toy and were confronted by two
actresses, neither of whom gave this toy to them. One seemed at least to try, plac-
ing the toy on a sloping table and looking on in feigned surprise as it rolled out of
reach, while the second actress was blatantly unwilling to hand it over. Later another
toy was placed on a table in such a way that it fell off. Both actresses stretched
unsuccessfully for the toy and the infants were far more likely to give the toy to the
actress who had at least tried to pass the toy to them. It was the intention that was
understood and acted upon. Indeed by about this age infants can take pleasure in
another’s misfortune, schadenfreude, maybe not a positive trait but showing impres-
sive understanding of another’s states of mind (Shamay- Tsoory et al., 2014).
Such mind- and intention- reading skills depend on having had other minds
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attention struggle to make sense of another’s mental states or facial expressions
(Moulson, Westerlund, et  al., 2009). Cold as opposed to empathic parenting is
linked to what are called callous- unemotional traits in children who often end
up with severe behavioural disturbances (Waller et al., 2014). Children who expe-
rience frightening and abusive parenting can develop a skewed understanding
of others, needing to be hyper- aware of adult intentions for self- protection. Such
mental- state understanding is more superficial, watching for behavioural signs
and consequences, rather than feeling genuine empathy for the other.
A parent using language that includes words referring to mental states
increases a child’s theor y of mind and mentalizing capacity (Ensor et al., 2014).
Even deaf children develop theor y of mind better if the form of sign language
used has more mental state words (Pyers and Senghas, 2009).
By the latter part of the second year infant language is normally developing
fast. It is also when children start to properly recognise themselves in mirrors,
and by this age when they see rouge on their reflected nose they often remove
the mark (Kärtner et  al., 2012). This often marks the start of autobiographical
memor y, when children begin to develop a sense of themselves as existing over
time with specific characteristics and histories. Three- year- olds still struggle to
recognise themselves in video footage and when a sticker is placed on their head,
and they are shown a video of this minutes later, children say things like ‘it’s on
his head’ (Povinelli et al., 1996). Normally by around the age of four or five they
can hold multiple versions of themselves and others in their minds, and work out
that that sticker on the head of the person in the video might in fact be on their
own head now.
The ability to make sense of others’ emotions and mental states from the earliest
months are precursors of what is often called theor y of mind. The idea of chil-
dren having a ‘theor y’ about minds is a cumbersome description of knowledge
that intuitively develops from the emotional hurly- burly of day- to- day interactions
in the early years. Having this capacity means stepping outside ourselves, under-
standing the intentions, beliefs and feelings of others, and distinguishing these
from our own. This is an important ability, yet one that some develop more fully
than others. For example, mothers with borderline personality disorder tend
to be less in tune with their infant’s emotional states, often wrongly ascribing
thoughts and feelings to their children who in turn develop less theor y of mind
or mentalizing skills (Schacht et al., 2013). Piaget (1976) had argued that young
children are ‘egocentric’ and assume that ever yone sees the world as they do.
If I watch a child who is about to grab what he thinks is a full packet of sweets
but I know that the packet is really empty, I assume that the child has a differ-
ent belief and sense of anticipation from mine, and that when he finds the box
he might be disappointed. Such thoughts require what is called theor y of mind.
There is a classic experiment which tests whether children have developed these
Theory of mind

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abilities, generally called the False Belief Test, and the best known of these, the
Sally– Anne Test, has the following stages.
• A child is told that Sally puts a marble in a basket and then goes out to play.
• While Sally is playing Anne gets the marble from the basket and hides it
in a box.
• The child is asked ‘When Sally comes back, where will she look for the
marble?’
Up until the age of four or five most children tend not to get the right answer.
(Astington and Gopnik, 1991). However recent research shows that even prever-
bal 10- month- olds have some capacities to detect false beliefs (Luo, 2011), even if
they cannot answer the questions verbally.
Some assume that theor y of mind just automatically comes ‘online’ at a
certain age, and that those who do not achieve this must have some kind of neu-
rological deficit. Yet in fact parenting, especially mind- mindedness (Meins et al.,
2013) and attunement (Lundy, 2013), are ver y important for achieving these
skills. Having siblings close in age also helps, the more the better (McAlister and
Peterson, 2013). It is possible to give children training that improves such skills,
so children on the cusp of this capacity, or who have not been given the right
input but have the potential, can be helped to achieve it (Lecce et al., 2014). Good
experiences are needed to bring such abilities online.
There are also differences between understanding another’s thoughts and
understanding their emotions. For example, using the Little Red Riding Hood
stor y children work out what the other feels (‘when she goes into grandma’s
house, she is not scared’), rather than what she thinks (‘that it is a wolf in the
bed’) (Bradmetz and Schneider, 1999). Such tests have shown that children
come to understand emotional aspects of theor y of mind (‘was she afraid?’) ear-
lier than the cognitive ones. Much current research focuses on deficits in such
mentalizing capacities, which is linked with a range of mental health issues, from
personality disorders to conduct problems (Bateman and Fonagy, 2013). Good
mentalizing is linked with better outcomes in children (Midgley and Vrouva,
2012), including better peer relations later in childhood (Caputi et al., 2012). This
capacity to use words and concepts to process mental and emotional experience
develops with self- regulation skills (Devine and Hughes, 2014) and executive
functioning (Barkley, 2012). The research on attachment, mentalization and
mind- mindedness suggests that being able to reflect on mental states is a crucial
capacity, the lack of which links with poor psychological health, even if it is differ-
ently valued and develops at different ages in different cultures.
The discover y of mirror neurons created a lot of hope for explaining the neu-
rological underpinnings of empathy. The neuroscientist Ramachandran wrote ‘I
Mirror neurons and Rizzolatti’s monkeys

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predict that mirror neurons will do for psychology what DNA did for biology’
(2000, p.1). The discover y was made by Italian neuroscientists (Rizzolatti and
Sinigaglia, 2007) who were looking at single cells in the brains of macaque mon-
keys that fire in grasping. The monkeys were wired so that when they grasped
something, a neuron in their wired- up brain fired. Scientists chanced upon an
astonishing eureka moment when one of the researchers grasped his lunchtime
snack and as he did so the monkey’s neuron for grasping fired up in response.
Researchers soon discovered a complex mirror neuron system in humans too. If
I see you inadvertently about to walk into a glass door, I might wince sympatheti-
cally, and here the corresponding neurons are firing in my brain too. The circuits
in the brain for imitation, language and empathy in humans are closely linked
(Rizzolatti et al., 2006). Mirror neurons fire when seeing someone actively grasp
an object, but neither at the sight of the object, nor at a pretend grasp. These neu-
rons respond to an intention, which is how many skills are learnt, by watching
and later replicating actions. This is also partly how we learn about emotions, and
similar areas of the limbic system, circuitr y central to emotional functioning,
are activated in both the imitation and the obser vation of emotions. Mirror neu-
rons suggest a human capacity to form powerful connections between people by
understanding from the inside what another is experiencing, possibly explaining
how mutual understandings develop.
Research has suggested that autistic people have a deficit in their mirror-
neuron functioning (Gallese et al., 2013). This does not explain autism, but sug-
gests that much of what mirror neurons facilitate is lacking in such individuals.
One might also speculate about the impact of severe institutional neglect and
lack of social contact on a developing mirror- neuron system, given that so many
children adopted from emotionally depriving situations lack a capacity to be in
touch with their own and other people’s minds and emotions. However caution
is also needed with respect to mirror- neurons, with some arguing that the claims
for them are over- blown (Hickok, 2014). Mirror- neurons are certainly part of the
picture, and they are an exciting and important discover y, but the explanation of
the brain mechanisms for empathy and understanding other minds are certainly
more complex than just this (Decety et al., 2012). Only some forms of empathy
utilise the mirror- system, while more sophisticated forms of mentalizing use dif-
ferent brain regions (Morelli et al., 2014) such as the anterior cingulate cortex
(Kawamichi et al., 2015).
Some people, such as highly neglected children and many on the autistic spectrum,
do not develop many of the capacities that I have been outlining in this chapter.
I mention autism not to give a description of a condition, as that is not this book’s
remit, but rather to use it as a counterpoint to the more typical development of empa-
thy and understanding of minds. Another example is seen in callous- unemotional
children who I  describe in Chapter  20. Many children and adults with autistic
Exceptions: neglected, maltreated and autistic children

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spectrum conditions struggle to understand the world from another’s perspec-
tive, and often also fail False Belief tests like the Sally– Anne experiment. They
are far less likely to manage the joint- attention and social- referencing that most
neurotypical children can at around a year, and often do not understand the
minds and emotions of others. For most of us, when listening to stories about
another person’s feelings, brain regions central to empathy and the mentalizing
system are activated, but this is not the case with many autistic children who use
different brain areas (Castelli et al., 2002; White et al., 2014).
Examining such exceptions to more usual development can help us under-
stand more typical development. Joint attention in one- year- olds is generally
accompanied by positive affect and enjoyment of the interaction, and such pleas-
ure in the mutuality of joint activity is often lacking in autistic children (Kasari
et  al., 1990), as it is in maltreated or neglected ones. The 12- month- old who
engages in joint attention already recognises another as having their own atti-
tudes and feeling states, and is able to somehow identify with their attitudes. The
autistic child struggles with this. Maybe this is not surprising given that, unlike
most people, many children with autism spectrum conditions use the same brain
regions for processing faces as they do for processing objects (Schultz, 2005).
This lesser capacity to process human faces and expressions is linked to differ-
ent functioning in cortical and a range of other brain areas (Corradi- Dell’Acqua
et al., 2014).
Some interesting experiments by Hobson (2002) illustrated such issues.
Children with autism were compared with a control group to see how well they
could make a match between pictures and accompanying sounds. The pictures
included neutral subjects, such as garden tools, types of birds, and vehicles,
but also emotionally expressive faces showing fear, sadness, or puzzlement.
As one might expect, the autistic children did just as well as the control group
in matching pictures and sounds referring to non- emotional subjects, but
they struggled to recognise or name the emotions on faces. Autistic children
also  struggle to imitate or ‘feel with’ another person, or put themselves in
another’s shoes. Life is ver y dif ferent if one cannot understand other people’s
minds or emotions.
The days when parents of autistic children were blamed for being emotion-
ally cold ‘refrigerator mothers’ are long gone. The condition is now generally
acknowledged to be a neurobiological disorder but one in which environmen-
tal influences can give rise to epigenetic changes leading to more likelihood of
autism (Wong et al., 2014). There are other children with symptoms which are
ver y similar to autism, but their symptoms arise for other reasons, such as pro-
found neglect. For example a large proportion of children adopted from depriv-
ing Eastern European orphanages showed symptoms that were strikingly like
autism (Rutter et  al., 2007), including self- stimulating behaviours, rocking, and
an inability to manage change, as well as having limited verbal ability, little desire
to be close to others, to seek comfort, or to understand their own and others’
emotions. However unlike in autism proper, these ‘quasi’- autistic symptoms often

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improved when children were adopted into caring families, particularly when this
happened when they were two years old or less.
The research on profound early neglect, albeit of a ver y tragic sample,
provided clear evidence of the effect of a lack of mind- minded attention early
in life. I  have emphasised how the ability to understand other minds occurs
through interaction with sensitive and attuned others. Unless there is an organic
predisposition, the capacity for empathy seems to be dependent on being empa-
thised with. Some people are more empathic than others, and those who are less
empathic also show less activity in the appropriate brain circuits. Indeed when
empathy is enhanced via empathy training programs then brain regions also
change (Klimecki et al., 2014). For most children, and indeed adults, capacities
for empathy are not set in stone and can increase or decrease. Empathy can be
enhanced through training (e.g. Schonert- Reichl et al., 2012) and psychotherapy,
and indeed capacities for understanding others’ emotions and expressions can
also be increased in people on the autistic spectrum. Thoughtful, empathic atten-
tion from an adult, particularly a parent, generally helps most children grow emo-
tionally resonant and affect regulating circuits in the brain.
• Ver y young infants are capable of complex social understandings.
• These are built upon until more sophisticated skills for mentalization,
empathy and theor y of mind develop.
• A child’s mind literally grows and develops through being thought about
and being attuned with.
• Some children expect to be understood emotionally, can recognise their
own emotions, and also are more able to recognise the emotions of others.
• Other children have had less attuned experiences and are less able to be in
touch with their own and others’ mental states.
• Some cultures and families value this capacity more than others. In some
children these skills barely develop, whether for neurobiological reasons,
as in the case of autism, or due to severe neglect.
• Receiving experiences of mentalization, mind- mindedness or attunement
from caregivers helps develop empathy, the understanding of both one’s
own and other people’s experiences, and the ability to regulate one’s
emotions.
• Not all children are given the seedbeds from which this grows, particularly
if their emotions are not regulated.
Key points

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59
P a r t   I I
OVERARCHING BODIES
OF IDEAS

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61
61
C h a p t e r   6
Attachment
Attachment theory’s second phase: Ainsworth’s Strange
Situation Test and Crittenden’s Dynamic
Maturational Model 63
Attachment inside us 66
Transmission of attachment 68
Attachment theory and culture 70
Attachment and disorders 72
Key points 73

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Attachment is a term with lots of colloquial uses, such as describing people
as strongly or weakly attached. ‘Attachment theor y’, though, describes a
field of scientific research originated by Bowlby (1969) and developed by
his successors into a hugely influential body of thought about child devel-
opment. In this chapter I  focus on this body of research, giving an initial
over view that will be expanded in later chapters.
Bowlby, a psychoanalyst and psychiatrist at the Tavistock Clinic in London, real-
ised there was a need for a new paradigm to both bring psychoanalytic theor y
in line with contemporar y researchable scientific thinking, as well as make
sense of the most complex children he came across. The main influences on
attachment theor y, apart from psychoanalysis and psychiatr y, were evolution-
ar y theor y and also ethology, the study of how animals behave in their natural
contexts. Bowlby learnt that infants of many species raised without maternal care
were badly scarred. He was influenced by Harlow (1965) who had found that
monkeys reared in isolation displayed shocking symptoms, such as fearfulness,
acting bizarrely, and an inability to interact or play. Harlow famously found that
such monkeys, when given a choice between two ‘wire’ monkeys, clung to one
covered in a soft terr y- cloth, and ignored the hard metal ‘monkey’ holding a bot-
tle of milk, only going to the bottle when hungr y. Comfort was more important
than food. Another researcher, Hinde (1970) showed that primates removed
from their mothers at first protested, then later showed despair, and eventually
became emotionally cut- off. These findings echoed Bowlby’s views, who argued
that human infants too have a biological need for a protective attachment figure,
the absence of which causes serious psychological difficulties.
Bowlby also studied young criminals and found that most had suffered
separations from parents, as well as inconsistent parenting, violence and neglect
(Slade and Holmes, 2014). Bowlby’s view that mothers or permanent mother sub-
stitutes were vitally important for children was unpopular with many who saw
this as an anti- feminist stance encouraging women to stay in the home rather
than take their place in the workplace. Despite this most of his ideas have stood
the test of time.
He was one of the first psychologists to highlight the importance of evolu-
tion, realising that the felt need to be close to mothers had changed little over
an evolutionar y past shared with other primates. Bowlby was struck by findings
showing how separated monkeys clung to their mothers when reunited, and even
a year later were more clingy and fearful than other monkeys, and less explora-
tor y (Young et  al., 1973). Bowlby and his colleagues found similar patterns in
humans. In the 1960s James and Joyce Robertson (1971), who worked at the
Anna Freud Centre in London, filmed young children being separated from their
parents, such as when admitted to hospital for routine operations such as tonsil-
lectomy with almost no visiting allowed. These films shocked audiences, and
continue to do so today, graphically revealing the extraordinar y stress a young
child experiences when separated from its attachment figures. Indeed, hospital
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were encouraged to visit daily, and in time allowed to stay overnight with their
hospitalised children. The children studied showed similar patterns to primates.
They started off relatively composed, expecting to have their attachment needs
met, but soon protested, cr ying and screaming, and later slowly sunk into a
despairing state, and eventually became ver y cut- off.
Attachment theor y at this stage was a kind of ‘spatial’ theor y in which the
closer the attachment figure, then the more happy and at ease the infant. An
attachment figure was a secure base to return to when anxious, and the presence
of this secure base gave confidence to explore and be more outgoing. Such early
research stressed the importance of physical closeness and the impact of separa-
tions from attachment figures, as well as the infant’s vulnerability after birth, and
the crucial nature of early experiences. Bowlby described the ties that develop
between parents and children as affectional bonds, social links accompanied
by powerful emotional involvement, building over time and long lasting. Such
ideas were radical at the time, and did not fit with many prevailing views about
babies’ needs. It is likely however that Bowlby overestimated the importance
of one- to- one infant– mother relationships and underestimated the importance of
other attachment figures (Hrdy, 2009). Contemporar y versions of the family  –
especially the nuclear family with a stay- at- home isolated mother  – are unlike
anything seen in most of human histor y, particularly in human hunter- gatherer
pasts, what Bowlby called our environment of evolutionar y adaptedness (EEA).
Attachment is better seen as a hierarchy, typically with mother at the apex, but
with significant contributions from fathers, grandparents, siblings, cousins and
other caregivers.
The next phases of attachment theor y extended its range and subtlety. Added
to the spatial theor y was the idea that not all parents offered the same kind of
secure base experience, and that different parenting styles influenced children
to have different patterns of relating. A  range of measures have been devised
that measure aspects of attachment. I  next describe the best known test, one
which was perhaps at the centre of this shift, and which gave attachment theor y
a new scientific rigour. This was the Strange Situation Test, and was devised by
Ainsworth (1978) an early colleague of Bowlby. However there are also a range
of other tests for measuring attachment such as the Child Attachment Inter view
(Target et al., 2003), for school age children, or stor y- stems (Hodges et al., 2003),
the Attachment Stor y- Completion Task (Green et al., 2000), and an array of oth-
ers described well elsewhere (e.g. Prior and Glaser, 2006).
Ainsworth’s Strange Situation Test arose in part due to her having been
struck by how, at about eight months, infants develop stranger anxiety, swiftly
seeking out attachment figures when near an unknown person. Stranger anxiety
might originate from an inbuilt fear of predators, as Bowlby thought, or from fear
Attachment theory’s second phase: Ainsworth’s Strange
Situation Test and Crittenden’s Dynamic Maturational Model

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of unknown humans (Hrdy, 2000). The Strange Situation Test, a straightfor ward
20- minute procedure, profoundly developed attachment theor y. The sequence is:
• A mother and a child of about a year old are in a strange room with some
toys, the child able to explore freely.
• Next a stranger enters the room and talks to the mother and tries to inter-
act with the child.
• The parent unobtrusively leaves the room, and the stranger adapts their
behaviour to the child.
• Then the mother returns and comforts the infant, but then leaves again,
and this time the stranger leaves and the infant is left alone.
• Then the mother returns again and tries to comfort the infant.
Particularly fascinating is the diversity of reactions infants have. Some cry, scream
and crawl towards the door but quickly calm on the mother’s return, some seem
to barely notice their mother leave, and still others are very preoccupied with their
mothers before and after separations and cannot settle. As a result of these dis-
tinct reactions Ainsworth categorised the behaviours into three main types, which
she described as securely attached (roughly 60% in Ainsworth’s Maryland non-
clinical samples), and two types of insecure attachment, now mostly called avoid-
ant (roughly 25%) and ambivalent (roughly 15%) attachment. The danger of using
words like ‘secure’ and ‘insecure’ is that they imply a judgement about whether such
forms of attachment are good or bad, natural or unnatural, judgements we need to
be wary of, which Crittenden (1992) helped to point out, as explained shortly.
Babies who came to be classified as in secure attachment relationships,
originally called the B group, were those who cried when their mother left, but
who greeted their mother’s return with relief, and sometimes delight, and then
quickly settled back into a relaxed state. The avoidant infants (Group A) seemed
not to notice when their mothers left the room. I say ‘seemed’ because research
has shown that when their mothers left their physiological stress symptoms
increase in the same way as the securely attached children, despite seeming to
not care (Sroufe and Waters, 1977). This is now thought of as a deactivating
strategy (Holmes, 2009). Interestingly, at the time when the test was first given,
many thought the children who did not cr y were psychologically healthier, some-
thing few think today. In ambivalent attachment (group C) infants were preoc-
cupied and clingy before their mother even left, and on her return they remained
vigilant and unsettled, or hyperactivated.
Ainsworth found remarkable consistency between parental interactive
styles and an infant’s reactions in the Strange Situation Test, a link that has been
replicated all over the world. Secure infants had parents who were sensitive to
them, responded to their distress, and who were consistently available. Generally
parents of insecure children were less responsive to their children’s emotional
needs. Parents of children with avoidant styles tended not to respond to signals
such as cr ying, and were less aware of a child’s distress. Of course there is little
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you display upset. Ambivalently attached children tend to have more inconsistent
parents, available one moment, and withdrawn or preoccupied the next. Thus
such children monitor their parents closely to feel safe. These children explore
less, presumably not trusting that there is a consistently safe base to return to,
they are clingy, enmeshed, and less at ease. It is important to remember that for
children in all three groups, their responses to attachment anxieties are success-
ful strategies for staying close to their caregivers.
Some years later researchers (Hesse and Main, 2000) realised that one
group of children did not fit Ainsworth’s original categories. These children
had often been subjected to unpredictable and traumatising parenting, and had
failed to develop a coherent and consistent strategy to deal with these frighten-
ing experiences. In the reunion phase of the Strange Situation Test they might,
for example, wander up to a parent, then move aside, bang their heads on a wall,
freeze or indulge in bizarre behaviours. The parent, who most children expect to
provide solace or comfort, was often the person causing the distress, such as by
being violent, and so these children could not find a way of getting their attach-
ment needs met. This group was classified by Main as disorganised, and such
children often are a cause of concern to professionals as they grow up. Building
on Main and Hesse’s ideas, Crittenden (1993) argues that many of these children
are caught in an avoidance– approach dilemma.
The Strange Situation Test typically assesses attachment at aged one year,
but of course the building blocks for personality traits are being put in place much
earlier. Beebe and Lachmann (2013) showed that mothers whose responses were
most attuned to their infants in the early months tended to have children who
were securely attached at a year, and by two showed more positive affect. She
predicted attachment classification at a year by examining the degree of mutual
coordination between mother and baby. Interestingly, the infant’s degree of con-
tingency with a stranger at four months is also predictive of attachment status at
a year, which means that infants are taking their expectations of interactive styles
into other relationships, even eliciting similar reactions in strangers to those they
had learnt to expect from attachment figures. Infants who at a year are classi-
fied as avoidant are already by four months looking at their mothers less fre-
quently, and while looking they sooth themselves by, for example self- stroking.
Such infants seem over whelmed by looking at their attachment figure, and as
Beebe describes, they have their ‘heads cocked for escape’. This is unlike those
who become secure who look straight at their mothers and smile with pleasure
an ease.
Infants develop ver y different regulator y strategies to sur vive. In avoidant
attachment, infants need to self- soothe and self- regulate much more, as they have
learnt there is little chance of emotional regulation from the outside. In ambiva-
lent attachment, infants monitor adults ver y carefully, as they do not know what
is coming next, and concentrate more on the outside world than on themselves.
Secure infants can rely on their mothers to be there for them when needed.
These categories are quite broad and in fact there are finer grained ways
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secure (B) group can be sub- classified as B1, secure reser ved, B2, secure inhib-
ited, B3, secure balanced, and B4, secure reactive. This allows a higher degree
of subtlety in making sense of such patterns. An even more nuanced alternative
system of classifying attachment has been developed by Crittenden (2015). She,
like Ainsworth, was a student of Bowlby, and developed a system of classifica-
tion that is gaining increasing sway in the field, called the Dynamic Maturational
Model (DMM).
Crittenden disavows the notion that some styles are ‘healthier’, avoiding
normative words like ‘insecure’ that have a judgemental flavour. She suggests
that throughout the lifespan attachment strategies will change in response to
changing contexts, and are nearly always adaptive to a child’s environment.
The best chance of sur vival comes from working out how to behave in order to
retain closeness to one’s attachment figures, whatever their emotional style, as
Ainsworth also found. Crittenden has added a wealth of complexity to attachment
theor y that cannot be done justice here, due to space. She describes, for example
children who are compulsive caregivers, or overly compliant or who show false
positive affect, and she has devised a multiple- axis way of conceptualising com-
plex personality traits, particularly in response to maltreatment. These become
non- conscious behavioural templates, what Bowlby called internal work-
ing models, and Crittenden describes as Dispositional Representations.
Children learn a strategy that works with particular adults, such as limiting emo-
tional expressiveness if a parent cannot bear displays of affect. This becomes a
non- conscious model in their minds, an internal representation of themselves in
relation to others. It is possible to develop several attachment strategies, each
appropriate for particular relationships. One might behave in a securely attached
way with one’s mother and an avoidant way with one’s father, each responding to
that carer’s cues.
While attachment theor y initially concentrated on behaviours, moving away
from psychoanalysis’s preoccupation with the psychological world of experience,
Bowlby’s concept of internal working models kept the psychological aspect alive.
An internal working model is a representational and emotional map whereby
people learn to predict others’ responses and develop a picture of how relation-
ships are likely to go. These models are not static, but are influenced by new
experiences, although new experiences are also ‘read’ in the light of previous
expectations.
The next leap for ward in attachment theor y occurred with the development
of an instrument called the Adult Attachment Inter view (AAI), which brought this
world of minds, ideas and representations centre- stage and led to a host of new
research. Main (Main et al., 1985) developed the AAI to measure adult thought
processes, and demonstrated links between parental states of minds revealed in
the AAI, and the child’s attachment as measured in the Strange Situation Test.
Attachment inside us

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This was a revolutionar y discover y, demonstrating that how parents think about
their own lives impacts their child’s development, and how attachment patterns
can be transmitted from one generation to the next.
The AAI is a semi- structured inter view that takes about an hour to com-
plete. It aims to ‘surprise the unconscious’, revealing important features of
the representational world that relate to attachment. For example, the subject
is asked for five adjectives that describe relationships with a parent, and then
supply memories which illustrate these. Other questions include giving exam-
ples of when one was upset as a child, memories of a first separation or asking
about any traumatic experiences. Such questions tend to stir up strong emotional
responses. The inter view is painstakingly transcribed and analysed in accord-
ance with scales that measure, importantly, not what actually happened in the
childhoods described, but rather how questions are answered, in particular the
internal coherence, consistency and reflectiveness of the narrative.
Some adults are classified as ‘secure- autonomous’ and tend to produce nar-
ratives that are consistent rather than muddled or contradictor y. They develop
a coherent stor y about their lives that takes account of emotional experience
and shows interest in how significant others experienced events. Such adults are
most likely to have securely attached children (Fonagy et al., 1995).
Adults who score ‘preoccupied’ tend to give answers that are quite angr y in
places, confused in others, and when asked to describe an event they can talk as
if catapulted back into the moment the event took place, such as having an argu-
ment with their parent. They speak in longer, more jumbled sentences, giving
answers full of detail but low on self- reflection. They are most likely to be parents
of children prone to ambivalent attachment relationships.
The adult categor y that tends to correspond with avoidant attachment is
termed ‘dismissing’. Here we see positive if brief descriptions of their childhoods,
and an inability to back up their positive statements with actual examples. Their
memories are generally fairly restricted, and when they do unearth stories they
often contradict the original rosy picture. For example, an adult might say that
his parents were ver y caring and then tell a stor y about getting lost in a strange
wood and no one noticing. Being in touch with emotions, particularly negative
emotions, does not come easily to this group.
The ‘unresolved- disorganised’ is the fourth group. Their narratives lack
coherence and show poor reasoning and bizarre thinking, with discontinuity and
abrupt changes lacking logical connections. These are parents who tend to be
both ‘frightened and frightening’ and are most likely to have children classified
as disorganised.
Strikingly these findings show how an adult’s reflective capacity can
power fully af fect the attachment status of their child. Impor tantly it is not
an  adult’s actual childhood that is predictive, but rather the ability to reflect
on experiences. One is more likely to be secure- autonomous if one has had
positive childhood experiences, but it is not inevitable. What makes the dif-
ference, even if one has had negative experiences, is the ability to mental-
ize, to be able to process and make peace with the past to some extent, and

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the capacity for what is called reflective self- functioning. Main coined the
term ‘earned security’ for adults who became secure despite having had dif-
ficult childhoods. These people experienced other protective factors, such as
later good experiences with alternative adults (Roisman et al., 2014), findings
that give hope to researchers and professionals that early experiences are not
overly determining.
Children with different attachment styles experience the world differently.
Children who are secure expect positive interactions with others, have the confi-
dence to explore, tend to have more flexibility and capacity to play, more ability to
empathise with and get on with other children, to understand and regulate their
emotions, and be in touch with others’ emotional needs. Such children generally
have a hopeful internal representation of themselves in relationship with others
and they expect help to arrive if in trouble.
Being secure seemingly confers advantages but in fact displaying secure
behaviours would backfire if one’s parents were abusive or cut- off, and so the
children of such parents need to develop other strategies. The avoidant child for
example dampens down (deactivates) feelings of need in order to retain their
carer’s favour, screening out painful affects in themselves and not recognising
these in others. They also have less rich representational worlds, are less able to
process emotional complexity than a secure child, needing to depict themselves
as strong and independent. In contrast the ambivalent child can be so anxious
that they make endless demands to avoid abandonment, but are less able to learn
to regulate their own emotional needs.
Children with disorganised attachment styles are in the most parlous state.
They have little strategy for getting their attachment needs met. The person who
would usually make a child feel safe, a parent, is often unpredictable and worse, is
likely to be the one to inflict hurt and upset. For such children there is nowhere
safe to turn. They lack a coherent strategy other than to avoid danger in the next
few seconds, and they can be unpredictable, although paradoxically this lack of
organisation generally turns into a personality with ver y controlling characteris-
tics as they get older. The world generally does not feel safe unless they are in
charge. They can develop a rather desperate level of self- reliance, or attempt to
control significant others through aggressive behaviour or compulsive caregiv-
ing, and when these strategies fail they can become ver y unpredictable.
It is not obvious to researchers by exactly what mechanism parents’ behav-
iours and states of mind have such an impact on the attachment status of their
children (Sette et al., 2015). The most common theor y is that adults who score
secure- autonomous are more sensitive parents, and various measures of parental
sensitivity have been devised as well as measures for parental reflective func-
tioning (Slade, 2005). There is still something of a ‘transmission gap’ in explain-
ing exactly how parental states of mind affect infant attachment. The concept
Transmission of attachment

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of mind- mindedness developed by Meins (Meins et  al., 2012) measures the
extent of parents’ mind- related comments to their children, and seems to predict
whether a child will be securely attached. More mind- minded parents tend to
focus on their children’s feelings, thoughts and experiences. If a preverbal infant
shows distress then the mind- minded parent might speculate aloud about why
they are upset, maybe saying ‘oh yes you have missed mummy’ or ‘well that was
a frightening loud noise’. Meins showed that repeated experience of one’s mental
states being reflected upon helps children become aware of both their own and
others’ mental states. Compared with mothers of secure children, mothers of
more avoidant children tend to make fewer mind- minded comments, and moth-
ers of ambivalent children might make some mental state statements but these
are often an inaccurate reading of the child’s internal state.
Thus the ability to understand a child’s state of mind is ver y important. The
number of maternal mind- minded comments about a child at six months predicts
attachment security at a year (Bernier and Dozier, 2003), mentalizing capacities
at 48 months (Meins et al., 2003), theor y of mind (Meins et al., 2013), and verbal
and narrative skills at five years old. Such findings about the importance of paren-
tal states of mind are exciting, not least because if we have learnt what transmits
attachment, then we can then begin to inter vene and help parents develop mind-
minded or self- reflective capacities.
A concept with much in common with mind- mindedness is mentaliza-
tion, developed by Fonagy and Target (1998) of the Anna Freud Centre, which
describes the ability to make sense of one’s own and others’ mental states and
to understand how people’s behaviour is driven by psychological and emotional
factors. Here again one sees a range of concepts from slightly different tradi-
tions that describe ver y similar phenomena. Mentalization is increasingly being
used in new mentalization- based treatments (Bateman and Fonagy, 2004) for
adults suffering with Borderline Personality Disorder. Affect regulation, mind-
mindedness, reflective functioning, and mentalization are linked concepts which
are central to attachment.
Ironically while secure attachment is linked with mentalizing capacity,
when we are securely attached to someone then some of our mentalizing capaci-
ties can go into abeyance in relation to that person (Bartels and Zeki, 2004). More
discriminating aspects of our judgement can shut down when we love someone,
and we tend to give them more benefit of the doubt, which is the basis of what
Fonagy calls epistemic trust (Fonagy and Allison, 2014).
Attachment theor y describes ways in which children adapt to their envi-
ronment. Yet, despite early results showing how the Adult Attachment Inter view
of a pregnant woman predicted the unborn child’s attachment status at a year
(Fonagy et  al., 1991), early attachment status is not necessarily as predictive
of future outcomes as once assumed (Beijersbergen et  al., 2012). Thankfully
children continue to adapt throughout the lifespan to their current environ-
ment. The continuity between childhood and adult attachment is quite variable,
although parental sensitivity at different ages remains a good predictor of secu-
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know that parental nurturance remains key (Chopik et  al., 2014) we still have
some way to go before we fully understand the exact mechanisms for the inter-
generational transmission of attachment or the extent to which early experiences
are predictive.
Finally, I  have not mentioned biological temperament, as ver y few links
have been found between this and a child’s attachment status. Infants born more
sensitive and less able to self- regulate, maybe for genetic reasons, are certainly
at more risk of insecure attachment, and parents will find such labile children
harder to tolerate. Some genes, such as one linked with oxytocin, seemingly
might affect attachment status, given the same kinds of parenting (Raby et  al.,
2012). Yet any such research is preliminar y, based on small samples, and other
researchers are urging caution, suggesting that the evidence, at least for now,
does not necessarily hold up (Roisman et  al., 2013). The relationship between
biological inheritance and attachment is also weakened by evidence that a child’s
external environment, whether therapeutic inter ventions or changes in a family’s
circumstances, alter a child’s attachment status. Parental sensitivity remains the
best predictor of whether a child will be secure or insecure, even if there might
be some link between temperament and disorganised attachment (Spangler,
2013). What seems increasingly clear from recent epigenetic research, as dis-
cussed in a later chapter, is that some children are, for genetic reasons, more
likely to be affected by both good and bad experiences (Belsky and Hartman,
2014a). Nonetheless despite new epigenetic research, parental sensitivity and
mind- mindedness remain as good a predictor as we have of the eventual attach-
ment status of a child.
While attachment theor y seems to describe a human and indeed mammalian
biological system (Panksepp, 2004), like all theories it is limited by the specific
cultural and historical framework in which it originated. An important question
is whether attachment theor y can usefully also be applied to other cultures, or
whether there is a bias in the research towards parenting styles valued in the West.
It is certainly possible to apply the concepts and protocols of attachment
theor y such as the Strange Situation Test across cultures. Doing so reveals that
secure attachment is the most common form of attachment, although there are
definite cultural variations. For example the Grossmanns (2005) found that in
North German but not the South German children, avoidant attachment was
most common. Similarly, in Israeli Kibbutz children who experienced communal
sleeping arrangements ambivalent patterns were predominant (Sagi et al., 1995)
for children not sleeping with their mothers. Some cultures simply do not seem
to have children who fall into certain categories. In the Dogon people of Mali 87
per cent of the children were categorised as secure, and none at all as avoidant
although some children with mothers who were frightened or frightening devel-
oped a disorganised style. Chinese (Archer et al., 2015) infants are more likely
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to show less avoidant and ambivalent styles than US samples, and in such inter-
connected cultures a mother leaving a child alone is less likely to occur. Korean
mothers for example were much more likely to stay beside their infant well after
the reunion episode (Jin et al., 2012), and these infants showed far less avoidant
attachment.
Attachment categories are relatively broad, which is a strength, as they
can be so widely applied, but also a weakness for understanding more subtle
nuances. For example in China, where ideas about filial loyalty are central, the
attachment relationship with paternal grandparents is hugely predictive of a
range of outcomes, irrespective of attachment to parents (Liu, 2013). Also all
securely attached people are not the same. Japanese secure children cr y less
when leaving their mother’s arms than secure German children, yet both groups
of children have the same secure classification. In China a secure adult might still
be disinclined to ask for help, or to show their feelings, due to cultural expecta-
tions, especially if they are of a status which requires them to take authority or
support others (Erdman and Ng, 2011), behaviours that are considered avoidant
in a Western attachment model.
We should ask not only if attachment concepts can be applied across
cultures, but also if the ver y concepts of attachment theor y contain cultural
biases. Concepts like ‘timely responsiveness’ or ‘maternal sensitivity’ might
have dif ferent meanings across cultures. Rothbaum and Morelli (2005) sug-
gest there exists a cultural bias in how attachment theor y values autonomy,
exploration and independence, capacities more prized in the West. Puer to
Rican mothers, for example, are on average more concerned with calm,
respectful attentiveness than autonomy. Physical control of children might be
associated with insecurity in American families but with security in Puer to
Rican families (Carlson and Har wood, 2003). Similarly maternal inter ference
predicts attachment insecurity in America but not in Colombia, where the
opposite is true (Posada and Jacobs, 2001), while in Turkey maternal control
and guilt inducement is not linked with insecurity as it is in the West (Sümer
and Kağitçibaşi, 2010).
I describe in the chapter on culture (Chapter 7) how societies differently
value independence and social responsibility. In many cultures it is the ability to
anticipate the infant’s needs that is prized. Attachment research does not meas-
ure this, but measures a child’s response to an anxiety- inducing situation that has
already occurred rather than an anticipated one.
Nonetheless there is compelling evidence for a universal attachment
system in human infants, and also in other primates. There is also now some
evidence from cultures as unrelated as Colombia, Mali, Chile and others show-
ing that maternal sensitivity is linked to attachment security, with scores being
examined by raters from different cultures. Even in societies where children are
reared in a more communal way and are often passed between carers, such as
the Efe studied by Tronick, children tend to have a primar y attachment with their
mothers (Tronick et al., 1992). It is true, as Keller (2013) argues, that attachment
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and some of its emphases, such as on the importance of autonomy, are less cen-
tral in certain cultures. Despite this, generally attachment theor y appears to
retain significant applicability across cultures.
Not all insecurely attached children have a bad prognosis, but at a year disorgan-
ised attachment, the most worr ying kind, is a good predictor of psychopathology
at 17 years old (Obsuth et al., 2014). Disorganised attachment often occurs along-
side other risk factors, such as poverty, single parenthood, violence, drug and
alcohol use, and poor neighbourhoods. The child with disorganised attachment
styles is likely to suffer from high stress, be hyperalert, show ‘helpless’ and/ or
‘hostile’ behaviours, and the care they receive is often inconsistent, confusing,
frightening, leaving them feeling dysregulated. Such children fail to find a strat-
egy to cope, as both approach and withdrawal can induce fear. Many traumatised
children displaying such behaviours, show poor executive functioning, hyper-
activity and seem in ways ver y like children diagnosed with ADHD (DeJong,
2010). They can be out of control but also become increasingly controlling as
they grow older. The world for them is frightening and not to be trusted, and the
unexpected is rarely something to look for ward to, and so they can avoid change
and control events as much as possible. Many children adopted from abusive
backgrounds show such patterns, and this can make parenting ver y difficult for
even the most sensitive and attuned carer.
Such children often have to deactivate attachment behaviours to sur-
vive, cutting themselves off from what is going on inside them, using extreme
defences, such as flight, fight or dissociation. When something frightening
happens there is no one to make sense of such experiences. These children
often show jumpy thought processes, and struggle to stay consistently on a sin-
gle mental track, something often also seen in their parents’ confused reports
in the AAI. They can struggle cognitively, to regulate emotions and to develop
consistent interpersonal strategies. Many fail at school, and advance along wor-
r ying trajectories, such as into the criminal justice system, psychiatric, or other
ser vices.
These days there is much talk of attachment disorders, and it is important
to distinguish this from disorganised attachment, which is a research categor y.
Attachment disorder began as an official psychiatric classification describing
children who have been chronically neglected or whose lack of care meant that
they never developed an attachment relationship with a particular caregiver.
The latest version of the psychiatric manual, DSM5, distinguishes Reactive
Attachment Disorder (RAD), referring to serious neglect cases such as in
depriving orphanages, from Disinhibited Social Engagement Disorder (DSED)
for the more dysregulated children. Many have argued that these categories lack
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a developmental understanding and many lobbied unsuccessfully for a new categor y, develop-
mental trauma disorder (van der Kolk, 2014) to be included in DSM5.
Caution is needed, as there is both a well- grounded scientific and psychiatric discourse
about attachment disorder, but as Prior and Glaser note (2006), also a large industr y of people
offering pseudo- scientific popularised attachment therapies using this label in a way that bears
little resemblance to official psychiatric ones. Most controversial are probably the so- called
‘holding therapies’, which attempt to enhance interactions by forms of enforced contact between
adults and children (Simmonds, 2007), which have been critiqued by many and actually found
to be dangerous, even leading to fatalities (Lilienfeld, 2007). This is in stark contrast to thought-
ful applications of psychotherapy by clinicians with deep understanding of attachment theor y
as a science (Holmes, 2014). Some children who have a disorganised attachment might also be
diagnosed with RAD or DSED, but these categories are not coterminous. What is clear nonethe-
less is that the long- term implications for children with a disorganised attachment, and for those
with an attachment related disorder, are not good.
• Attachment theor y began as a spatial and behavioural one, highlighting the importance of
children having proximity to a secure base provided by one or more attachment figures.
• It then became increasingly sensitive to the quality and style of parenting.
• Later research increasingly emphasised mental states, the state of mind of the carer and
the relationship of this to the attachment status of the child.
• All the attachment styles can be seen as adaptive for the environment in which they
develop, including insecure ones.
• The most worr ying categor y with the worst prognosis is disorganised attachment, often
seen with trauma and abuse.
• A child in secure attachment relationships generally has advantages, such as interacting
well with peers, playing creatively, understanding emotions and minds, and being better
able to regulate their own emotions.
• The mechanisms for the transmission of attachment seem linked to parental sensitivity,
and the concept parental mind- mindedness captures this well.
• Attachment theor y has cross- cultural significance even if some of its concepts might have
a Eurocentric bias.
• There are related but different discourses to attachment theor y, such as Reactive
Attachment Disorders or the various therapeutic inter ventions that claim a link to under-
standing attachment.
• Attachment styles are also not set in stone and can change with new experiences and new
relationships, which should give hope to professionals and parents.
Key points

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C h a p t e r   7
The importance of culture
Some differences 77
Sociocentric and egocentric, dyads and groups 79
What is universal and natural? Breastfeeding and emotions 82
Cultural variations in development 84
Cultures frame our thoughts, physiology and brains 85
Key points 86

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Different cultures raise children ver y differently, yet people in most soci-
eties strongly believe their own childcare philosophies. Cross- cultural
understanding is necessar y to appreciate the variety of ways of bringing up
children that we encounter, perhaps especially for those living and working
in multicultural communities. Some aspects of children’s development are
almost universal to the species while others are culturally specific and we
are all deeply imbued with our own cultures. It is challenging to even make
sense of concepts that derive from cultures ver y different to our own. Here
is an example from the Pacific Bimin– Kuskusmin people, who have a com-
plex cosmological belief system (White et al., 1985). Although the ideas are
different, one might be tempted to translate them into our own understand-
ings. One of their central concepts is that of a ‘finiik’, which might loosely
be translated as spirit or lifeforce.
Box 7.1 The finiik of the Bimin– Kuskusmin people
An infant’s finiik is small, weak and fragile, and can easily escape. The finiik
is present from conception, drawn from ancestral spirits who guide its devel-
opment, and one’s finiik might even give rise to foetal movements, although
ritual acts can strengthen it. However, after birth it is weak, and will only be
strengthened by the infant being embedded in the moral, social and ritual
community. At birth the infant is in a highly polluted state, and fragments
of the finiik escape, through coughing, shrieks and other movements. The
mother can calm the infant with cradling, warming, nursing and speaking
to it, and all this prevents the finiik from escaping by reducing the infant’s
‘thinking feeling’ and motor movements. A father has a key role, through his
presence and ritual activities, in helping firm up the finiik, but an abusive or
neglectful mother severely threatens the child’s future as the finiik or parts
of it can come loose or escape.
We each might have our own explanations of what is being described here, using
our own preconceptions. It is uncertain how possible it really is to translate
beliefs and values from one culture into those of another.
In utero we imbibe the tastes and sounds of the culture we are likely
to live in, and from bir th onwards an infant responds to culturally influenced
ways of being. Infant– mother vocal pitch and interactional synchrony dif fer
across cultures (Van Puyvelde et  al., 2015). Indeed so do a new- born’s cries,
with French new- borns producing cries with rising melody contours, as
opposed to German babies who straight after bir th cr y using falling contours
(Mampe et  al., 2009). To grow into a socially competent adult, people must
learn the expectations of their cultural context. The sociological concept of a
habitus (Bourdieu, 1977) describes how cultural and social arrangements and

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influences become lived through the subjective life of an individual, mostly
non- consciously.
Most of us feel challenged by practices different to our own. Our language
is replete with words implying that which is different is foreign or alien. For a
long time Western thought has been suffused with ideas about ‘civilised’ people
being different to ‘savages’, sometimes simplistically grafting evolutionar y ideas
onto beliefs about the superiority of its way of life (Spencer, 1895). Most societies
think their ways of looking after children are best. Rural Cameroonian moth-
ers, when shown videos of European mothers leaving their babies to cr y, asked
if they could come and teach them to do it better (Keller, 2007). People from
one culture are often perplexed by values that those in another culture take for
granted, something that becomes a more serious issue in societies where there
is a lot of immigration.
Beliefs var y cross- culturally about many aspects of childcare, such as how
much we hold babies, feed them, guard their safety or communicate with them.
I flag up the extraordinarily diverse ways that humans bring up children which
challenges any ideas that ‘our’ ways of bringing up children are right. I hope to
avoid portraying any non- western practices as in any way ‘exotic’, but the oppo-
site danger, taking our own beliefs and practices as ‘natural’, seems to me more
risky. I  also outline an important distinction between societies that are more
interdependent as opposed to being more autonomous, sometimes described as
sociocentric as opposed to egocentric, or individualistic or collectivist (Markus
and Kitayama, 1991). More interdependent cultures are geared to ensuring that a
child grows up more aware of being embedded in its community and as part of a
social context. Egocentric or individualistic cultures value autonomy and individ-
uality more, as often seen in Western industrial societies, where the development
of the child as a separate individual is highly prized.
Ideas about what a baby is or represents differ hugely. For some Christian
Puritans a baby is born full of sin, and needs to be civilised, while some Balinese
babies are seen as reincarnated ancestors to be treated with reverence. Practices
are performed to ensure that one is warding off ‘the evil eye’ in cultures, such as
Turkey or Nepal, and we all probably have our own beliefs that could be viewed
as superstitions. Many newly pregnant European mothers keep quiet about a
pregnancy until about three months to avoid ‘tempting fate’, whereas in some
societies people disclose pregnancies earlier.
Societies have ver y different practices and ways of conceptualising life
events. For example, most cultures privilege particular moments in the lifespan.
In the West many transitions are taken for granted that might make no sense
elsewhere, such as starting or leaving school, even birthdays, whereas in many
cultures, such as Cambodia or Chad for example, birthdays are not celebrated.
The rituals of a society tend to indicate something ver y central about the culture’s
Some differences

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core values. In the Hindu upanayana ceremony, boys become full members of the
religious community; they undergo a ritual that includes spending a night all
alone, often for younger ones the first night without their mother, and from then
they will eat only with male members of the family (Friedlmeier et al., 2005). For
the Navajo there is the ‘first laugh’ ceremony, celebrated by a major feast that is
given by the first person to make the baby laugh, and ensures that the baby will
be generous and happy (Willeto, 2015). This is when a Navajo baby is thought of
as becoming a person.
Such customs cannot really be understood in isolation from a culture as a
whole. Some beliefs and practices might seem ‘interesting’ to us and others threat-
ening. For example, parents in most cultures worr y about safety, but the nature
of these worries varies across cultures. In some places the fear might be about
lions and other predators, and in others cars or paedophiles. Some cultures worr y
about surprising dangers. Many Nigerian Fulani mothers roll their babies in cow
dung to tr y to fool the spirits into thinking their children are not worth taking.
Ideas about what is appropriate and safe also var y hugely. In the USA and Europe
children are normally not allowed to play with knives until at least five years old.
Western parents or social workers might be aghast that young Congolese Efe
children regularly use machetes safely, Fore infants in New Guinea use fire by the
time they are walking (Sorenson, 1979), and Aka children in central Africa safely
learn by 10 months how to throw spears and use axes (Rogoff, 2003).
A more controversial example of ver y different childrearing comes from
the Sambia of New Guinea (Herdt, 1994), whose practices provide a huge chal-
lenge to our assumptions. Inhabiting longhouses where the sexes are segre-
gated, they undergo rituals whereby masculinity is passed on, including ‘fellatio’,
and the continuation of the masculine world is said to depend on imbibing semen.
Despite undergoing experiences that most of us would describe as abusive, the
males emerge seemingly unscathed into adult life, yet most readers would still
consider this abuse.
Practices that challenge our core values so drastically are rare, but many
other ways of treating children seen in other cultures fly in the face of contempo-
rar y Western belief systems. A few examples include polygamy, marriage of girls
before adolescence, or female circumcision or FGM. Other cultural differences
such as arranged, or forced marriages can give rise to tensions between mem-
bers of the same family, as often seen in second generation Asian young women
(Anitha and Gill, 2009).
Practices also change over time from being deemed acceptable to unaccep-
table within a single culture. In pre- industrial and industrial Britain children took
a full role in economic and work life, in factories, in the fields, and even notori-
ously up chimneys. The British childcare guru Truby King (1932) influenced a
whole generation by devising a childcare system partly derived from rearing cat-
tle. This included a fixed four hours between feeds, no picking up and cuddling
or ‘spoiling’ between feeds, plenty of time alone in a pram at the end of the garden
for ‘fresh air’, with cr ying seen as ‘good for the lungs’. Practices that seem fine for
one generation can seem barbaric to the next.

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Our own values easily inter vene when thinking about other cultures
(Music, 2014a). The example I  described earlier of Brazilian shanty towns is
typical (Scheper- Hughes, 1992). Here mothers show what might seem like harsh
indifference to babies seen as weak and unlikely to sur vive. They say ‘if a baby
wants to die, it will die’, and actively discourage any attempt to save a baby that
they think will not sur vive, as Scheper- Hughes, the researcher, herself found
when rather naïvely tr ying to help a child who was seen as ‘weak’. All of us are to
an extent prisoner within our own cultural value systems.
A central distinction is between cultures that are more egocentric or sociocentric,
or individualistic or collectivist, a distinction describing a spectrum rather than
any absolute differentiation (Geertz, 2000). A central Western assumption is that
the development of an ‘autonomous self’ is natural, an assumption not shared in
all cultures. Caudill and Weinstein (1966, p.27) write,
In Japan the infant is seen more as a separate biological organism who,
from the beginning, in order to develop, needs to be drawn into increas-
ingly interdependent relations with others. In America, the infant is seen
more as a dependent biological organism who in order to develop, needs to
be made increasingly independent of others.
Indeed, the Japanese have a concept, amae, which is not really translatable into
Western languages but loosely describes an expectation of being loved, cared for,
and looked after, and indeed the concept of amae might present a challenge to
Eurocentric variants of attachment theor y (Erdman and Ng, 2011). The Danish
concept of Hyggelig is equally hard to translate, meaning in part a warm, cosy
relationship with others. Similarly the Chinese concept of yuan suggests that inti-
mate relationships are in important ways predestined, an idea which challenges
many Western views about adult attachment and romantic relationships (Erdman
and Ng, 2011).
Infant sleeping arrangements typically express differences between socio-
centric/ collectivist and egocentric/ individualistic childcare beliefs. Practices
such as sleep training regimes teach babies to expect no comfort when they
cr y while in most societies in human histor y infant sur vival might well have
depended on babies and mothers sleeping together. Few babies in the USA sleep
with their mothers, in Britain it is seen by some as dangerous, whereas in many
South American cultures it is unthinkable for babies to sleep separately (Morelli
et al., 1992). Many Japanese believe that co- sleeping aids children’s transforma-
tion from separate beings to being members of the wider community (Caudill
and Plath, 1966; Shimizu et  al., 2014). The language we use is telling. Western
parents often talk of the need to train infants to be ‘self- reliant’ and ‘independ-
ent’, and worr y about ‘dependency’, while mothers in more sociocentric cultures
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emphasise qualities of ‘interdependence’. Where we think a child should sleep is
linked to our most central views about being human. Co- sleeping possibly does
not work so well in a Western industrial world where mothers often have to leave
the home to do paid work, and too much infant dependence might interfere with
economic sur vival.
Babies in cultures that value either independence or interdependence
have ver y different experiences. In Keller’s (Otto and Keller, 2014) studies
three- month- old German babies spent 40 per cent of their time out of physical
reach of their mothers, whereas infants in interdependent farming communities
were never alone. In Western families the mother often does the lion’s share of
childcare, and maybe only a few other adults help, whereas in rural African and
Indian cultures many other adults and young people were at hand to participate
in childcare. A Nso (rural Cameroonian) saying is ‘A child belongs to a single per-
son when in the womb, but after birth he or she belongs to ever ybody’ (Keller,
2007, p.105). In such interdependent cultures social adaptation is highly valued,
not independence and autonomy, and immediate bodily comfort of infants, primar-
ily via breastfeeding, is seen as ‘obviously’ what is needed. Nso mothers watching
videos of German mothers tr ying to comfort their children without breastfeeding
could barely believe what they saw, and several wondered if German mothers
were forbidden to hold their babies, even questioning whether they were really
watching the actual mothers.
Close bodily contact is taken for granted in more interdependent cultures,
whereas there is more distal, face- to- face communication between Western moth-
ers and babies. Similar differences are also seen in language use, with more
vocalising with infants in egocentric cultures, where infants in turn generally
become more vocal. Mothers with more interdependent values tend to value lin-
guistic expression less. Sociocentric language is used not so much to encourage
autonomy but more to support social and moral codes. In sociocentric practices
it is also common for mothers to indulge in quite rigorous bodily stimulation and
massage. German mothers watching some practices on video such as mothers
vigorously massaging their infants and suggested that these mothers were being
intrusive and insensitive in not matching the infants’ own tempo.
In much of Europe and America the assumption is that dyadic, mother–
child relationships are ‘natural’, and many theories have developed about the
importance of the father being an external presence who helps to ‘break up’ a
symbiotic mother– infant bond by facilitating a more triadic form of interaction
(Winnicott, 1958; Music, 2004). In many cultures, though, interaction is based on
complex group dynamics and not dyadic ones, and intricate webs of social bonds
are more valued.
In some Guatemalan Mayan communities social organisation consists of
a group interacting in a circle (Chavajay and Rogoff, 2002), and toddlers fit into
the flow of group processes rather than expecting to gain someone’s sole atten-
tion. To take an example using older children, in schools in Alaska, teachers
have by tradition tended to facilitate group processes and communal rather than
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teachers fostering group speaking. However, in one instance a supply teacher
caused disarray when, on arrival, she turned all the desks to face her, insisting
that all speaking was directed through her (Lipka, 1994). Culturally usual prac-
tices, such as openly helping each other in lessons, were seen as insubordination
and ‘wrong’.
Yet even within Western societies, different cultural groups value coopera-
tion and group goals more highly; for example Korean- American pre- school chil-
dren respond to other children more cooperatively than their Anglo- American
counterparts (Chen, 2012). This can lead to judgement of parenting in other cul-
tures. Some parenting styles encouraged by European professionals might not
be culturally appropriate for parents from African- Caribbean, Latin American or
Asian backgrounds. This might include too much emphasis on mothers and too
little on the extended family, and too little appreciation of beliefs about parenting
that differ from the cultural mainstream.
As Rothbaum and Morelli show (2005) in Western cultures autonomy, self-
esteem and self- assertion are particularly valued. Yet from some Asian perspec-
tives an autonomous person can be seen as immature and uncultivated (Kitayama
et al., 1997). Sociocentric practices emphasise parental control, social cohesion,
interdependence and community expectations. A Cameroonian Nso mother will
normally respond ver y quickly to an infant’s signs of distress, whereas a German
mother will respond more to positive signals (Keller, 2007). Central African Gusii
mothers do not amplify interactive excitement, but rather turn away from excited
infants to calm them down, as they do not want to produce individualistic or
expressive children. Such differences are not about one way being ‘better’, nor
about some parents loving their children more or less. One study comparing
Korean and German mothers even specifically tested this, and found no differ-
ence in how much the mothers loved or accepted their children overall, but that
Korean mothers encouraged more group- oriented and social, rather than individ-
ual activities, more compliance to parental expectations, and less independence
(Ziehm et al., 2013).
‘Control’ is highly valued in sociocentric cultures yet has quite negative
connotations for many American or Western European parents. Many rural
Chinese mothers actively discourage individuality in their children and encour-
age compliance, co- cooperativeness and interdependent ways of behaving (Chen
et  al., 2010). Children and adults in sociocentric cultures such as Nepal have a
much keener sense of social obligations such as to look after elders, something
viewed more as a personal choice not an expectation in more individualistic cul-
tures (Chernyak et al., 2013). Chinese people seem to show more disapproval of
norm violations than Americans, and this has been picked up in differences in
brain activation (Mu et al., 2015).
As the influence of education, industrial development and urban life
increases across the world, parenting has tended to move to a more independent
‘egocentric’ model. Research (Hofstede, 2010) examining cultural attributes in
50 countries, showed that the USA, Australia, Britain and Canada ranked highest
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to traditional rural ones with the advent of new economic opportunities, giving
rise to less strict and more individualistic styles (Chen et al., 2010). In contem-
porar y European societies such as Germany, within a few decades parenting has
become more individualistic and egocentric. Keller and Lamm (2005) looked at
free- play scenarios with mothers and children in the 1970s and again in 2000.
Mothers gave less bodily contact in the later examples, responded more quickly
to positive signals rather than to signs of distress, and encouraged more face-
to- face, distal contact, with more use of object manipulation and toys and more
use of language that supported autonomy and personal expression. All this was
change within just one culture in just a few decades. Generally cultures seem
to be moving in more individualistic and egocentric directions, although it is as
yet uncertain whether this will be the direction of travel in some non- Western
cultures such as China and India where industrialisation has grown apace but
distinct cultural patterns have remained in place.
Given such large cultural variations, one can ask if there are any practices that
humans are ‘naturally’ adapted for, especially given that for such a high percent-
age of our histor y humans were exclusively hunter- gatherers. One seeming con-
stant is the prolonged relationship between mothers and infants, even if the form
of this relationship varies, from infants primarily being cared for by mothers to
the Efe foragers of Zaire (Tronick et al., 1992), whose infants have simultaneous
relationships with many carers, being handed from adult to adult, even if the
mother remains the primar y attachment figure.
Breastfeeding is obviously something that human mothers are biologically
primed to do and so is a good candidate for being considered a ‘natural’ prac-
tice. Human mothers produce more diluted milk than some species, with smaller
amounts of proteins and fats, aiding breastfeeding following a ‘little but often’ pat-
tern. At birth mothers produce colostrum, a thick creamy milk with recognised
immunity boosting capacities, being full of antibodies. During periods when doc-
tors discouraged mothers from breastfeeding immediately after birth infant mor-
tality rates shot up (Hrdy, 1999), and for most of human histor y, breast milk has
been the only source of infant nourishment.
A danger of arguing that breastfeeding is natural, is that such thinking can
slide into moral ideas such that not breastfeeding is ‘unnatural’. There is also
the opposite danger and mothers in some parts of Europe are discouraged from
breastfeeding for too long, or in public, as some consider it ‘unsavour y’. The
human species adapts to its environmental conditions, and it is hard to argue that
one adaptation is more ‘natural’ than another.
A practice or trait might be called natural if it was universal to all cultures,
but these are hard to find. Academics debate whether some emotions are univer-
sal to all cultures. Anthropologists have stressed cultural differences, whereas
Ekman (1987) suggested that there are basic emotions common to all cultures.
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He identified these as happiness, surprise, disgust, contempt, anger, fear and sad-
ness. He researched one tribe in New Guinea, the Fore, which had hitherto had no
exposure to other cultures. He showed pictures of emotions as expressed in a pho-
tograph of white Western faces. He also asked what might have happened to the
person just before the picture was taken. Generally the Fore people had no difficulty
recognising the emotions, suggesting that such emotional signals were universally
recognisable. Although these results were replicated, other recent research using
different methodologies and looking at remote tribes has challenged the extent to
which emotions are quite as universally recognised (Gendron et al., 2014).
The Mafa of West Africa were found to recognise emotions in samples of
Western music, despite never having been exposed to such music, although in
fact people are more likely to recognise emotions in music of their own culture
(Laukka et al., 2013). Interestingly, babies born blind seem to express emotions
using the same muscle movements as sighted people, despite never having
seen them, again suggesting something that is biologically inherited. A  study
showed that the smiles of athletes at the Olympics were the same, irrespective of
whether the athletes were congenitally blind, non- congenitally blind, or sighted
athletes. For example, those who lost in the final of a fight all wore the same
‘social smile’, irrespective of whether they had ever seen anyone else’s face, and
their smiles were ver y different from the winners who wore broad Duchenne
smiles. This suggests a high degree of species- wide inherited wiring for emo-
tional expressions (Hwang and Matsumoto, 2015).
Others have tried to disprove Ekman’s views. Argyle (1988) looked at how
well Japanese, Italian and English people recognised each other’s emotions.
All groups were able to recognise each other’s signals, with the exception that
the Japanese faces were harder to read. This was taken to prove that emotional
expression might be culturally specific. However, this was challenged when
Japanese and American subjects were filmed watching TV programmes. The
Japanese subjects expressed few recognisable emotions in the presence of the
experimenter, but when watching films alone their emotional expressivity was as
recognisable as that of the Americans. This implies a cultural rule about hiding
emotional expressions in public rather than a different way of showing emotion.
There are many other cultural rules that can lead professionals and others
to make mistakes in understanding the people they deal with. For example, in
most Western societies looking someone in the eye is a sign of straightfor ward-
ness and honesty, in some African countries it is seen as rude or disrespectful,
and in some Arab cultures not looking at someone can be rude. One African
mother I worked with was clear that misunderstandings about such matters with
a social worker increased the risk of her parenting being judged inadequate,
and that she was being viewed as being ‘evasive’ whereas in her culture looking
directly at people who had authority was a sign of disrespect.
Cultural values even impact on when emotions are deemed appropriate
to express. As Rogoff (2003, p.27) showed, Hausa mothers in Nigeria do not
show affection to their babies in public, which might confound European infancy
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in the nature– nurture debate. The research is complicated by the fact that in
some cultures, as Matsumoto (2002) found, there might be cultural rules about
whether it is appropriate to even acknowledge recognition of another’s emotions.
Some research (Elfenbein and Ambady, 2003) suggests that there are advantages
in recognising emotions of people in one’s own group, and that people are better
at recognising the emotion of another if the obser ver and the obser ved are of the
same culture, and even babies prefer faces that ‘look like them’ (Liu et al., 2015).
There might well be a universal range of emotions, but their expression is more
like different dialects in one language, rather than entirely separate languages,
with cross- cultural nuances that are only picked up by members of one’s own cul-
tural subgroup. These issues are and will continue to be hotly debated, and might
come down to a question of emphasis; it seems possible to delineate emotions
that one might consider universal, but also to discover fascinating and significant
cultural differences in emotional expression.
Most psychology texts suggest normative developmental ‘milestones’ which
‘should’ be achieved at clearly defined ages, and children are often judged as
being either ‘behind’ or ‘ahead’ in relation to these. Often parents are understand-
ably anxious about whether their child’s behaviour is behind or ‘on- track’, and the
Western competitive analogy implies a clearly defined developmental sequence.
However, age- specific expected developmental stages differ across cul-
tures too. In parts of India, children as young as one and a half learn their left
from their right, far earlier than in most European children, and for good reason;
their right hand is the ‘clean’ hand, used for eating, or shaking hands, while the
left is used for cleaning oneself after defecation. In many societies physical skills,
for example to do with hunting or setting fires, would be learnt ver y early, while
the kind of learning valued in the Western school system might never occur.
There are large cultural variations in the ages that children manage
achievements cited in child development texts. For example many textbooks
suggest that children recognise themselves in a mirror after rouge is placed on
their face at between 15 and 18  months (Keller et  al., 2004). Keller shows that
cultures differ in when such milestones are reached, and that such differences
are linked to the ‘interdependent– independent’ continuum. Children in cultures
that value more sociocentric ways tend to achieve self- recognition later than their
Western counterparts. Children who recognise themselves earlier are those who
had received less bodily contact in early infancy and more face- to- face interac-
tion and more encouragement in object manipulation. The more egocentric the
culture, the earlier this skill develops.
Yet when it comes to self- regulation the opposite is true. Cultures that value
close bodily contact and quick response to signals of distress, and where there
are clear imperatives for children to abide by rules, are ones where self- regulation
develops earlier and more fully. Children in more interdependent cultures are
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also quicker to develop skills in compliance and in emotional regulation (Wanless
et al., 2013), especially boys.
Autobiographical memor y is another example. This is highly prized in
Western cultures, and beliefs in its importance are central to attachment theor y.
Western parents with good autobiographical skills are likely to have children who
are securely attached; these parents tend to use more elaborative narrative styles
about their own and their children’s lives. Western children can develop such
skills as much as 16 months earlier than some other children, and for example Nso
Cameroonian children’s first memories are of considerably later experiences than
those of Western children. Similarly the ability to understand what is in someone
else’s mind, and to know that another person might perceive things differently
from oneself, theor y of mind, also comes on stream at different ages depending
on one’s culture (Mayer and Träuble, 2014). It is easy to be judgemental about the
stage a child ‘should’ have reached from the viewpoint of one’s own culture
As well as cultural differences in developmental stages, there are also dif-
ferences in how ‘disorders’ or psychiatric issues are conceptualised (Maitra and
Krause, 2014). For example, toddler tantrums and the ‘terrible twos’, the bane in
the life of many Western parents, seem not to exist in some cultures where there
are different beliefs about childcare practices (Mosier and Rogoff, 2003). There also
exist culturally specific mental health disorders, many of which have recently been
included in official psychiatric classifications. These include latah, seen in Southeast
Asia and marked by sudden startle reactions, loss of control, profanity, and mimick-
ing of others, koro, seen in parts of Africa, where people fear that their sexual organs
are shrinking or disappearing, and Amok, seen in Malaysia, in which males respond
to slights by brooding and then are involved in frenzied, uncontrolled violence, giv-
ing rise to the term ‘running amok’ (Lilienfeld and Arkowitz, 2009). Taijin kyofusho,
seen in Japan, is a disorder marked by a terrible fear of upsetting others, such as
via one’s body odours, and such problems are especially seen in more sociocentric
cultures where how one is perceived by others has huge importance.
Given the cultural variations in practices and what are seen as disorders, it
is all too easy to see how any of us can inadvertently be prejudiced against other
people’s ideas, practices, or parenting by our own cultural beliefs.
The next chapter describes how experience changes the ver y structures and con-
nections in our brains, and cultural factors play a central role here. For example
the brain tissue of Chinese and American children seems to develop differently
due to different social and cultural influences (Xie et  al., 2015). Different cul-
tures provide different experiences which in turn lead to different brain develop-
ment. A typical example comes from the Moken society, often called sea gypsies
(Travis, 2003) who have for centuries dived 30 feet under water and har vested
sea cucumbers and clams. Few could believe that Moken children could see
clearly at that depth without goggles, which is almost unheard of. They however
Cultures frame our thoughts, physiology and brains

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learn to control the size of their pupils and the shape of their lenses. This is not
a genetic capacity, as an experiment was done with Swedish children, who were
able to learn this if they were taught early enough. Here what were assumed to
be hardwired circuits in the brain were changed through cultural influences.
In some countries, such as Russia and India, negative emotions are linked
to depression, but not in others such as China and Ghana (Chan et  al., 2015).
More strikingly, anger in Americans is linked to increased inflammation and risk
of heart- disease, but not in Japan, where negative feelings are more accepted
(Kitayama et al., 2015). Indeed a large study (Han and Ma, 2014) found that East
Asian and Western people were using quite different brain areas for social and
emotional processing.
People in different cultures can have somewhat different cognitive archi-
tecture. In experiments American and Japanese people have been shown to per-
ceive a slightly different reality (Masuda and Nisbett, 2001). Subjects in both
cultures were shown animations of coloured fish swimming, and in each anima-
tion there was one ‘focal’ fish which was larger, more brightly coloured and faster.
After wards the Americans usually remembered the focal fish while the Japanese
referred far more to the less prominent fish, and to background features such
as rocks. Americans recognised the focal fish whether shown with its original
background or not, whereas the Japanese only recognised it in its original context.
Such experiments suggest that people reared in sociocentric ways perceive things
more ‘holistically’ whereas Westerners might see things more analytically, relying
more on left hemisphere functioning (McGilchrist, 2010). Interestingly, children
of Asian immigrants to America tend to have both capacities, suggesting that cul-
ture is the driver of these differences. A caveat is needed here. Although cultural
influence is profound, inheriting certain genes may make one more or less likely
to be influenced by a culture’s individualistic or collectivist ethos (Kitayama et al.,
2014), and so as always nature and nurture can interact powerfully.
To sur vive in a Western post- industrial world one might need a sharp ana-
lytical focus. In other contexts it might not be such an advantage. The Moken
(sea gypsies) were one of the few groups who, like many animals, sur vived the
Indonesian tsunami in 2004, despite living in the heart of where it hit. When the
elephants left for high ground, and the cicadas fell silent, they began telling an
ancient stor y of ‘the wave that eats people’ and retreated to either higher ground
or ver y deep water, and all sur vived. It seems that Moken sea gypsies were in
some senses living in another world to those other fishermen.
• There is extraordinar y richness of cultural diversity, and a danger of assum-
ing one’s own practices are right or best.
• Different societies not only have different cultural or psychological habits
but the ver y concepts, ideas and presuppositions of each culture can differ
hugely.
Key points

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• Cross- cultural understanding is especially important when working in mul-
ticultural environments, or travelling to societies where values are ver y dif-
ferent to our own.
• The continuum between individualistic and collectivist, or sociocen-
tric and egocentric, beliefs has wide implications for understanding
childrearing.
• A cultural perspective is central to understanding child development gener-
ally, including for example attachment, language development, play, gender
identity, or childcare.
• Culture is not so much a separate topic as another lens for examining the
whole range of questions concerning children’s psychological and emo-
tional development.

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C h a p t e r   8
Biology and the brain
Brain basics: neuroplasticity and neuro- glia 90
Brains, nervous systems and bodies 92
Evolution and brain areas 95
Hormones and opiates 98
Empathy, cerebral hemispheres, attentional and
creative networks 100
Maltreatment 102
Hope or hopeless? 103
Key points 104

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This chapter introduces thinking based on interpersonal neurobiology that
I expand upon throughout the book. Since the so- called ‘decade of the brain’ in
the 1990s there has been a huge proliferation of neuroscience studies, particu-
larly using new scanning techniques. I will outline some of the new knowledge,
albeit cautiously, as neuroscience remains in its infancy, and some scepticism is
in order (Weisberg et al., 2008; Rose and Abi- Rached, 2013; Farah, 2014). I focus
not just on the brain or what goes on in people’s ‘heads’, but on whole body pro-
cesses. In recent years many scientists have come to see the brain as embodied
(Thompson and Cosmelli, 2011) as well as enactive (Ward and Stapleton, 2012),
or in other words a brain does what it does and is what it is in part due to its
owner’s embodied actions in the world.
One way of thinking about the brain is that it is like a muscle group, albeit an
extraordinarily sophisticated one. The areas that are used are strengthened from
being exercised while others can wither from neglect. Our brains are highly com-
plicated and able to make incredible calculations in a fraction of a second.
The most studied units of the brain are ‘neurons’, which communicate
with each other via electro- chemical signals. They are long entities with a central
nucleus (containing genes), and extensions called axons. Neurons pass electro-
chemical signals to other neurons across a gap called a synaptic cleft, causing an
electrical spike and leading to further signalling between neurons. Synapses are
the contact points between neurons. Each neuron has, as well as a cell body
and one or more axons, tens of thousands of tiny branches (dendrites) which do
the receiving via electro- chemical messages. Incredibly, the average neuron con-
nects directly to 10,000 other neurons and the average brain seemingly has up
to 100 billion neurons. There are about 100 trillion synapses in the human brain.
A piece of brain the size of a grain of sand contains about 100,000 neurons, 2 mil-
lion axons and a billion synapses.
However we also have another kind of cell, glia, which in fact far out-
number neurons, and they have recently been discovered to be ver y much
more crucial to brain functioning than previously thought (Fields, 2009).
Interestingly when Einstein’s brain was examined after his death it was
found that he had no more neurons than the average person but in cer tain
brain regions he had many more glia cells (Burrell, 2015). Humans have a
higher propor tion of glia cells than any other species, and the higher up the
evolutionar y chain the more glial cells a species has, indicating their impor-
tance. Various dif ferent kinds of glial cells have recently been discovered to
be impor tant communicators, via chemical rather than electrical messages,
which is why their activity has been harder to see in scans. They are actively
involved in helping neurons function, in pruning cells and in forming synaptic
connections, and they have the potential of neurogenesis, as they can function
as stem cells. The discoveries about the impor tance of glia are relatively new
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and this stor y is yet to fully unfold, but is a sign of how much we have yet to
discover about the brain.
The human brain is born prematurely, with an overabundance of cells but with
very few connections between them. In the postnatal period there is a massive pro-
cess of ‘pruning’, often described as ‘use it or lose it’, in which cells that are not used
simply die off, a process in which glia (in fact microglia) are very involved. Schwartz
and Begley (2002, p.117) quote a figure of 20 billion synapses pruned every day
between childhood and early adolescence, say: ‘like bus routes with no customers,
they go out of business.’ Once a connection is formed it remains wired, but unused
cells are ‘pruned’, although new pathways and wiring can still form later in life. New
experience is filtered through already formed pathways, just as water will naturally
flow down existing channels, hence ‘Hebb’s law’ (1949) stating that ‘cells that fire
together wire together’, and some have added ‘and survive together’ (Schore, 1994).
Thus humans have an ‘experience dependent’ brain (Kleim and Jones,
2008). In other words, different experiences give rise to particular brain pathways,
which form at the expense of other potential ones. These then become standard
media through which we experience the world, including the interpersonal world.
This allows us to adapt to different cultural lives and attachment experiences.
Figure 8.1 neuron

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The human brain adapts quickly to its environment, and is an extraordinar-
ily powerful predictor (Clark, 2013) of the future. Infants as young as six months
whose parents reported couple conflict were brought into a lab and placed in
fMRI scanners while sleeping (Graham et al., 2013). Compared to infants whose
parents reported less conflict, these infants showed much higher reactivity in a
range of brain regions central to fear when hearing a deep male voice. The brains
of these tiny babies were, presumably, quickly adapted to be ready for danger,
even in their sleep! Other research shows that also by just six months social
adversity and less parental sensitivity is linked with more activity in brain areas
associated with emotional dysregulation (Rifkin- Graboi et al., 2015).
The human brain, and particularly the infant brain, is very malleable, a capac-
ity described as ‘neuroplasticity’ (Doidge, 2008; Begley, 2009). The period from the
last trimester of pregnancy through to the second year of life is crucial, although
thankfully some plasticity remains throughout the lifespan, particularly during ado-
lescence. It is the job of parents or other primary caregivers to act as what Schore
(2012) called the ‘psychobiological regulator’ of the developing infant brain, so that
in effect a parent’s communications stimulate a child’s neuronal circuitry.
We use ver y different parts of our brains and ner vous systems when in different
moods, or in different contexts, such as when in a loving environment or under
threat. When in danger we tend to become highly aroused, and resort to primitive
sur vival responses such as fight or flight, or even freeze. Our whole being and
physiology then is geared to the threat, as we tense up and prepare for trouble,
while other bodily functions, such as digestion or immune responses, temporar-
ily go into abeyance, as do higher order thought processes. Children who have
suffered extreme trauma, such as many with disorganised attachments, are often
predisposed to swiftly go into such states and find it hard to come out of them.
Porges (2011) suggests that we have three aspects of our autonomic ner v-
ous system, the system that is central to emotional regulator y processes and
responses to threat. Each branch is rooted in a different stage of our evolutionar y
histor y. Our most primitive reaction is one we share with the least developed of
species such as reptiles and amphibians. It depends on the evolutionarily ancient
dorsal vagus ner ve, and its activation leads to complete immobilisation, freezing
and the closing down of our systems. Dissociation and metabolic shutdown are
typical of this ‘rabbit in headlights’ system. It is adaptive because predators are
not attracted to creatures that seem lifeless, although our bodies only resort to
this in the most extreme situations.
An evolutionarily more advanced response comes from our sympathetic
ner vous system, which includes the fight– flight response, and is seen in all mam-
mals. Under threat this system’s responses include increased heart rate, sweat-
ing, quicker breathing, dilation of the eyes, feeling cold and inhibited digestion.
It fires up when we feel anxious, furious or frightened. The sympathetic ner vous
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system works closely with our two main stress response systems. The fastest
to react is the SAM (sympathetic adrenomedullar y) system, leading to the fast
release of adrenaline and noradrenaline, and stimulating the body’s vital organs.
Its actions are almost instantaneous but are also short- lived. Slightly slower is
the better known HPA (hypothalamic- pituitar y- adrenal) axis, involving the stress
hormone cortisol, a more slow- burning but longer- lasting system. We all need
such arousal mechanisms when frightened or angr y, but some people can get
stuck in this system, with dire physiological and psychological consequences.
The third, and evolutionarily most advanced, element of our autonomic nerv-
ous system is seen in particularly complex form in humans, and is central to feeling
good and being open to others. It depends on a sophisticated (ventral) branch of
our vagus nerve which travels through our bodies from brain stem, heart, stom-
ach, other internal viscera and our facial muscles. This ‘smart’ vagus nerve is active
in processes like bonding, attachment, social communication, empathy and care
for others. This system stops working when we feel anxious or threatened, and has
an opposite effect to the sympathetic nervous system’s arousing mechanisms. It is
part of the parasympathetic nervous system which calms us down.
When feeling calm and trusting, such as when a child is relaxed and play-
ing happily in the presence of a mother, then this system involving our ‘smart’
vagus ner ve will be active. Its thousands of ner ve endings communicate with
many of our internal organs, like the gut. Indeed the gut has its own ‘enteric’
ner vous system which some consider our second brain (Furness, 2008). Eighty
Figure 8.2 Autonomic Nervous System

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per cent of its fibres are afferent, or in other words most of the communication
is going from gut to brain and not the other way around, which might make
sense of so- called ‘gut instinct’. Indeed the gut has about 100 million neurons, as
many as in a cat’s brain, and we also know that there are even more glial cells
than neurons in the gut (Kabouridis et al., 2015). These are firing both sympa-
thetic and parasympathetic patterns, and are rich with neurotransmitters such
as serotonin. The heart too has many neurons that communicate to the brain, and
the ventral vagus ner ve is implicated in this communication between brain and
bodily viscera, and in attachment, bonding, love and co- operation.
Vagal tone is a ver y measureable trait, most easily via something called
heart- rate variability, which is basically the variation in time between heart beats.
Greater variability is generally linked to both better physical and psychological
health. Ideally our heart rates go up when we breathe in, maybe such as when
watching scar y films, and come down when we breathe out, such as when watch-
ing films that induce loving feelings (Goetz et al., 2010). At our most healthy we
move easily between these states. This is what we see in securely attached chil-
dren after the Strange Situation Test. They are quickly distressed but return to
normal easily when their attachment figure returns. Clinicians are worried about
children and adults who can only respond within a ver y narrow range.
People who have what is called high vagal tone are more relaxed and open.
Premature babies with low vagal tone are more stressed and less likely to sur vive.
Adults with borderline personality disorder have lower vagal tone, and less vari-
able heart rates (Austin et al., 2007), and those with low vagal tone are more prone
to PTSD (Minassian et al., 2015). Indeed it is being seen as an important biomarker
for psychopathology generally, across many diagnostic areas (Beauchaine and
Thayer, 2015). Secure attachment is also linked with better vagal tone (Diamond
et al., 2012). Children with high vagal tone are the ones who tend to be friendly
and helpful in class, generally the securely attached ones, whereas those with
low vagal tone are more likely to have behavioural problems, be less able to self-
regulate and also be less happy (Taylor et al., 2015a).
All three variants of the autonomic ner vous system are adaptive. We need to
become sympathetically aroused, and move into fight or flight, to sur vive fright-
ening situations. In extremis, when facing life or death situations, a numbing
freeze response can be lifesaving. Yet most of us will equate the states seen with
high vagal tone as the psychologically healthy ones, in which one feels physically
at ease and more able to be empathic, open and give and receive love.
Thus modern interpersonal neurobiology takes account of whole bodies,
not just brains. As Damasio points out, emotions are in fact bodily states (1999).
Via a process called neuroception (Porges, 2011) we non- consciously read envi-
ronmental cues and react accordingly. Threat can be picked up out of conscious-
ness and for example in busy cities our metabolism speeds up (Levine et al., 2008).
Just living in a deprived area, such as one with many boarded up shops, has an
effect on body states including increasing testosterone levels (linked to aggres-
sion) in boys (Tarter et al., 2009). By contrast the presence of green spaces and
trees affects the body and ner vous system positively (Haluza et al., 2014).

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Children brought up in a violent environment are likely to have a more
highly activated sympathetic ner vous system and be easily aroused, often in a
dramatic way, finding it hard to calm down, concentrate or feel at ease. Such
hyper vigilance and high arousal might be adaptive in violent or abusive homes,
but less so if, for example, an adopted child in fact now has benign and kindly
parents.
Similar to our ner vous systems, different aspects of the functioning of our com-
plex brains also have their origins in different stages in our evolutionar y histor y.
Although a simplified model, Maclean’s (1990) concept of the triune brain is a
useful starting point. This theor y uses the metaphors of a more ancient reptilian
brain, the mammalian limbic system and the more recent neo- cortex, suggesting
that different aspects of human brain functioning can be linked to these three
stages in our evolutionar y histor y.
Of course the brain is far more interconnected than the simplified triune
metaphor suggests, nor is there a one- to- one relationship between specific activi-
ties and brain areas. For example speech or fear are not located in just one brain
region (Barrett, 2016). The brain’s complex sets of neural networks can have
Evolution and brain areas
Figure 8.3 triune

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multiple functions and each depends on a host of other brain areas to do their
work. Yet despite some over- simplification, the shorthand of the triune brain pro-
vides a helpful metaphor for making sense of different brain processes.
Many aspects of our brain functioning have changed little since the reptil-
ian brain reached its most advanced stage some 250 million years ago in reptiles,
or indeed since amphibians some 500  million years ago. These areas control
ancient sur vival instincts for dominance and aggression, and vital processes
such as heart rate, breathing, temperature regulation, pain perception, balance.
They also are central to our freeze- based sur vival response described earlier.
Older structures within the reptilian brain such as the brain stem are central
to consciousness (Solms and Panksepp, 2012), although not of a self- reflective
kind. We also share with reptiles ancient brain areas such as our hypothalamus,
important to ner vous system functioning and the hormones we release, and also
our cerebellum, central to habitual or procedural learning. These areas are fully
active from birth, and are also ver y affected by early trauma. These ancient brain
functions are ver y reliable, but not ver y flexible and once their patterns get set
they are hard to change.
In mammals, some 100  million years later, the limbic system came into
existence. This is sometimes seen as the seat of our emotional lives. It is con-
cerned with how we make judgements, learn whether an experience is likely to
be pleasurable or not, and how we form emotional memories. It contains vital
structures such as the amygdala, central for emotions such as fear, as well as the
hippocampus, which has a vital role in other forms of memor y. The limbic sys-
tem powerfully links with our endocrine (hormonal) system, via the thalamus,
as well as with our autonomic ner vous system. In the limbic system we also see
areas involved in our wanting or seeking systems (Panksepp and Biven, 2012)
particularly the system involving dopamine.
The limbic system is connected to the evolutionarily more recent cortical
areas, which includes the frontal lobes. Their origin is a mere two or three million
years old, and is most highly developed in humans. Without it there is no self-
reflection, language, abstract thought, empathy, emotional regulation, imagina-
tion and much that we consider quintessentially human. These develop well with
good parenting but are profoundly affected by trauma, which as we see can turn
off capacities for empathy, emotional regulation and complex thinking. These
prefrontal areas are involved in calming subcortical areas such as the amygdala
that fire up in fear or anger.
The different prefrontal regions play different roles. We need certain areas
for self- reflective processes (especially the dorsal- medial prefrontal cortex),
others for working memor y, including keeping emotional memories (the dor-
solateral prefrontal cortex), while our ventromedial prefrontal cortex is vital to
our sense of self as embodied, our capacity for emotional regulation (such as by
calming the amygdala), as well as for much social decision- making. It is thus not
surprising that emotional trauma and abuse not only profoundly affects the devel-
opment of these brain regions (McCror y et al., 2011a) but as a result can have a
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All these regions, and the networks they are embedded in, are profoundly
interlinked. For example another area (the cingulate), runs centrally from the
back of the head to the brow, and also inhibits amygdala firing, again less suc-
cessfully in those traumatised people who struggle to dampen emotions (Lu
et al., 2013).
There are of course too many important brain areas to describe. One
central one is the insula (or insula cortex). This is maybe best known for being
activated in disgust (Sinha, 2014), but is involved in awareness of bodily sensa-
tions, or interoception. Some, such as Craig (2011), view the insula as central to
our sense of self. It is another area that is profoundly affected by experiences of
trauma, becoming much more activated and leading to more autonomic arousal
(Bruce et al., 2012) but it is also an area where functioning can be enhanced, for
example by meditation (Lazar and Treadway, 2013).
An exercise I quite often undertake with myself when working with clients
is to ask whether it is their reptilian or mammalian brains or the cerebral cortex
that is active at a particular moment. Basic instinctual responses emanate from
the reptilian brain, responses such as hate, lust, aggression, and particularly the
powerful defensive strategies of fight, flight or freeze. If one is confronted by
massive anger or hatred in a child who at that moment has a highly active brain
stem and is in ‘fight’ mode, it is folly to make an intellectually complex comment
that only the cerebral cortex could make sense of, as those more complex parts
of the brain are not active at such moments.
Figure 8.4 frontal Lobes

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In reality the three brain areas are not separate, and complex relationships
and pathways have developed between them over the millennia. Siegel (Siegel,
2012) suggests that psychological health is marked by ever- increasing complexity
and interdependence of aspects of brain functioning, and that many of the people
who have developed psychological problems of one form or another show a less
complex and inter woven structure, with more chaos and rigidity, and less organi-
sation. These traits develop as adaptive responses to challenging experiences.
Experiences thus get written into our bodies and brains, and one way this hap-
pens is via our neurochemical and hormonal systems. The human brain produces
many hormones and opiates, some of the best known being cortisol, dopamine,
oxytocin (sometimes called the ‘cuddle hormone’) and serotonin, as well as
endogenous opioids and endorphins. Cortisol levels of children starting nurser y
shoot up compared to those receiving home- based care, attachment anxiety trig-
gering its release (Groeneveld et al., 2010). Children with less secure attachment
patterns, such as those whose parents have serious social phobia, tend to have
even higher cortisol levels (Russ et al., 2012).
Some children become predisposed, for example, to be quickly sympa-
thetically aroused, releasing large amounts of adrenaline and cortisol after the
slightest stimulus, such as a loud noise down the road, and they might not have
the buffer of the protective hormones such as oxytocin that can lower fear and
increase feelings of ease. The smart vagus seems to be a kind of oxytocin super-
highway and when vagal tone is high, we become calmer, more at ease and open,
and release protective hormones.
Cortisol has a number of pernicious effects, leading Gerhardt (2014) to
dub it ‘corrosive cortisol’, particularly in light of how it can attack cells in the
hippocampus, the part of the brain that is central to memor y. It can also severely
compromise the immune system (Morey et  al., 2015). Occasionally extreme
trauma can have the opposite effect and result in extremely low cortisol levels,
something often seen in PTSD victims such as Holocaust sur vivors (Yehuda
et al., 2005). Either way too much or too little cortisol or stress is not what the
human body was designed for.
Oxytocin is particularly important in attachment and bonding (Zak, 2012),
and monogamous pair- bonding mammals produce higher levels of it. Famously,
one study of two different kinds of voles found that promiscuous meadow voles
showed very few loving or nurturing behaviours and released little oxytocin (or the
molecularly similar vasopressin) compared to monogamous nurturing prairie voles.
Indeed if meadow voles were artificially given vasopressin they tended to become
loyal and faithful to their sexual partners, while if the release of oxytocin and vaso-
pressin were inhibited then prairie voles became as undependable as their meadow
cousins. We see the same pattern in other creatures. If we stop the oxytocin release
in rats they become much worse parents (Odent and Uvnas- Moberg, 2011).
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Oxytocin induces tranquillity, reduces social fear and pain, and increases
empathy. Experimenters found that when shown pictures of threatening and scary
faces, those given a placebo showed much higher activation of the amygdala, that
brain area central to stress and fear, than the group given oxytocin (Kirsch et al.,
2005). We release oxytocin when we have a massage, or are being lovingly touched,
and with more oxytocin we become more generous (Morhenn et al., 2008), have
lower blood pressure (Holt- Lunstad et al., 2008), and even pay more attention to
the eye- regions of those around us (Guastella et al., 2010). Oxytocin it seems oils
the wheels of social life, enhancing trust, generosity, empathy and loyalty.
In one study fathers given oxytocin intra- nasally not only became more
sensitive to their infants, but these infants became more responsive in return
(Weisman et  al., 2012). The oxytocin levels of human parents of either gender
rises considerably in the months after becoming a parent, and the higher the
levels, the more affectionate play we see (Gordon et  al., 2010), and the more
sensitivity to infant cues (Strathearn et  al., 2012). Mothers with more insecure
attachment styles have high activation of brain areas such as the insula, and the
insula plays a central role in rejecting and aversive responses.
The variants of genes we inherit in part predict how much oxytocin we will
release. There are two versions of the oxytocin receptor gene, OOXTR, A  or G,
which means that any of us might have AA, GG or AG. Those with two G’s seem to
act the most empathically, so much so that when observers watched less than half a
minute of 23 romantic couples in conversation, they consistently tended to say that
those with two G’s were kinder and more empathic (Kogan et al., 2011). Similarly
a recent Chinese study (Wu et al., 2012) isolated different variants of the oxytocin
receptor gene, and found that some genetic variants were predictive of empathy
and understanding another’s feelings, while other variants predicted more cogni-
tive empathy, such as perspective taking. Genes do play a role, but generally, the
more good loving experiences we have early on in life, the more oxytocin receptors
we are likely to develop, while stressed childhoods lead to lower oxytocin in both
men (Opacka- Juffry and Mohiyeddini, 2011) and women (Heim et al., 2008).
While I have concentrated on oxytocin, there are other chemicals that play
a central role in attachment and emotional wellbeing. For example the important
BDNF, Brain Derived Neurotrophic Factor, is central to neuronal growth and
sometimes called brain fertilizer, and it too is adversely affected by childhood
trauma (van der Meij et al., 2014). However it is increased by enriching environ-
ments, leading to new neuronal growth as well as lower anxiety (Cao et al., 2014).
The better known serotonin, targeted by anti- depressant drugs like Prozac, is fun-
damentally linked to feeling good. We see low levels of it in depression, alongside
irritability and aggression, both in humans and primates (Car ver et al., 2008).
In the next chapter I examine epigenetics in more detail, but research is clear
that those who inherit the short version of a serotonin transporter gene are much
more vulnerable to childhood trauma and neglect, releasing even less serotonin in
the face of bad experiences and being more prone to aggression, anxiety and depres-
sion (Harkness et al., 2015). For example monkeys removed from their mothers at
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from groups (Shannon et al., 2005), and human childhood adversity such as mater-
nal depression or trauma gives rise to lower serotonin levels (Field, 2011).
Abusive early experience equates generally with lower serotonin levels
anyway, and we know that many on the fringes of society, such as aggressive psy-
chiatric patients, prisoners and others, have had terrible early experiences and
have low serotonin levels (Davidson et  al., 2000). Poor early emotional regula-
tion, and exposure to violence, neglect or abuse, can all have a devastating effect
on our hormonal systems.
There are counter vailing tendencies to the actions of oxytocin and sero-
tonin, as seen for example in the hormone associated with males, testosterone.
We know for example that violent prisoners, both male and female, have higher
testosterone levels (Dabbs and Dabbs, 2000). While we know that oxytocin
enhances cooperation and mutual kindness, testosterone has the opposite effect,
making people more egocentric and less collaborative (Wright et al., 2012). Even
infants with higher levels of testosterone are less able to read the emotions of
others, tending to have less empathy (Baron- Cohen, 2011), while artificially giv-
ing people testosterone has a negative effect on empathy levels. Interestingly
males, on becoming fathers, tend to experience a lowering of testosterone levels,
presumably to enhance nurturing and loving behaviours which testosterone can
inhibit (Gettler et  al., 2011). Thus biology, culture and life- histor y inter weave,
and while people can be born with lower or higher levels of testosterone, life
events and cultural influences also play a part.
Dopamine too deser ves a mention. It is central to the reward system, acti-
vated when we are positive, excited or eager for something, and is central to our
appetitive or ‘seeking’ system (Panksepp, 2004). However it is also involved in
addiction, such as to drugs, alcohol, as well as gaming and pornography (Voon
et al., 2014). Depressed mothers have low dopamine levels, but more worr yingly
so do their ver y young babies. Of course such mothers do not feel ver y rewarded
by their infants, and their infants experience less pleasure. On the other hand
mothers of securely attached children have their dopamine circuitr y stimulated
by seeing pictures of their infants (Strathearn et al., 2009). Many medical and rec-
reational drugs such as cocaine target the dopamine system, and indeed many
mimic the body’s own opiates. It is low status, highly stressed mammals that
consume more cocaine when it is placed in front of them (Cruz et al., 2011), as
if compensating for the lack of naturally produced hormones that make us feel
good. What the research increasingly shows is that not only our brains but our
whole hormonal systems are powerfully programmed by the kinds of early expe-
riences that we have (Galbally et al., 2011).
Schore (2009) stresses the importance of the early months and years for brain
development, a time when huge developments are taking place in the right
Empathy cerebral hemispheres, attentional and
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hemisphere, which can be viewed as the seat of emotional processing, along
with other elements of the limbic system. The parts of the brain which are more
involved with logic and thinking, the left hemisphere and parts of the cortex,
which in evolutionar y terms are relatively new, are in fact not much ‘on- line’ in
the first couple of years when many vital neuronal pathways and synaptic con-
nections are forming. Similarly the part of the brain that contextualises explicit
or declarative memories, the hippocampus, is not ver y developed in these
early years.
McGilchrist (2010) has particularly helped make sense of how our two
cerebral hemispheres experience the world quite differently. He has shown, for
example, that strokes in areas of the right hemisphere disable empathy circuits
and give rise to calculating, instrumental ways of relating to others, typical of left
hemisphere functioning. The right hemisphere is much more involved in emo-
tional experience, in empathy and bonding. The kinds of emotional skills central
to parenting, and indeed to therapy, such as empathy, are primarily occurring
through the right hemisphere. When patients have damage to parts of their right
hemisphere, they can lose their ability to empathise and become less attuned to
other people’s feelings, hopes and concerns.
With left hemisphere dominance one sees much higher levels of optimism,
often of an unwarranted kind. People who are more positive have higher activa-
tion of their left prefrontal areas, whereas more depressed children and adults
have higher right prefrontal activation (Davidson, 2008). This might link with
how we see an overly optimistic presentation in avoidant attachment, an attach-
ment style that tends to privilege rationality over emotional understanding.
It is important to note that both hemispheres are vital to emotional health,
and it is the over- valuation of one or the other that can cause difficulty, as
McGilchrist shows. For example the capacity to develop a coherent narrative
about emotional experiences, as seen in adults with secure autonomous styles
in the Adult Attachment Inter view, requires both the capacity to tell a coherent
consistent stor y, for which the left hemisphere and language centres are cru-
cial, and the ability to take in and process emotional experiences via the right.
Stor ytelling led by the left brain alone can be rather wild when not harnessed by
right brain emotional understanding, as evidenced in the remarkable but oddly
out of touch stories seen in studies of those with right hemisphere brain damage
(Ramachandran, 2012) or split- brain patients (Sperr y, 1971).
It was discovered just a few years ago that when we stop actively paying
attention or tr ying to do a task then a whole linked set of brain regions, called the
Default Mode Network (DMN), start firing up together and these turn right
off again the moment we actively attend to something or make an effort (Raichle,
2015). Another set of brain regions called the Executive Attentional Network
(EAN) turns on we are actively tr ying to do something or are being focused. The
EAN is only active when the DMN turns off and vice- versa. The Default Mode
Network plays an important role in creativity (Kühn et al., 2014), and may trig-
ger states of mind that get too little emphasis in an increasingly task oriented
world (Immordino- Yang et al., 2012). Children just playing or musing would have

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higher DMN activity for example, as do more creative people, and it is active
in daydreaming (Kucyi and Davis, 2014). Interestingly the DMN consumes
most of the energy used by the brain. Too much DMN activity is not a good
thing, and is seen for example in schizophrenia (Landin- Romero et al., 2015) and
chronic mind wandering, but too little inhibits creativity. Indeed the level of our
DMN activity is something that distinguishes humans from almost all other spe-
cies including primates. It seems that the DMN activity is centrally implicated
in developing associational networks which are central to creative thought, as
well as a range of autobiographical memor y processes. Interestingly the DMN
recruits brain regions in both the left and right hemispheres in its creative work.
Yet there is also a link it seems between the left– right hemisphere differences
and the Default Mode and Executive Attention networks. When concentrating
on mechanical objects our Executive Attention Networks are much more active
than when thinking about other people’s feelings and states of mind, when we
have more active Default Mode Network activity (Jack et al., 2013). The DMN is
actively involved it seems in personal memories and our sense of self.
There is a lot more that we are bound to find out in the next few years, not
only about the effects of different experiences on particular areas of brain func-
tion but also on the connectivity between these brain areas.
Brain science has recently discovered many networks involved in the attach-
ment system, in empathy, creativity and understanding of other minds. In secure
attachment we see more activation of areas crucial to empathy, particularly in
the prefrontal regions, while in avoidant attachment we see a deactivation of the
medial orbitofrontal cortex (Lenzi et al., 2012). A consistent finding is that there
is much higher activation of the amygdala, that brain area central to fear and
other strong emotions, in those subjected to trauma and violence, leading them
to be far more reactive and less able to be still and calm (Palombo et al., 2015;
Sigurdsson et  al., 2007; Thomason et  al., 2015a). Parents who are more intru-
sive and less sensitive tend to have a more ‘triggered’ amygdala, especially in
response to infant cr ying (Riem et al., 2012). Indeed some studies suggest that
insecure attachment in infancy is linked with larger amygdala volume in adult-
hood (Moutsiana et al., 2015).
A host of research is combining to show that trauma, abuse and early levels
of stress affect a range of brain areas in a way that we are beginning to under-
stand more (Andersen and Teicher, 2008). Victims of trauma and abuse have a
smaller corpus callosum, the bundle of fibres that links the right and left hemi-
spheres, and so less capacity for the hemispheres to communicate effectively,
or to work well in tandem (Teicher et  al., 2004). In traumatic memor y we see
higher right hemisphere activation as left hemisphere more logical processes get
turned, presumably as sur vival response.
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Similarly childhood trauma is ver y linked to reduced activity in language
centres such as Broca’s area (van der Kolk, 2014), inhibiting the ability to put
feelings into words. Those suffering childhood trauma often have smaller hip-
pocampi in adulthood (Andersen et al., 2008), the hippocampus being central to
forming and retrieving memories, amongst other things. We also consistently
see less activation of prefrontal areas such as the ventromedial prefrontal cortex
in children who have suffered trauma, abuse as well as severe neglect (Mehta
et  al., 2009). As I  have described, these prefrontal areas are vital for empathy,
self- reflection and emotional regulation.
Chronic activation of the sympathetic ner vous system after high stress or
trauma not only gives rise to the physiological signs of stress but has profound
long- term effects. We see higher levels of worr ying biomarkers after trauma
and high stress. These include lower immune responses (Gonzalez, 2013), more
mental and physical illness and risk- taking, a higher propensity for speeded
up metabolisms (Danese and McEwen, 2012a), and both higher levels of inflam-
mation (Cattaneo et  al., 2015) and shorter telomeres (Price et  al., 2012), both
classic signs of poor health. Shortened fraying telomeres, the caps on the end of
chromosomes, are classic biomarkers for ill health and early death, both of which
are linked to such early adversity (Van Niel et al., 2014). The connection between
high stress, chronically raised cortisol levels, inflammation, poor immune func-
tioning, illness and early death has become well established (Baylis et al., 2013).
Of course these risk factors will be moderated by genetic inheritance too. For
example, although boys as young as nine years old from adverse backgrounds
were found to have shorter telomeres than non- traumatised same age counter-
parts, the effects were less bad in carriers of some alleles or gene variations
(C. Mitchell et al., 2014). However genes notwithstanding, our whole bodies, not
just our minds, react to psychological adversity, and as van der Kolk writes ‘The
Body Keeps the Score’ (2014).
How hopeful or gloomy should such research leave us? We know that the behav-
ioural patterns that are established early on can be ver y hard to shift, and that
once an experience is burnt into the circuits of the amygdala it tends to stay there.
However we also know that new circuits can grow and form, and indeed neuro-
genesis is possible in brain areas such as the hippocampus as a result of new
experiences (Kempermann, 2015). There are definite windows of opportunity
during which certain aspects of brain growth mainly occur, even if the brain can
certainly change throughout the lifespan. It is also true that some opportunities
can be lost forever if not taken in time. Language development is one well known
example, and it seems the same is also true for certain emotional capacities. The
best known windows of opportunity, when there is massive brain growth and
change, are the last trimester of pregnancy through the first few years of life, but
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also in adolescence when huge changes equally occur in the brain. Maybe it is not
surprising that so much therapeutic effort is directed towards those age- groups.
We also know that change is possible throughout the lifespan. A hearten-
ing example is the fact that London’s famous black cab drivers seem to ‘grow’
different sized and shaped hippocampi from the rest of the population (Woollett
and Maguire, 2011). There are also studies showing how professional help such
as psychotherapy (Cozolino, 2010; Beutel et al., 2010; Karlsson, 2011) and mind-
fulness (Davidson et  al., 2003; Hölzel et  al., 2011) give rise to ver y clear brain
changes, particularly in areas linked to emotional regulation, interoception,
memor y and self- reflection.
It also seems fairly clear that other forms of caregiving can facilitate forms
of neurobiological reprogramming (Fisher et al., 2011; Kroupina et al., 2012; Bick
et  al., 2012). Good foster placements of infants and toddlers leads to changes
from insecure to secure attachment and also to lower biomarkers of stress
(Bernard et al., 2014). Support such as therapy can aid the capacity to interpret
experience in new and less frightening ways, which, as LeDoux (1998) argues,
can strengthen cortical brain areas that are able to dampen down subcortical
regions such as the amygdala. Other effects of such help are likely to include
the laying down of new procedural memories, strengthened links between left
and right hemispheres, enhanced reflective capacities, better understanding of
other minds, greater ability to form a coherent narrative about oneself, improved
capacity to regulate emotions and to tolerate difficult emotions without acting out
and to sustain positive affect.
However caution is also needed. The field is constantly changing and there
is much that we do not know. New discoveries are continually opening up whole
new vistas. These might be about glial cells which as discussed might be the seat
of all manner of new discoveries, or the Default Mode Network (DMN), which
seems to have important links with attachment and emotional health (Bluhm
et  al., 2009). There are likely to be many more new and unexpected discover-
ies. We have learnt a lot, but maybe more than anything we are learning how
much we do not yet know. Nonetheless this is an exciting time for neurobiologi-
cal science. New findings are increasing our understanding of the ways in which
humans develop, as well as opening up all manner of new possibilities for making
sense of therapeutic work.
• The human brain is hugely affected by experiences.
• Different parts of our brains and ner vous system have origins in different
points of our evolutionar y histor y.
• Stress and trauma lead to important brain functions going offline and oth-
ers coming to the fore.
• We should think of whole body systems not just the brain as an organ in
our head.
• Our left and right hemispheres interpret the world somewhat differently.
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• We have both a Default Mode Network, that turns on when we are idle
and not doing anything, and Executive Attention Network which is actively
when we are tr ying to do anything.
• Experiences profoundly affect our autonomic ner vous systems and our
hormonal programming.
• Serious maltreatment has particularly worr ying effects on the brain.
• Change is possible throughout the lifespan.

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C h a p t e r   9
Epigenetics, evolution
and how nature meets
nurture
Epigenetics and evolution 108
Nurturing nature in action 109
Orchids and dandelions 111
Sins of the fathers and Lamarck 112
Genes affect behaviours in self and others 113
Gene environment interaction and caution 114
Key points 115

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The relatively new field of epigenetics has in recent years revolutionised under-
standings about the relationship between genes and environment. Historically
genes were seen as inherited and set in stone, and personality traits viewed as pre-
determined by genetic inheritance. Evolutionary theory as we currently think about
it is a field that has combined the ideas of Darwin with the discovery of genes by
Mendel (Gorp, 2007). Darwin’s theories described how the species or traits which
‘fit’ a particular environment survive and reproduce and hence pass on their genes.
A classic example is peppered moths. Before the industrial revolution a huge major-
ity had a light colour which provided good protection against predators. The dark
ones were easily spotted and devoured and hence could not reproduce and pass
on their genes. Following the industrial revolution the number of dark coloured
peppered moths grew from a mere 2 per cent to about 95 per cent, because with
changes such as pollution it was now the light coloured ones which were easily spot-
ted and eaten. The successful propagation of one trait over generations is simply
due to more carriers of a particular trait surviving and then reproducing.
This was a different view to that of Lamarck (1783) who thought that what
happened in one generation literally affected the next generation; for example
giraffes might stretch their necks to get food and neck- stretching might become
a skill learnt in one generation and that new skill was passed down to the next
via genes. This is different to Dar win who suggested that it was just that the
long- necked giraffes got enough food to sur vive and reproduce and pass on that
long- necked trait while short- necked giraffes perished and did not reproduce.
For Lamarck neck- stretching or colour changing capacities were developed and
passed on, but for Dar win the genes and DNA in the moths or giraffes did not
change, but rather, simply, the ones that best ‘fitted’ the environment sur vived
and reproduced.
Dar win’s view has prevailed and been proven mainly right, although with
some challenges recently as we will see. Dar win though did not understand the
mechanism whereby traits were passed down the generations. This vital piece of
the jigsaw was provided by Mendel, an Austrian monk, who discovered genes.
Mendel found that when he crossed yellow peas with green ones, the next gen-
eration surprisingly were all yellow, but in subsequent generations green ones
popped up. Here yellow genes were dominant and green ones recessive.
We inherit two versions of a gene, one from each parent, these versions
being called alleles, and when these alleles are different then one will be domi-
nant (e.g. the yellow colour in Mendel’s peas) and one recessive. This can affect
which of multiple traits are dominant, such as eye colour, height or certain per-
sonality predispositions. The genes we inherit are called our genotype, and how
they express themselves is called the phenotype. Going back to Mendel’s yel-
low  and green peas, subsequent generations of mating peas might inherit two
yellow alleles, two green alleles, or one of each.
Obviously human traits are much more complex than this but we see some
of the same principles. For example in a Chinese population a gene involved with
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producing serotonin can have two variants (either a C or G allele), and as we
inherit one from both parents we might have CC, CG or GG alleles. Those with
two C’s were statistically more likely to have a good romantic relationship than
the other two groups (Liu et  al., 2014). Of course multiple other factors would
affect whether or not one is in a successful relationship, but genetic factors add
another twist.
After Mendel the next stage of research was unlocking the secrets of DNA
by Watson and Crick, alongside the unsung Rosalind Franklin (Watson, 2010), by
studying DNA sequencing. This was the precursor of the Human Genome Project
that has in effect been mapping all human genes and uncovering their codes.
A genome comprises all of an organism’s DNA and genes. It had been
thought for a long time that genes are the main causative factor in how we turn
out, that our physical and personality traits were determined by the genes that
we inherit. Thus there were huge hopes for, and investment in, the Human
Genome Project, which people believed might revolutionise biology and medi-
cine. However the new science of epigenetics has in part undermined these
hopes. Epigenetics (epi means above) studies how various genetic traits might
be turned on or off, and cells might read genes in different ways, due to differ-
ent environments and experiences. In other words the genes we inherit do not
change, but how they might be expressed does, or in the more technical lan-
guage, our phenotype is affected by our experiences.
A classic example was the Dutch famine study reported in Chapter two.
Star ving pregnant mothers had babies who grew up to be more susceptible to
heart- disease and other illnesses. These illnesses were not caused by the genes
that were inherited but by how certain genes were expressed due to the experi-
ence of the famine. The same is true of many personality traits.
A genetic predisposition, such as for depression, might be expressed or
silenced in response to certain experiences, such as abusive or loving parent-
ing, and people with different alleles might respond quite differently to exactly
the same parenting experiences. Our genes receive and respond to messages
from other genes, hormones and other cues like nutrition or emotional stressors.
Hence nature and nurture, genes and environment, interact powerfully. The days
when researchers thought they could explain traits like intelligence or hyperac-
tivity purely by genes are over, but nor does experience explain ever ything. It is
always a combination of the two.
Some of the earliest relevant research concerned a serotonin transporter gene
(serotonin being a neurochemical implicated in positive feelings). Those with
a shorter version of this gene who experienced maltreatment as children were
much more likely to experience depression than those carriers of the longer
alleles who had similarly traumatic experiences. However, neither long nor short
carriers were more likely to experience depression if they had nurturing rather
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than adverse early experiences (Uher, 2014). People with this short allele also
react more to frightening images, with brain scans showing more activation in
response to such images in a range of brain regions, including the amygdala,
something not seen in those with the longer allele (Drabant et al., 2014).
Similarly if children are traumatised or severely neglected, and also have
a particular gene variant which produces low levels of an enzyme, monoamine
oxidase A (MAOA) in the brain, then they are more likely to engage in violent
or antisocial behaviour than people with the same gene who were not mistreated
(Provençal et  al., 2015). Also, children who suffered maltreatment, but have
the variant which produces high levels of MAOA are protected and tend not to
become antisocial. Treating children badly can affect them hugely, but all chil-
dren are not necessarily similarly affected by the same mistreatment. This link
between childhood adversity and later antisocial behaviour and MAOA has been
found many times, albeit mainly with males (Byrd and Manuck, 2014).
What has been exciting for many researchers is that genes need not be
our destiny, and our experiences make a huge difference to whether genetic
potentials are expressed or silenced. Our genes follow instructions from the epi-
genome, and we can think of the epigenome as like the software that induces
the hardware (genome) to act in certain ways. This gives hope in many ways.
For example inter ventions such as meditation (Kaliman et al., 2014) or exercise
(Goto et al., 2015) have been shown to have a beneficial effect on how a range of
health related genes get expressed.
There has in recent years been research on a whole host of candidate genes,
too many to mention here, which have been identified and linked to a range of
behaviours and disorders. Variants of the dopamine receptor gene, DRD4, for
example, have been highly researched. If you have the long rather than the short
allele of this gene then you are more likely to get ADHD (Langley et al., 2014),
and this genetic variant also increases the likelihood that children will be nov-
elty seeking, and even become disorganised in attachment terms (Bakermans-
Kranenburg et  al., 2008). Another study looked at how genes predisposed for
ADHD, but only if there was harsh parenting (Harold et  al., 2013), and in this
study the parents were adopters and so had different genes to their children, so
the adhd symptoms were evoked by a harsher parenting style. Yet if the same
children receive sensitive and attuned parenting these worr ying effects are not
seen. As often we see that experiences and genes, nature and nurture, interact to
produce their effects (van Ijzendoorn and Bakermans- Kranenburg, 2015).
It is worth asking why evolutionar y processes or nature would decree that
any child should be born with a version of a gene that gives rise to a worr y-
ing prognosis such as ADHD. It seems though that such a temperament might
well be advantageous in some environments. For example when we examine the
genes of people involved in major migrations, such as refugees, we see that a
higher proportion than average have the same ‘novelty- seeking’ genetic variant
that leads to ADHD in children (Matthews and Butler, 2011). One can speculate
that being a carrier of that novelty- seeking variant might have aided the likeli-
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danger loomed, and hence sur vive to pass on this genetic variant. To add yet
another twist, about one seventh of a Kenyan tribe, the Ariaal, had this long ver-
sion of the DRD4 gene. The Ariaal live either a nomadic life, moving from place
to place, or a more settled pastoral life. Of those with the novelty- seeking allele,
those living a nomadic life, wandering across territories with sheep and goats,
were well nourished and healthy, whereas those with this same allele living a set-
tled pastoral life were less well nourished (Eisenberg et al., 2008). It seems that
having the ‘ADHD- inducing’ variant might well be a better option when living a
less settled kind of life, and that different genetic variations aid sur vival or suc-
cess in some environments but not others.
Thus what we are seeing is that some children are born with more genetic
susceptibility than others to certain disorders, and also, as we will see, certain
kinds of parenting, such as closely monitoring a child’s behaviour, can hugely
reduce the potential expression of genes that other wise might give rise to wor-
r ying behaviours.
When such epigenetic research was first published, most assumed it meant that
some people were just more resilient genetically while others had more genetic
vulnerability. If you had the short version of the 5HT gene for example then you
were more susceptible to bad experiences and hence viewed as less resilient
than those with the long version. In fact it is more complex than that. As Belsky
(2011) and others have argued, one way of thinking about such research is that
some children are more susceptible to ‘rearing influence’ generally than others.
Belsky suggests that this makes evolutionar y sense because parents increase
the chances of more children sur viving and thriving if some of their children are
influenced by their current environment, while others are more likely to flour-
ish if the environment changes. Again we need to be aware of the influence of
both nature and nurture. Being spanked is not generally good for kids, and many
physically chastised children turn out to have antisocial behaviours, but more so
if they inherit certain genetic variants (Boutwell et al., 2011). Similarly cumula-
tive exposure to risk and stress, for example, was shown to affect patterns of
cortisol release in youth irrespective of which allele they had, but those who
were the most affected had the short variant (Willner et al., 2014). What seems to
be the case is that nurture has more effect on some children than others.
A metaphor that is often used is that of orchids and dandelions. Like
orchids, some children are ver y sensitive and thrive in certain environments
but struggle to do so in others, whereas others are more like dandelions who
seem to grow reasonably well almost anywhere but do not especially flourish in
ver y good soil. Different genes will be differently responsive to different kinds
of stressful or supportive environments (Melas et  al., 2013), and with different
results. For example one variant of a FAAH gene increases the likelihood of high
anxiety and also of being more likely to reach for drugs like cannabis as a way
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of managing this anxiety (Filbey et  al., 2010). Similarly, just one variant of the
dopamine D2 gene predisposes people for drug use such as cocaine in response
to difficult experiences, but if the environment is not difficult then they have no
more risk of substance abuse (Nader and Czoty, 2005).
Looking again at the DRD4 (7 repeat allele), insensitive parenting in the
early years predicts more externalising behaviours for carriers of the long but
not shor t variant (Windhorst et al., 2015) as well as worse emotional regulation
and more likelihood of disorganised attachment (Pappa et  al., 2015). Belsky
and others argue that we should not think of vulnerability genes but rather in
terms of relative plasticity (Belsky and Har tman, 2014b), because some peo-
ple are simply more influenced by experiences than others due to their genes.
These influences include positive as well as negative experiences. New genes
are being identified constantly which have similar dif ferential susceptibility
issues, such as for depression and anxiety linked to amygdala activation (Alisch
et al., 2014).
Linked to this idea, those with some genetic variants respond better to
certain inter ventions such as parenting programs (Bakermans- Kranenburg and
van IJzendoorn, 2015). One large study looked at children from adverse envi-
ronments and found that a group of ‘orchids’ with a variant of a gene involved
in cortisol production (NR3C1) were not just more susceptible to the effects of
bad experiences, but ver y importantly, these same children were the ones who
benefitted most from the Fast Track treatment program (Albert et  al., 2015);
in other words they were more likely to flourish in good soil and wither in bad
soil. An African study found that of a sample of young people at risk of substance
misuse who were given a treatment program, only those with the long allele (the
orchids) were successfully helped to avoid drug use (Brody et al., 2015). Similarly
the classic drugs for ADHD work better on children with some alleles than oth-
ers (McCracken et al., 2014), and different genetic variants are also linked to the
effectiveness of some anti- psychotic medication (Zhang et al., 2010) and antide-
pressants (Gibbs et al., 2014). Such findings might well have big implications for
future treatment planning. They also raise ethical issues about whether profes-
sionals should screen to see who might benefit from therapies, or who is more at
risk from certain environments; but what is beyond doubt now is the surprising
fact that some of us are more susceptible to being influenced by inter ventions
and by life experiences, than others.
Lamarck’s ideas were for a long time seen as naïve and simply wrong. However
in recent years we have seen some surprising discoveries that give some of his
ideas credence. For example Meaney (Anacker et al., 2014) bred generations of
both jumpy, insensitive rat mothers and calm nurturing ones. What tended to
happen was that subsequent generations followed the maternal pattern, rat pups
of insensitive rats became mothers who barely licked their own pups whereas
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loving rat mums licked and stroked, lowering stress symptoms and enhancing
health outcomes. Yet when jumpy baby rat pups were cross- fostered with loving,
calm nurturing rat mothers they not only became calm, not jumpy, but their own
pups then became high- licking loving nurturing mothers when they gave birth.
More importantly, the good or poor maternal rat care had an effect at a molecular,
genetic level, affecting the expression of receptors that regulate cortisol levels,
and more amazingly still, this then had an effect on how genes were expressed
in the next generation down as well (Anacker et al., 2014). Here nurture not only
turns on or off the expression of specific genetic potentials, via processes such as
methylation or demethylation, but can even alter the markers in genes that the
succeeding generation inherit.
Another recent example comes from mice. Male mice were subjected to
severe stressors at the same time as being exposed to a particular smell. Their
offspring, who had never encountered this smell, nor met their fathers, showed
clear fear of this smell when exposed to it (Dias and Ressler, 2014). They also had
definite changes in the relevant genes. This is a Lamarckian idea. It is also one
that is beginning to be researched in humans. Yehuda (2014) has found similar
effects in the children of Holocaust sur vivors, and further research is also taking
place looking at less powerful stressors and their epigenetic effects (Bowers and
Yehuda, 2015). In the children of the Holocaust sur vivors the relevant glucocor-
ticoid receptor genes were tagged in the same way as their parents’ genes were.
These were similar epigenetic changes to those Meaney found in his stressed rat
sample. Meaney also found ver y similar changes in the brains of adult humans
who committed suicide and had also experienced childhood trauma (Labonté
et al., 2013). Yehuda’s research on children of Holocaust sur vivors carefully dis-
counted the idea that the epigenetic changes could be caused by trauma in the
children’s lifetime and seems to provide evidence that the genes of offspring were
affected by their parents’ experiences. It is important to note that their genetic
code did not change, and the effects are unlikely to be transmitted across many
subsequent generations, but nonetheless experiences in one generation affected
the genes of a subsequent one, something Lamarck would have expected but not
Dar win.
Other intergenerational effects are beginning to be found, such as how
stress affects not just one’s own telomeres, which are really important bio-
marker of health, but could also affect the next generation too (Haussmann and
Heidinger, 2015). Such intergenerational transmission might well be evolutionar-
ily adaptive, as the offspring of trauma sur vivors would then born with a prepar-
edness for stress, which might make them more likely to sur vive or be more
resilient in the environments they were be born into.
Genes interestingly can also work the other way around. The kinds of genes
I have may affect how you respond to me and a child’s genes can have an effect
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on parenting styles. Studies suggest a bidirectional influence, whereby not
only do parents influence children, but a child’s temperament might tip a par-
ent into different states, such as depressive symptoms (McAdams et al., 2015).
More impulsive boys, for example, are more likely to provoke harsh parenting
responses, as one huge meta- analysis of twins showed (Avinun and Knafo, 2013).
Much research suggests that different children will evoke different reactions
from parents, peers and other adults (Klahr and Burt, 2014). Children with one
variant of another dopamine receptor gene were much more likely to evoke hos-
tile parenting and to be antisocial than those with the other allele (Hayden et al.,
2013). Of course the actual quality of parenting always remains central and if
parents are more consistently calm and less emotionally labile then this seem-
ingly ‘blunts’ the genetic influence of so- called provocative children, leading to a
calmer family life (Feinberg et al., 2007).
Harsh parenting can never be explained by a child’s characteristics but
these have been shown to have an effect. For example there is a link between
how adoptive parents parented their adopted children and the presence of char-
acteristics like antisocial behaviour in their adopted child’s biological parents
(Hajal et al., 2015). Some adopted children were seemingly more provocative in
part due to what they inherited from their biological parents. Such studies sug-
gest that children’s disruptive behaviour and temperaments can be a further fac-
tor in evoking harsh parenting in those parents anyway predisposed to be harsh.
However this will never be the major factor and one can never ‘blame’ a child for
a parent’s behaviour towards them.
Quite rightly there has historically been much suspicion of genetic research,
partly because such research has sometimes been used for questionable pur-
poses with insufficient evidence. An example that Rutter gives is how genetic
explanations were often given for the fact that people of Caribbean descent in
the UK have a far higher than average likelihood of developing schizophrenia.
Although genes can have a role in the development of schizophrenia, in this case
genes were unlikely to provide a proper explanation because rates of the illness
are far lower for ethnically similar populations in the Caribbean (Fung et  al.,
2006). One has to assume that distal factors such as inequality, racism, or socio-
economic status have a bigger effect. More worr ying uses of genetic research
include Eysenck’s controversial work on race and IQ (Eysenck, 1971), or the
questionable claims by Cyril Burt on the inheritance of IQ, which seems likely to
have used falsified data (Ward, 1998). Even more worr ying has been the use of
simplistic genetic ideas in eugenics, which led to practices such as mass sterilisa-
tion of some 20,000 unwilling Americans with learning disabilities in the 1930s or
the unthinkable genocide in Hitler’s Germany.
Rarely does a week go by without seeing a newspaper article declaiming
some newly discovered gene that is said to cause this or that kind of illness, such as
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a form of cancer, or a particular psychological symptom. These mostly should not
be taken seriously. Genes do not generally work in isolation or cause such major
effects on their own. More commonly, one sees genetic inheritance giving rise to
an increased probability of certain conditions ensuing, and there is nearly always
some interplay between genes and environment. To take one example, a study of
adolescent smoking patterns showed that when there is low parental monitoring of
behaviour, a particular genetic predisposition is likely to lead to smoking, but when
parental monitoring is high, then smoking is less likely in the same young people
(Dick et al., 2007). Here the parental environment snuffed out the genetic potential.
The question of whether people are more influenced by their biological
inheritance or their experiences is the heart of the nature versus nurture ques-
tion. What most of the research concludes is that neither nature nor nurture is
in charge. Genes matter but experiences can turn genes on and off and genetic
predispositions for behaviours, disorders, or personality types generally do not
become a reality without the trigger of particular experiences. While much epi-
genetic research remains at an early stage, it seems clear that nature and nurture
work in tandem and neither provides all the answers.
Epigenetics is a relatively new field of study and in the coming years we will be
seeing many more discoveries. One of the more exciting areas of potential research
concerns how gene– environment interaction can be understood at a macro- societal
level as well as at the level of family interactions. For example, in a massive Finnish
study of about 10,000 twins (Rose and Kaprio, 2008) the use of alcohol and tobacco
in adolescents was found to have a clear heritable element. However, this was modu-
lated not only by different kinds of parenting and sibling interactions, but in addi-
tion different schools and neighbourhoods also affected this, as also did differences
between urban and rural environments. More collectivist cultures such as China
seem to reduce the likelihood of externalising behaviour and aggression, even in
those carrying riskier alleles (J. Chen et al., 2015). Thus certain alleles are less risky
in collectivist than individualistic cultures, and this suggests that culture and genes
might mutually influence each other and co- evolve (Kitayama et al., 2014). Similarly,
in another study harsh parenting, perceived racism and the presence of certain
alleles were found to all have an effect on the presence of both risky thoughts and
behaviours (Gibbons et  al., 2012), while economic conditions such as the recent
great Recession affected harsh parenting, but more so in parents with some geno-
types than others (Lee et al., 2013). Overall this research is prodding us to think not
only about parenting, nor just about genes, but also about the interaction of these
with external contexts, culture and socio- economic situations.
• Genes can play a role in a range of psychological presentations.
• Genes can almost never be the main causative factor in how someone turns
out, and nurture and nature, genes and environment, are always interacting.
Key points

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• Some people with certain genetic inheritances seem to be more influ-
enceable by their environment, whether parenting they receive or socio-
economic stressors.
• Some people with certain genetic variations might be more or less helped
by both psychological and pharmaceutical inter ventions.
• The genes of a child can be an influence, if never the major one, on how
harshly a parent parents

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P a r t   I I I
DEVELOPMENTAL
CAPACITIES AND STAGES

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C h a p t e r   1 0
Language, words and
symbols
Parentese and infant- directed speech 122
Culture and language 123
Intersubjectivity and language learning 124
Language and brains 126
Language and emotional processing 128
Language ability and social advantage 129
Key points 130

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Sophisticated language use is unique to humans. Other primates and ani-
mals produce sound patterns, monkeys can warn of predators, birds sing
in complex ways, but none match human language. Attempts at teaching
chimps to speak have met with limited success; they have been taught up
to 100 signs, and even to joke and lie, but they never really develop syntax
or sentences (Yule, 2014).
Considering humans probably diverged from Great Apes some 6,000,000 years
ago, we gained language relatively recently, probably about 70,000  years ago.
This was roughly when humans expanded into new territories, developed cultural
capacities such as cave painting, and were becoming the last sur viving hominid,
with the demise of the Neanderthal. Most evolutionar y theories suggest that
humans achieved their success at least partly through social solidarity and com-
munication skills. Dunbar (2011), from an evolutionar y perspective, has argued
that language helped ensure group unity when human group sizes increased so
much that the mechanisms for ensuring group cohesion seen in other primates,
like physical grooming, no longer worked. Evolutionar y psychologists suggest
that language allowed social conventions and information to be stored in group
consciousness, maybe via chants, songs and stories, allowing humans to trans-
mit culture and, for example, pass on information across generations, such as
about plant species, hunting skills and seasonal changes, as well as cultural and
religious conventions.
In much Western thought, dominated by rationalism, the logical and cogni-
tive content of words has been priveleged. Language was viewed as a way of com-
municating ideas from one person to another, ideas conceptualised as discrete
entities passed from mind to mind rather on the model of a telegraph. This leaves
out how speech is an emotional, bodily and sensuous process, and a feeling- full
expressive act.
For most of psychology’s histor y language has been considered in terms
of cognitive capacities, with words primarily seen as developing scaffolding for
thinking. This sat comfortably with an ethos that saw emotion and affect as rela-
tively poor cousins to cognition. In this chapter I stress social, emotional and cul-
tural aspects of language, how linguistic abilities are being laid down in infancy,
and are linked to early emotional and gestural communication, as well as the
understanding of other minds.
A relationship with language is even developing in utero, and infants start
to recognise sounds in their first months. By about nine months infants gener-
ally begin to understand the meaning of some words, and just before a year first
words often appear. Between about 12 and 20 months vocabular y grows, and by
the end of their second year many infants can use between 20 and 50 words, some
in combination. Through the next year the rudiments of grammar are learnt,
leading sometimes to the quaintly overzealous application of rules in statements
like ‘he fallded over’ or ‘she winned the race’. More complex capacities for stories
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the roughest of guides, some children reach them earlier, others later, and sadly
some might never do.
The world is never the same after we acquire language. Words can deter-
mine how we see and understand the world, altering one’s perspective, as
Eva Hoffman (1990, p.29) describes in her autobiographical account, Lost in
Translation, where she writes ‘Sometimes, when I find a new expression, I roll
it on the tongue, as if shaping it in my mouth gave birth to a new shape in the
world’. Language can open up new vistas, as poetr y often does, and it is neces-
sar y for developing the autobiographical and narrative capacities that are central
to forming a coherent sense of self. Yet language can be a loss as well as a gain, as
Daniel Stern (1985, p.176) shows. He describes a child perceiving a patch of yel-
low sunlight on a wall, ‘experiencing the intensity, shape, brightness, pleasure’,
having what is a global sensor y experience which can be disrupted forever when
someone says something like ‘look at the yellow sunlight’. Putting experiences
into verbal categories (e.g., yellow sunlight) inevitably reduces the complexity of
experience, depleting what Mindfulness theorists (e.g. Williams and Penman
2011) call ‘beginners’ mind’. Stern says that language can ‘fracture amodal global
experience’ so that one becomes distanced from it.
Some argue that people are ‘prisoners’ of their language, unable ever to
think outside its confines. Others such as Pinker (2002) suggest that thoughts
and thinking occur independently of the ability to use language. Indeed some
neuroscientists such as Damasio (1999) suggest that thinking is occurring most
of the time, irrespective of language. We can distinguish language and thought,
and also language and communication, even though they are linked. Infants are
biologically primed to communicate, and their early communications contain
emotional understanding, intentionality and expectations. This differs from a tra-
ditional view of communication as one person ‘sending’ a ‘parcel’ of information
to another, with an understanding that the other can receive and understand this
parcel. An infant’s urgent vocalisation is a kind of proto- communication, which a
mother might respond to in a way that makes it meaningful, communicating back
this understanding so that the baby learns to make sense of their own feelings, as
described in the psychoanalyst Bion’s (1977) theor y of containment. In this way
meanings are socially constructed through dialogic interaction.
Central to language is symbolism. Words are arbitrary, and alternative ran-
dom sounds could just as easily be used to denote the same things. For example,
while we use ‘paper’ to denote that thing that words are printed on, it would be
equally possible for another symbol to do the same job. With the exception of
onomatopoeic or iconic words, such as ‘bang’ or ‘woof woof’, in linguistic sym-
bols a psychic space is open between the word and that which it describes. This
allows a psychological space between the language, the symbol itself and the
thing being described. When we label something with a symbol this increases
our capacity for self- reflection, as the symbol and that which is symbolised can
be reflected upon and spoken about, increasing cognitive flexibility and control
over thoughts (Callaghan and Corbit, 2015).

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Central to emotional development is learning to label and monitor feelings
and thoughts. The ability to use symbols in their full richness, such as in poetr y,
or to use words to understand thoughts or feelings, is something that some chil-
dren barely develop. Because symbols are arbitrar y, without fixed meanings, and
meanings can var y depending on a speaker’s state of mind and intentions, some
people who struggle to grasp mental states are particularly challenged, such as
some on the autistic spectrum. Linked to the ability to use symbols is the capacity
to understand other people’s minds. What distinguishes human language from
the rudimentar y copycat words that parrots can use, or the alarm calls that mon-
keys make, is such psychological understanding. Language use is not just about
signs, that one word ‘stands for’ a thing. It requires the ability to ‘tune in’ to
another’s mind, to make sense of their intentions. To begin to explore this, once
again, I will start with early infancy.
The precursors of language can be seen in the early parent– infant relation-
ship. Mar y Bateson originally coined the term motherese to describe a way
of communicating with babies seen in most cultures (1971). Many now use the
word parentese instead, to avoid the gender- biased assumption that only moth-
ers do this, and some academics use the label infant- directed speech (IDS).
Parentese has clear characteristics; we tend to speak to babies using a higher
pitch, longer hyperarticulated vowels, shorter pauses and more repetitions than
in usual speech. Infants show an interest in the rhythm, prosody and tempo
of speech long before they understand the meaning of words (Malloch and
Trevarthen, 2009). Not only mothers, but fathers, grandparents and children as
young as four years of age tend to automatically adopt this way of speaking with
babies, even speaking to pets in the same manner (Previde and Valsecchi, 2014).
In experiments with infants using language stripped of its grammatical meaning,
parentese has been shown to be superior to traditional adult- directed speech for
communicating intentions and expectations.
Infant- directed speech or parentese is common in nearly all cultures stud-
ied. Central to it is a musicality that facilitates the regulation of social and emo-
tional relationships (Mithen, 2006). There is some variation between cultures,
such as Japanese mothers using a slightly lower level of emotional expression,
but these tend to be minor, as was found by Fernald (1993), who has travelled the
globe examining mother– infant speech patterns. In an interesting experiment,
parentese that expressed prohibitions was played to babies in four languages,
and also in English using nonsense words. In addition, loudness, which is gen-
erally the most significant difference between approval and prohibition, was
filtered out, so infants were primarily responding to ‘melody’. The infants consist-
ently frowned when the speech expressed prohibition and smiled at the phrases
expressing approval, showing how intentions in a speaker can be communicated
simply via the musicality of speech.
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Infants can understand extremely subtle differences in sounds, and differ-
entiate separate words from what is really a continuous ‘sound- bath’ (Marchetto
and Bonatti, 2015). This sophisticated task requires detecting statistical regulari-
ties in spoken sentences, and is how one differentiates specific words and part-
words from a stream of sound (Saffran and Thiessen, 2003). Spoken sentences
do not have gaps between them like written words, making this feat all the more
remarkable. In one experiment eight- month- olds were exposed to sound streams
denuded of all prosody and melody, and a few nonsense words, such as like ‘bo-
ti- nim’ were placed several times into the sound- stream. The infants somehow
worked out which sounds had appeared regularly. They could similarly extract
the patterning when listening to musical tones, again suggesting a link between
linguistic and musical abilities.
Musicality is fundamental to early language use, triggering reward circuits
and interpersonal skills (Wang, 2015). Babies, including premature ones, are
soothed by soft songs and gentle music, which regulates the autonomic ner v-
ous system and lowers cortisol levels (Trehub et  al., 2015b). Across cultures
babies are soothed by lullabies, which generally have similar melodies, rhythms
and tempos. A  mother’s voice singing lullabies to premature infants increases
sucking abilities, thereby aiding weight gain, stabilising oxygen saturation lev-
els, and improving general physical development (Picciolini et al., 2014). Singing
improves infant mood, sleep, eating and learning, and is central to how infant
emotional life is regulated.
The role of positive emotion in this is crucial. When infants are presented
with both adult- directed speech and parentese, they generally prefer parentese,
but when emotion is held constant, neither negative nor positive, infants show
no preference. More positive adult speech is preferred to emotionless infant-
directed speech (Singh et al., 2002). The lilt and melody of parentese has a posi-
tive tone that naturally inspires interest (Corbeil et al., 2013). Parentese is both
more emotionally expressive than ordinar y adult speech, and more positive, and
through it the precursors of early language learning are inter woven with learn-
ing about the world of emotion.
A seemingly rare exception to the universality of parentese is seen in the Kaluli of
Papua New Guinea (Ochs and Schieffelin, 2009), whose speech lacks the lilting
softness and high- pitched tones. Here infants and children are rarely addressed
directly. Infants learn by obser ving how adults or older children speak to each
other, not through parentese nor the dyadic interactions we in the West might
assume to be natural. The Kaluli expect children to fit into adult speech patterns
and barely attempt to understand what a child might be thinking; believing that
one can never know what is in another’s mind (Sicoli, 2015).
Similarly the Gusii of Kenya believe that if you talk too much to your chil-
dren then they end up self- centred (LeVine, 1994). Gusii children are immersed
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in adult conversation but are not talked to or taught to talk. The Western middle-
class ideal of lots of dyadic mother– infant communication again does not pertain.
As ever, we cannot assume universality for what we think of as natural.
The relationship between culture and language is more complex than
such variations. One cannot understand culture without language or vice versa.
Language provides basic tools for thinking, and as importantly, for becoming cul-
turally embodied. Birdwhistell (1970) showed that bilingual Kutenai tribespeople
consistently moved in different ways depending on whether they were speaking
Kutenai or English. They literally embodied not just rules of speech, but also the
feeling and cultural mores expressed via language. Language can thus be viewed as
‘performance’ (Butler and Athanasiou, 2013), and for those learning a second lan-
guage it is often accompanied by new social roles and ways of being (Burck, 2005).
As already noted, infants are learning about language even before birth, and
are able to recognise voices and words from their time in the womb (May et al.,
2011). Two- day- old babies have a preference for their native tongue, presumably
because of exposure in utero, and humans are primed to be socialised into their
own cultural mores (Moon et al., 2012). Infants are born ver y sensitive to sounds,
but their ability to distinguish between them diminishes quickly so that by the
end of the first year they are less capable of differentiating sounds that are not
used around them. For example, at around this age a Spanish baby would stop
distinguishing so well between a ‘b’ and a ‘v’ sound. Kuhl (2011) and colleagues
undertook research in Japan, watching when babies stopped noticing that the
sounds in certain words were changed from what we know as ‘l’ to ‘r’ sounds
When the babies successfully noticed a change she was relieved and smiled, only
to look around and note that her Japanese colleagues had not noticed anything.
The infants still had a skill that her adult colleagues had long since lost.
Interestingly, the West African Beng have a religious explanation for such
infant capacities. In their belief system, babies are born able to speak ever y lan-
guage. It is believed that in wrugbe or the afterlife, where babies are believed to
come from, all languages are spoken. Children are said to only slowly shed other
linguistic understandings during the first years, understandings that had derived
from wrugbe. If we translate wrugbe as evolutionar y or cultural inheritance, theirs
might seem a surprisingly accurate view, much more so than the idea of humans
as a tabula rasa in relation to language. Language use becomes culturally distinct
in the first year or so and helps distinguish whether someone belongs in one’s
group or not, aiding processes of group cohesion.
In the West developmental psychology has tended historically to focus more on
individual than social development, but there is increasing understanding of the
social and emotional nature of language. The Russian psychologist Vygotsky
(1962) particularly emphasised the influence of social factors on individual devel-
opment and the links between social learning and language, describing how
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children internalise culture, thinking capacities, and ways of being from parental
figures and other adults. Social constructionism has similarly emphasised how
the world is partly created through culturally specific linguistic understandings
(Gergen, 2009) or what Bourdieu described as the habitus (1977).
It is often assumed that children learn words for objects through having
things pointed out to them. Parents often ask questions like ‘what colour is that?’
or say things like ‘that is a doggy’. Many other cultures do not have this form of
‘teaching’ language, and instead words are picked up from the ordinar y flow of
social interaction. Children particularly learn through making sense of the inten-
tions of those around them. It is almost definitely no coincidence that there are
mirror neurons in Broca’s region of the brain, central for language use. These
neurons allow us to read the intentions of others, something that is necessar y to
use language effectively. In one experiment with two- year- olds, Tomasello and
Merriman (2014) invented verbs for actions, and these verbs were then used
(e.g., ‘plinnock’) when a particular act was performed. The infants were later
able to associate this made- up word with the action, but only when they could
read the intentionality that went alongside the use of the word. These infants
were entering a complex intersubjective universe requiring an understanding
of adult’s intentions, and building on skills like social referencing and joint atten-
tion. This is why some children on the autistic spectrum, lacking the more usual
understanding of other minds, can struggle with the subtle nuances of mean-
ing. Simple statements such as ‘that’s hot’ mean something completely different
depending on whether the speaker is complaining about the temperature of a
drink, or showing pleasure in the summer sun, describing an item that is fashion-
able, or subtly hinting that someone should turn up the air conditioning.
As the philosopher Wittgenstein (1974) taught us, the meaning of a word
derives from its use in the language games of social discourse, rather than simply
referring to something external in the world. It is from a word’s use in a variety
of context that its meaning becomes particularly clear to babies (Roy et al., 2015).
In another experiment by Tomasello an adult told a child that they were looking
for a ‘toma’. The adult then picked up various objects, which were unfamiliar to
the children, and made gestures, such as disappointment or excitement, indicat-
ing whether they had found it, and sure enough these infants soon picked up the
meaning of ‘toma’. This is more than pointing at an object and naming it; they had
to understand wishes and intentions to decipher the meaning. Such learning is
quite a feat for young children faced with a new sound and several possible things
to which it might refer. Children as young as 18 months work out the meaning of
words through deciphering adult behavioural cues, such as by watching lines of
vision and emotional expressions, thus joining a joint- attentional world.
The skills infants are learning in their first months, such as imitation, the
to- and- fro of early proto- conversations, the subtle dances of dyadic interaction,
are all building blocks for later language use. Beebe showed that the rhythms of
adult– infant communication are similar to those seen in conversations between
adults, in terms of timings, pauses, and how infants look at and away from con-
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providing a rhythmic understanding of how conversational dialogue works. There
is a developmental line from ver y early interactions to joint attention at about a
year. The discover y of mirror neurons has added weight to the link between
language use and understanding other minds. Nonverbal gestures are central to
spoken conversations, language and symbolic communication developing from
the foundation of gestures and actions (Fonagy and Target, 2007). Moving in
the same rhythm as someone’s speech is often a sign that one wants to join in a
conversation. Skills such as switching a conversation, or changing emphasis, are
achieved through nonverbal means such as facial expression and hand move-
ments, skills being learnt well before words.
It is no coincidence that words arrive more or less when children become
aware that people have separate minds. Proto- declarative pointing, such as point-
ing excitedly at an object that you want someone else to appreciate, demonstrates
a wish to share an experience, and so to build intersubjective bridges between
people. Again some on the autistic spectrum struggle with this, only managing
proto- imperative pointing, a more instrumental than intersubjective motivation,
pointing because they want something passed to them.
Children work out what another person understands and adjust their com-
munications accordingly. In an experiment children of about two saw a toy being
hidden. Some knew that their mothers had hidden this toy, while others knew
that their mothers did not see the toy being hidden (Akhtar and Tomasello, 2000).
Children were more likely to name both the toy and where it was hidden when
they assumed their mothers did not know its whereabouts. In other words, they
had worked out what was in their mother’s mind and hence what they needed to
communicate to ensure the object was successfully retrieved. Slightly younger
preverbal children similarly used different kinds of gestures depending on
whether or not they thought their mothers knew where the toy was. Such skills
need some understanding of another’s mind. When adults express incomprehen-
sion to one- year- olds these children tend to tr y all manner of tactics, from repeat-
ing themselves to exaggerating gesticulations to substituting different gestures,
requiring considerable intersubjective sophistication (Golinkoff, 1993).
Joint attention at 14 months predicts language development at two years, or
in other words, the better a child is at understanding other minds and intentions,
the better their language skills are likely to be (Mundy and Burnette, 2005). How
well a child follows its mother’s attention during interaction predicts word com-
prehension when language proper comes into play (Silvén, 2001). Thus language
is an inherently intersubjective process that ‘human beings have collaboratively
invented for establishing, regulating and maintaining intersubjective interactions
with fellow human beings’ (Akhtar and Tomasello, 1998, p.334).
We have to be careful to avoid claims about language being processed in spe-
cific brain areas, as the reality is more complex than this. Many researchers
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assume that the left hemisphere is dominant for language use (McGilchrist,
2010), alongside more linear and rational thought, while the right hemisphere is
dominant for emotionality across many species (Corballis, 2014). There is some
truth in this. Even babies when babbling open their mouths more on the right
side, suggesting left hemisphere activation (Holowka and Petitto, 2002), and
indeed that is what scans show (Shultz et al., 2014). The same regions of the left
hemisphere that adults use in speech are also ver y active in infants (Dehaene-
Lambertz, 2000). However, to be a language user one must be able to use and
bring together many facets of the personality, and link many separate brain func-
tions and regions. Human language also remains closely linked to the brain’s
emotional centres and both cognitive and emotional capacities are central to
language use. Indeed the extent of right hemisphere use in language differs
by gender and by culture:  Asian language users depend more on their right
hemispheres (McGilchrist, 2010), a Turkish whistling culture uses both hemi-
spheres (Güntürkün et al., 2015) and females, in Western samples at least, use
their right hemispheres more in speech than males do.
Two particular regions, Broca’s and Wernicke’s areas, both found in the
left hemisphere, are central to language use. Damage to Broca’s area in adults
leads to an inability to produce words, even if sufferers can generally still under-
stand them. If Wernicke’s area is damaged sufferers can form words, but their
understanding is limited. Such discoveries suggest a difference between thought
and language, and that words can be used to capture thoughts. For example
Solms and Kaplan- Solms (2001, p.104) describe a patient suffering from the brain
and language disorder Wernicke’s aphasia, who said ‘I know what I want to say
but I can’t find the words; they just aren’t there. And then, before I can find the
words, the thought is gone’. This is a graphic if painful example of how words and
thoughts cannot be conflated.
Language use depends on procedural rather than declarative memor y.
For example, patients who have lost their memories, and who cannot make
meaningful sentences, still use the same grammatical structures as other people
(Ferreira et al., 2008), based on nonconscious learnt templates.
There are definite windows of opportunity for developing the ability to use
language. If one learns a second language after one’s first few years, then one
uses a different part of the brain for that second language than for one’s first
language (Klein et al., 2014). Children with little exposure to speech in their first
years rarely use language fully, and often have problems with complex grammati-
cal forms. Many severely neglected children show an inability to use language
normally, and reports of feral children suggest something similar (Newton, 2002).
A famous example was Genie, imprisoned by her father at 18 months and
discovered at 13  years of age in the 1970s who, despite attempts to teach her
language, managed only rudimentar y speech with little syntax. It seems likely
that brain areas for learning language atrophy with lack of use at the right time.
Similarly many late- adopted children reared in depriving orphanages show deficits
in linguistic capacity, in social understanding and have different brain activation in
areas associated with language use (Helder et al., 2014; Rutter et al., 2007). Social

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interaction and having someone attuned to one’s experience, as well as exposure
to language, are all necessar y for verbal and communicative abilities to flourish.
Of course to communicate verbally we need to understand something of
the other’s states of mind. This can be hampered by developmental disorders
such as autism, by early experiences and also when the cultural expectations of
speaker and listener are alien. Burck (2005) quotes a second language speaker
who was asked by a teacher ‘what is the magic word?’, the teacher assuming that
the pupil would understand this magic word to be ‘please’. However, the pupil
came from a culture that did not require such expressions so his lack of the use
of ‘please’ was considered rude in Britain whereas in his own family doing things
for others required no words signifying gratitude. Having such an understanding
of others, and being able to work out something about their thoughts and feel-
ings, is a prerequisite of successful language use.
We have seen from the attachment research that parents who score ‘secure-
autonomous’ in the Adult Attachment Inter view are likely to have securely
attached children. Such parents can use language to make sense of emotional
experiences, creating coherent narratives. Using words to describe internal
states such as emotions is an aspect of affect regulation. For example verbalising
and labelling fears downregulates brain regions such as the amygdala (Kircanski
et  al., 2012). When subjects re- appraise pictures that they have seen using lan-
guage, this lessens arousal levels and helps regulate emotions. Labelling difficult
emotions downregulates fear responses (Hariri et al., 2000) and lowers cortisol
levels (Daubenmier et al., 2014). However trauma can have the opposite effect,
and van der Kolk found that PTSD suffering war veterans used Broca’s area less
and struggled to put experiences into words (2014).
Ordinarily putting feelings into words helps an individual manage difficult
emotional states. Indeed, it has consistently been found that writing about dif-
ficult experiences aids both emotional and physical health. In particular it is the
ability to shift from first person pronouns (‘I’) to third person (‘he’, ‘she’) or ‘we’
statements, that is linked with enhanced health outcomes (Pennebaker, 2012).
Children who are able to share difficult experiences with parents, and feel under-
stood and heard, later describe these experiences less negatively (Horstman
et al., 2015). The ability to use words ‘mindfully’ to process experiences, and in
self- reflective ways, facilitates both affect regulation and also executive function-
ing (Winsler et al., 2009). This is seen in many therapies.
If we develop the psychological equipment to process difficult experiences,
we no longer have to defend against them so much. Using words in a coher-
ent narrative to reflect upon emotional states is linked with secure attachment
and mind- mindedness (Meins et  al., 2012). Such findings have consequences
for practitioners. Children who struggle with impulsivity often have low verbal
skills (McEachern and Snyder, 2012), and insecurely attached children tend to
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have parents who do not develop complex narratives about their emotional lives.
Avoidant attachment tends to be accompanied by a limited capacity to use words
to describe emotional experiences. Using language to put thoughts and feelings
into words is a primar y way in which emotional intelligence or literacy develops,
as well as being a central tool of therapeutic work.
Language skills, perhaps particularly in the West, confer considerable advantages
on children and adults. Linguistic skills differ according to how much language
is valued in a family, social group, or culture as a whole, and how much children
are exposed to it. In a fine- grained study Hart and Risley (2003) taped the speech
of families and children throughout their first years. The families were grouped
according to whether they were welfare (i.e. out of work), working- class, or pro-
fessional families. The researchers aimed to count the words a child heard in
ever y interaction with its parent or caregiver. The analysis revealed stark class
differences. A  professional’s child had had 50  million words addressed to it by
the age of four, compared with the working- class child’s 30  million words and
the welfare child’s 12  million. In other words the welfare child heard less than
a quarter of the number of words that a child of professionals heard. In an aver-
age hour the child of professionals had 2100 words addressed to them while the
working- class families had 1200 and the welfare families just 600. Maybe even
more worr yingly, by three years old children of professionals had received about
800,000 encouragements and only some 80,000 discouragements. However, the
children of welfare parents had only been encouraged 60,000 times thus far, but
had received twice as many discouragements. This is indicative of how psycho-
logical outcomes are closely connected with social determinants such as poverty,
psychosocial stress and status.
These children generally turned out similarly to their parents in terms of
vocabular y and verbal interaction styles. A  child’s measures at three years old
also predicted later school results. Of equal worr y was how IQ corresponded with
vocabular y, with the professional child having an average IQ of 117, and the
working- class child one of only 79. These early findings held up right until age
10. The sample size was admittedly relatively small, but nonetheless these results
fit with other research, although a re- analysis suggested that parental educa-
tional level was at least as important as socioeconomic class (Rindermann and
Baumeister, 2015). Exposure to a wide vocabular y, more encouragement, less
discouragement, more ordinar y interest in children’s mental states, less stress,
and more positive feeling, all are likely to stimulate verbal and other abilities. Lest
one becomes too deterministic, these results were not just about words spoken
to, or indeed ‘at’, children, but this and other research has consistently shown
that what counts is how much parents respond verbally to a child’s gestures,
communication, or other initiation of communication (Tamis- LeMonda et  al.,
2014). As ever, it is being involved in two- way interactions that counts most.
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Hart and Risley’s work is just one example of how a social dimension can
inform an understanding of language. Others might include having a particular
dialect or vocabular y, such as an English public- school accent or a working- class
dialect, as yielding tremendous advantages or disadvantages. Words and speech
forms have meanings that take on a particular flavour for individuals, and as
Bakhtin (1982 p.293– 294) writes
each word tastes of the context and contexts in which it has lived its socially
charged life …. language only becomes one’s own when the speaker popu-
lates it with his own intention, his own accent … language is not a neu-
tral medium that passes freely and easily into the private property of the
speaker’s intentions; it is populated – overpopulated – with the intentions
of others.
• Communicating is about more than just words, it is also a gestural bodily
process.
• Sophisticated language use depends on developing capacities for intersub-
jectivity, for emotional and social understanding, which in turn is depend-
ent on sensitive mind- minded parenting.
• Language can be used to process emotional experience and deactivate
stress and threat systems.
• Language can be used in the ser vice of deception or emotional honesty, for
support or threat.
• Language can be used in a dead, stultifying way or in a lively, expressive
way; it can open up previously un- thought symbolic or imaginar y realms,
or close down thinking.
• Language can be the medium for the most intimate of communication and
yet can also be the way people distance themselves from others, and from
their own emotional selves.
• Language is dialogical and potentially a way of knowing the other, and of
course oneself.
• Language development arrives as infants realise that minds can be joined
and can share in attending to something, whether an object of fear, or a
pleasurable moment.
• Not all infants develop sophisticated linguistic capacities, such as neglected
children and those with some neurological disorders.
Key points

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C h a p t e r   1 1
Memories: learning
who we are and
what to expect
The brain as predictor of the future 132
Memories of events and facts 134
Episodic and autobiographical memory 136
Trauma, memories and forgetting 138
Key points 141

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In this chapter I look at memor y, and the dif ferent ways in which people’s
pasts impact on their present lives. We explore how past experiences are
taken with us into our present functioning through procedural memo-
ries. I also examine declarative memories, the ability to remember facts
and events from the past, including the thorny issue of memories of trau-
matic experiences. I will look too at autobiographical memor y, and how
people develop a sense of themselves as having a histor y and continuity
over time.
To ensure sur vival, any creature needs to predict what is likely to happen next.
The brain is predictive (Clark, 2013), not in the sense of predicting lotter y num-
bers or the weather, but rather in its attempts to foresee forthcoming interper-
sonal moments. If we do not know that the sun will rise tomorrow, or if we cannot
predict the mood of an inconsistent parent, we can feel anxious and then watch
harder for clues about what to expect. We tr y to imagine the future by making
sense of the present, and do so by using past experiences. Similar brain areas are
active in both, and damage to certain regions disrupts both memories and predic-
tions of the future (Coste et al., 2015). If my father usually hugs me lovingly when
he sees me then I probably expect this in the future from him, and maybe from
other adults too. We are making predictions outside of consciousness almost all
the time, in fractions of seconds.
Ironically, predicting what will happen can alter what actually happens.
If I  predict good weather and the sun shines, I  have not altered the weather.
However, if I  expect someone to be uninterested in me then I  might relate to
them in a way that causes them to not show interest in me. Similarly, approaching
someone with an expectation that I will be responded to with warmth is in fact
likely to lead to a more welcoming response. We bring our past expectations into
the present in the form of ‘templates’ of relationships, attachment patterns being
typical of this, and generally if a strategy has worked then we tend to stick to it.
This approach is usually successful and efficient, swiftly giving a sense
of whether a situation, person or moment is safe. However we can also sur-
mise wrongly, such as in what psychologists call the ‘fundamental attribution
error’ (Moran et al., 2013). This describes how we can too easily expect people
to be consistent over time. In a classic study, subjects were asked to converse
with a woman posing as an undergraduate (Goethals and Reckman, 1973). With
some people she acted friendly and warm, but was cold and aloof with others.
The students were asked to evaluate not her behaviour but her true personality.
Unsurprisingly, those who had witnessed the unfriendly version rated her per-
sonality as cold and rejecting, while those exposed to the friendlier incarnation
believed she was ‘really’ nice and kind. Interestingly, even when told that she
was actually an actress playing a role, they still more or less gave exactly the
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same answers. The new facts had not altered the power of their earlier views of
her personality.
We often ascribe stable characteristics to people after seeing only fleeting
behaviours. If someone is shown a picture of a neutral face and told it was of a
Nazi, they tend to see cruelty in the features, but if shown a science equation next
to the same neutral face they might see a studious face. Depending on our mood
we can also ascribe all manner of characteristics that say more about our state of
mind than the person in the picture, a phenomenon that psychoanalysts call pro-
jection (Klein, 1960). Emotional learning from early experiences has a particu-
larly strong effect on how the brain constructs its version of reality. An adopted
child who was abused and is offered a helping hand by a kind teacher or parent
might experience this as an aggressive gesture. This is why therapists can lay
such store by conscious self- reflection as a means of challenging non- conscious
predicting. If I  am able to step back from my preconceptions and examine the
evidence, I might just see that my teacher/ parent/ therapist was in fact not being
aggressive. Of course other, more superficial factors also alter how we see the
world. Judges are much more likely to give guilty verdicts when they are hungr y,
for example (Danziger et al., 2011), as well as being influenced by factors such as
racial bias (Kutateladze et al., 2014). Our perception of what we think of as ‘real-
ity’ is hugely influenced by both such superficial or contextual influences, and by
past experiences.
Predictions change experiences, and, for example, when people are told
to expect a painful stimulus, pain- related brain regions begin to react before
the actual stimulus. Furthermore, after applying a cream that subjects are told
removes the pain, but is in fact a placebo, these same brain regions for pain do
not react (Colloca et al., 2013). Interestingly, depressed people tend to feel physi-
cal pain more acutely (Yoshino et al., 2012), presumably having developed more
expectations of unpleasant experiences.
We need such procedural and automatic understandings to efficiently
do things like ride a bicycle or play the violin. The centipede would fall over if
expected to be aware of its ever y step. Emotional learning and our expectations
about how relationships are likely to go, are forms of procedural memor y that
start as useful shortcuts which can have lasting psychological effects. Someone
who has been badly criticised as a child might protect themselves by shirking
the limelight and withdrawing from social situations, which in turn might harm
their capacity to manage later social situations. Yet to change such a pattern
requires conscious effort, which is often resisted, as somewhere non- consciously
and deep in our beings we have learnt to trust our automatic procedurally based
judgements. We can learn to adjust our tennis ser ve, or driving style, but while
emotional re- learning is also possible, it can be resisted more deeply and seen
as dangerous or frightening. This is not mere conditioning. The behavioural
aspect is only part of the stor y. A child who is often attacked might become con-
ditioned to expect danger, and might interpret a neutral cue as a sign of threat,
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or ‘if I trust her I’ll be let down again’). Conscious and mindful practices can help
counter such expectations.
Through our memories, we integrate our experiences into a coherent sub-
jective sense of ourselves. Memor y is how we make sense retrospectively of
events. As Stern (2004) shows, experiences that can be thought of as mini-
moments of sensation become episodes or ‘chunks’ of experience organised
by our minds. For example, if we have an experience that resembles a previous
one, such as seeing a grandparent smiling and carr ying a bag, we may begin
to believe there is a pattern; perhaps like last time the person with a bag will
give us sweets and kisses and make us feel good. Even in infants such expec-
tancies develop after something happens only once or twice, and when similar
events happen several times children develop what Stern termed RIGS (rep-
resentations of interactions generalised). These RIGS arise from an ability to
do abstract averaging from past events, working out what the likelihood is of
something happening next.
Infants of depressed mothers have learnt to expect low mood in their moth-
ers, and at just a few months they also expect such flattened mood with attuned
others (Murray et al., 2015). As we have seen, in the ‘still- face’ experiment babies
are disconcerted when their expectations (non- conscious predictions based on
memories) are confounded by their mother who does not respond as expected.
The accumulation of memories gives rise to a sense of who we are, and what is
possible and likely. The child who is struggling with a task will draw on their
previous experiences, consciously or not. They might respond to a difficult puz-
zle by smashing it up, or asking for help, or saying the puzzle is wrong, or maybe
determinedly tr ying to solve it and saying aloud ‘I can if I tr y, I can if I tr y’, as one
child I saw in treatment did. These various approaches all draw procedurally on
past experiences.
In early infancy most learning is of the implicit or procedural kind, and
although things, faces, and other ‘facts’ might be remembered for a short while,
they are rarely available for recall later on. True, some declarative memor y is
possible even in the first months, such as babies remembering objects 24 hours
later, and five- month- olds remembering faces after a few weeks (Mullally and
Maguire, 2014). Yet it is uncommon for adults to remember events from much
before the age of three or four, a fact often described by the term infantile
amnesia. By four, children can definitely remember some things that had hap-
pened previously. Some children between three and five were asked about a trip
to Disneyworld that occurred in the past 18  months, and seemed to have ver y
accurate recall, as validated by adults, even if they would not remember this trip
20 years later (Hamond and Fivush, 1991). The older ones had better recall, and
giving them prompts helped. The research on imitation similarly shows that 14-
month- olds who witness motor sequences can reproduce these same sequences
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a week later (Marshall and Meltzoff, 2014). Such deferred imitation is linked to
procedural memor y and remembering ‘how to’ do something.
Psychologists still have many questions about exactly why infantile amne-
sia occurs, and why some memories do or do not make it across this ‘divide’.
Bauer (2006), a leading memor y researcher, has argued that due to neurological
immaturity our early memories are less likely to be consolidated, and that con-
sequently there are more storage failures. She suggests that prior to about four
years of age memories are lost faster than they are gained, but with later develop-
ments in the frontal cortex and hippocampus, memories are formed faster than
they are forgotten.
We can, however, underestimate the young child’s capacity to remember
events that are not encoded in language. They can remember a lot without having
conscious verbal recall, and can express such memories nonverbally. Emotionally
charged events are more likely to be remembered than others. Children who
have a stressful medical procedure (e.g., having an injection) remember this bet-
ter than those who have a less stressful one (von Baeyer et al., 2004). Gaensbauer
(2011, 2002) has described children as young as seven months seemingly retain-
ing memories of traumatic events several years later. For example one nine-
month- old was in a car accident that had never been talked about, and yet he
later re- enacted the accident scene with toys at two years old. Gaensbauer and
others have reported accounts in which abuse experienced preverbally, includ-
ing sexual abuse, was later represented in children’s drawings or play with seem-
ingly surprising accuracy. For example one child depicted an abusive act to a
ver y specific part of her body that was later corroborated by video evidence.
These are anecdotal stories and might not count as research evidence, but the
combination of such reports and research suggests the ability to retain memories
of events from the first few years, at least nonverbally.
In these examples the memories were recalled through a medium other
than language. Language was not available at the time of encoding the memor y,
and the memories had not been translated into a verbal format. There is a higher
likelihood of later recall of early trauma when the child is able to verbally narrate
some of what happened at the time of the trauma (Mcnally, 2003). It is possi-
ble but not easy to ‘infuse’ a preverbal memor y with language in order to trans-
form a nonverbal memor y into a verbal one. Bauer (2006, p.321) has shown that
when this occurs, perhaps when a parent talks about an event with a child, then
that memor y is more likely to sur vive and cross the barrier of infantile amnesia.
Preverbal experiences are not recalled via linguistic cues, which makes evoking
them more difficult, and this is why research about children’s early memor y can
be flawed when researchers only provide verbal cues.
Our ability to remember is influenced by other factors, such as how safe
people feel. If one is too stressed, one’s capacity for recall is reduced, affecting
brain regions for memor y (Gamo et al., 2015), although one also needs a degree
of stress to remember something. Infant mood clearly affects memor y (Flom
et al., 2014). In one test distressed and cr ying babies did not remember a mobile
they were presented with three weeks later, whereas the non- distressed ones

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did (Fagan and Singer, 1983). Of course the child in school who is hyper- alert to
danger will have less ability to concentrate and take in information.
Stress also impacts how the brain develops, and the hippocampus, a region
especially involved with memor y formation and retention, is profoundly affected
by early child maltreatment, sufferers having smaller hippocampi in adulthood
(Teicher et  al., 2012). Neglect as well as trauma can affect developing memo-
ries. The memories of young children adopted from Romanian orphanages into
more ‘enriched’ families performed poorly when asked to undertake tasks such
as deferred imitation, and their capacities for declarative memor y were worse
(Kroupina et al., 2010).
Unlike chronic ongoing stress, however, some stress aids memor y. If we
walk down a street and nothing remarkable happens we are less likely to remem-
ber the walk than if a car drives fast and noisily the wrong way down that street.
People remember unusual and emotionally charged moments, sometimes called
flashbulb memories, such as what they were doing at President Kennedy’s
assassination or when 9/ 11 happened. This has been called a stress signature,
after the biological process whereby a mark of a previous event leaves tell- tale
signs on an organism. We need some stress for memories to be encoded, but too
much can inhibit memor y.
Having an ‘autobiographical self’ depends on having organised memories of situ-
ations that characterise our life, such as who our parents are, our names, where
we were born, what we like or dislike, our personal histor y and our usual reac-
tions to situations. Damasio (1999, p.172) characterises such a sense of identity
as a kind of feeling, what he calls a ‘felt core self’, which uses both nonconscious
experience and memories that can be recalled to form an ongoing idea of who we
are in time and in relation to others. This is called episodic memor y. These tend
to take shape after a child can put events into language, after which memories
take on a new form. Before the age of about two, as noted, the main areas of the
brain involved in encoding explicit memor y are not fully ‘online’, and most learn-
ing is of a procedural kind. In the next few years the explicit memor y system
gradually consolidates. By two children start to develop stories about their own
and others’ desires and wishes. This is also around the age when infants can real-
ise that a mark they see on the face in the mirror is actually a mark on their own
face. This is sometimes seen as the beginnings of a sense of self that includes
autobiographical memor y, which is a form of episodic memor y.
A fuller version of autobiographical memor y is not really seen until about
four or five, when full- blown theor y of mind capacities kick in. At around this age
most children start to think of themselves as existing over time, and can relate
stories and facts about themselves that suggest a more cohesive idea of self.
They develop a sense of themselves as ongoing in their own and other people’s
eyes. This is when they can really recognise themselves when watching a video,
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so that if the child in a video (them) has a sticker on their head, and they are
asked where the sticker is, it is at this age that they can point to their own head
(Suddendorf et al., 2007). This is seen as a sign of a child’s more sophisticated
representational capacities, holding multiple versions of the world in their mind
simultaneously. Early mutually attuned interactions with parents enhance such
capacities (Kristen- Antonow et al., 2015).
The ‘felt’ aspect of such memor y is central, as episodic memories are
not simply stored but ‘lived’, as opposed to semantic memories which are
facts, meanings or ideas more disconnected from lived experience. Language
and the ability to use narratives to reflect on oneself are central to episodic
memor y which requires a self- reflective capacity. This is more likely if one
has had mind- minded parenting. Parents of securely attached children tend
to have more elaborated and sophisticated narrative styles, and their children
develop these too. As Damasio says ‘whether we like it or not, the human mind
is constantly being split, like a house divided, between the par t that stands for
the known and the par t that stands for the knower’ (1999, p.191). This auto-
biographical sense we have, this cer tainty about our own ongoing identity,
depends, to use Damasio’s metaphor, on a sense of self in which we are the
stor yteller of our own stories. We might add that we feel we exist insofar as
we are in other people’s minds, par t of other people’s stories. The impor tance
of being in another’s mind is obvious to those who know the ef fect on some
unfor tunate children of having rarely really been in anyone’s minds, nor hav-
ing a clear stor y told about themselves. This is seen in many children in the
care system.
Autobiographical memor y is never an exact filmic reproduction of what
happened in the past. It, and indeed all memor y, is hugely influenced by our
current concerns and preoccupations, and by the context in which they arise.
When we feel happy we more easily remember pleasant childhood events.
Context is also central. Some scuba divers were asked to remember words
while under water. They were later tested both above and below the water and
were more able later to recall the words under water than on dr y land (Godden
and Baddeley, 1975).
Autobiographical memories are expressed verbally, and so are depend-
ent on linguistic and narrative skills, and some children are advantaged in this.
Children who are quick to develop skills in autobiographical memor y are also
early to recognise themselves in the mirror (Kristen- Antonow et  al., 2015).
Mothers who use more elaborative language have children who develop theor y
of mind earlier, and indeed children of mothers trained in developing elabora-
tive narratives develop better understanding of other minds (Taumoepeau and
Reese, 2013). Such elaborative narratives are seen more and earlier in Western,
more egocentric, cultures. Korean and Chinese children and adults, for example,
are less likely to have as many personal memories, make fewer references to
themselves, but describe more generic events and shared histories (Leichtman
and Wang, 2013). Some societies, as we have seen, place less emphasis on
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whatever the culture, children exposed to a more elaborative narrative style tend
to describe personal events within autobiographical memor y in more complex
ways. In the West at least these are generally the children who become securely
attached.
One of the big controversies in psychology concerns traumatic memories, how
reliable or accurate they are, and whether traumatic memories from the past can
be repressed and only remembered later. Memories are not like exact photos or
videos of the past stored in a hard drive in one’s brain, and they can be notori-
ously unreliable. The brain only stores traces of information later used to ‘make’
memories. As Bateman and Fonagy (2004, p.105) describe, ‘A complex neural
network, involving many different parts of the brain, acts to encode, store and
retrieve the information, which can be used to “create memories” ’.
In one study, over 70 boys were asked questions like ‘how often did your
father hit you when young?’, or ‘how concerned were you with particular issues’.
Some 30  years later many of these boys were re- inter viewed and their memo-
ries, which they would have sworn by, were completely at odds with their origi-
nal views. For example, some remembered themselves as outgoing but in fact
at 14 had described themselves as shy, and their ability to guess how they had
described themselves 30 years earlier was no more accurate than chance (Offer
et al., 2000).
Experiments consistently show the unreliability of memories. In a classic
experiment (Loftus and Palmer, 1974) people watched a film of a car accident.
If asked ‘how fast was the car going when it smashed into the other one’, then
their ‘memories’ were entirely different from the responses seen when the word
hit was substituted for smashed. Those who heard ‘smashed’ assumed the car
was going faster, and later they often claimed to have witnessed things not in
the film, such as windscreens breaking. False autobiographical memories can be
implanted because memories are so vulnerable to suggestion.
This question of the reliability of memor y gets more controversial when
the memor y is of something traumatic like sexual abuse in childhood. Not only
are memories vulnerable to suggestion, but also the memories we recall at a par-
ticular moment are coloured by our current contexts and influences. Although
it is possible for therapists to suggest events to patients, as in so- called false-
memor y syndrome (Davis and Loftus, 2009), evidence also suggests that forget-
ting traumatic events does occur. Brenneis (2000) analysed a number of cases in
the therapeutic literature. Some could not be substantiated but for others the evi-
dence compellingly suggested that the stories of remembering abuse were true.
In one example a woman had always remembered being sexually abused
as a child but had no memor y of any abuse in adulthood. Someone mentioned
to her that child victims sometimes also become abused as adults. Driving home
after wards she was reported to have remembered being raped by a stranger
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at 22  years old, some 13  years before. She investigated this, and later brought
charges against the assailant who was convicted after the facts were confirmed in
court (Geraerts et al., 2007). Yet she had not remembered these events for many
years. Brenneis analysed several similar cases in which memories seem to have
returned, and these had similarities. The memories were cued by linked informa-
tion, and once prompted, memories unwound straight away and did not need any
deciphering. They were accompanied by powerful emotional and somatic reac-
tions, such as the person recalling the memor y starting to shake, and in none of
these cases were the memories suggested by therapeutic work.
Forgetting traumatic memories is not uncommon. For example, research
(Epstein and Bottoms, 2002) on 1400 women found that in interpersonal trauma,
particularly sexual abuse, forgetting was seen in as many as 20 per cent of cases.
It was less likely in non- interpersonal traumas such as car accidents. However,
the mechanism of forgetting was not necessarily that of Freudian repression,
and in many cases the forgetting reported was partial, and was explained as an
active avoidance, and sometimes as a re- labelling. Others, such as Loftus and col-
leagues (Patihis et al., 2014), remain more sceptical but also suggest that some
experiences may be reinterpreted as abuse later whereas at the time this was
not clear.
Procedural memories are different to memories of trauma as they gener-
ally are ‘content- less’. The expectation of danger in a child subjected to violence is
ingrained in brain circuits, and might cause them to flinch at the slightest noise,
but is not necessarily accompanied by conscious memories. There is, however,
another form of memor y that is neither quite a normal declarative memor y nor a
procedural memor y. The flashbacks of post- traumatic stress victims seem to be
also embedded in the amygdala, and have content, but are not explicit memories
in the sense we usually mean. One theor y is that such traumatic flashback memo-
ries are not contextualised in terms of time and place by the hippocampus, so
that they lack a ‘signature’ of context. As van der Kolk shows, in serious trauma
the thalamus can shut down, part of a process stopping experiences becoming
part of autobiographical memor y. Sufferers of these intrusive and over whelming
memories seem not to be open to the influence of suggestion in the way that is
seen in cases of false- memor y. Their memories rarely become part of a narrative
with verbal processing, and indeed areas central to language such as Broca’s
region are often barely functioning in such moments, when the left hemisphere
is almost off- line (van der Kolk, 2014). A PTSD ‘memor y’ is experienced as if it is
in the present, often accompanied by deactivation of the dorsolateral prefrontal
cortex. Such memories become like immediate experiences being relived and
less amenable to change. A big difference between traumatic memories and non-
traumatic ones is that in the traumatic ones we see powerful physiological reac-
tions such as shaking or sweating.
Children who have experienced horrors such as violence or torture often
cannot stop images of violence intruding. An example was reported by McNally
(2003, p.105) in which children who had sur vived the brutal Pol Pot regime were
constantly disturbed by images of killing. Victims seem to be reliving something

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of the emotional experiences of the events, often in a way that includes other
senses such as smell and taste. It seems it is the emotional experience of the
trauma that is remembered, rather than any photographic re- representation, and
the details are not necessarily accurate. In secondar y trauma, for example, peo-
ple whose loved ones have been murdered can experience nightmares and flash-
backs of the murder, even though they were not there themselves.
There remains much controversy about traumatic memor y, and whether
such memories can be repressed, or dissociated from. Some research sug-
gests that suppressing unwanted memories usefully inhibits their influence
on future perception (Gagnepain et al., 2014). What cer tainly happens in trau-
matic experiences is that we narrow our focus, and after wards cannot remem-
ber wider details of an event. For example, some people were shown only
neutral pictures, while others had a shocking image of a murder victim slipped
into their sequence of pictures (Kramer et al., 1990). Those who saw the grue-
some picture were not so able to remember the pictures that came after wards.
When we witness something terrifying such as violence we focus on the most
salient details (who had the knife and how near it was) and are less aware of
peripheral details (whether it was raining outside). This can make witnesses
in cour t seem unreliable, as they are less likely to have as much detailed infor-
mation in their minds. Show people a violent or nonviolent version of the same
event, and the group who see the nonviolent version have a much more accu-
rate recall of the peripheral details.
After trauma there is impairment in the ability to recall autobiographical
details. This has been shown, for example, with some Vietnam veterans who
often have what is called an ‘over- general’ personal memor y, and struggle to
remember specific events in the usual way (McNally et al., 1994). In response to
cue- words, like ‘kindness’ or ‘panic’, they could not find memories or narratives
that fitted the words (Moore and Zoellner, 2007). It is possible that parenting that
does not give rise to narrative capacities in children intersects with the impact of
trauma, leading to even less likelihood of forming and processing memories. The
narratives of trauma victims can often be filled with thoughts that seem unfin-
ished and language that is vague, unclear and repetitive with more narrative frag-
mentation (Brewin, 2011).
A goal of much therapeutic work with trauma is to ensure that traumatic
memories are not re- evoked too powerfully. There is also a need to build up
areas of thought and memor y which concern more well- functioning parts of the
personality. Then it is more possible to integrate traumatic experiences so that
they can be reflected upon, modulated and processed. This ability to process
emotional experience is seen in some parents traumatised in childhood who still
score ‘secure- autonomous’ on the Adult Attachment Inter view (AAI). It is not
seen so much in the AAIs of more ‘unresolved’ adults who were traumatised.
A telling difference between these two types of adults is that one type (the secure-
autonomous) has developed self- reflective capacities, and an ability to integrate
experiences in the form of a coherent narrative within autobiographical memor y.
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reflecting on our own and others’ states of minds, for mentalization and narrative
coherence.
• Memor y concerns the relationship between past, present and future, and
the human brain is especially efficient at predicting the future on the basis
of what has happened in the past.
• The meaning we give to a present experience is partly determined by our
past experiences, but our memories are hugely dependent on our current
moods and contexts.
• Experiences are engrained in implicit memories from early in life,
becoming patterns of relating that we take into new relationships, even
before children gain the ability to encode, maintain and retrieve explicit
memories.
• Memor y is notoriously unreliable, and some supposed memories can be
the result of suggestion.
• Traumatic memories as seen in PTSD can be intrusive, frightening and
over whelming, are not linked to narratives or reflective functioning, and
tend to be accompanied by powerful physiological reactions.
• We remember more in certain moods, such as when mildly stressed, as
seen in flashbulb memories, but not when there is little stress or too much
stress.
• Children who have experienced elaborate narratives about their lives and
feel ‘held in mind’ are more likely to develop complex autobiographical
memories.
• Many children do not have such experiences, notably those with primarily
avoidant attachment styles, and many in the care system.
• Procedural memories, when laid down, are hard to shift, but new learn-
ing can take place, par ticularly with the development of a more self-
reflective capacity. This is more likely to develop if our emotional and
psychological selves have been witnessed by another reflective mind,
such as in therapy.
Key points

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C h a p t e r   1 2
Play: fun, symbolising,
practising and
mucking about
Early play 145
Play in other species and rough and tumble 146
Different kinds of play, different kinds of learning 147
Play as a window into the psyche 149
Play, pretending, symbolism and growing minds 151
Key points 153

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Play is an important childhood activity, one that is necessar y for many
other capacities to take root, and yet one that can only arise if certain other
developments have already occurred. Children who are lost in play often
evoke a sense of awe in adults. We can get lost in play, be taken over by
it. It is no coincidence that the psychoanalyst Winnicott (1971) contrasted
play with reality, suggesting that playing, symbolising and creativity are
fundamentally linked. Play is generally seen as having intrinsic value; we
do not do it to achieve anything else, although there are often rewarding
by-products. As Fonagy and Target show (1996), even ver y young children
can distinguish the worlds they create in play from reality. Harsh realities
can sometimes come crashing in to destroy fragile moments of play. Think
of the little girl who puts on her father’s best shoes and hat and is pretend-
ing to be a teacher until her father comes in and harshly asks what she
thinks she is doing.
What makes something play rather than not play, or even work? There is no single
overarching definition of play. It comes in all manner of shapes and sizes. It can
be solitar y or social, imaginar y, or rough and tumble, more or less rule bound,
verbal or nonverbal, object based, pretend, and more. Play is often characterised
by its flexibility, such as putting things in new combinations, changing roles, or
making objects represent other things. Play also is generally characterised by
positive affect, as seen in Tom Sawyer’s classic ruse when ordered to whitewash
a fence by his aunt Polly (Twain, 1986). Begrudging the duty, he managed to
trick his friends into believing he was going to paint the fence for fun, whereupon
they all fought to do the task that a moment before had seemed drudger y and
work, but suddenly had became play. Twain writes ‘work is whatever a body is
obliged to do, and play consists of whatever a body is not obliged to do’ (p. 14).
Various experiments back this up, such as one in which participants were paid to
problem solve a task, while others were not paid for the same task, and the remu-
nerated ones gave up earlier than the others (Deci and Ryan, 2000). Similarly,
some kindergarten children were rewarded for using pens with stars and rib-
bons whereas others were given no reward. Next time felt tips were left casually
around it was the unrewarded children who wanted to play with them (Lepper
et al., 1973). The intrinsic reward of just wanting to do something, like enjoying
helping another, is by itself motivating for both children and adults (Warneken
and Tomasello, 2008).
Play produces benefits in its own right for the player, spurring other devel-
opments, yet it is generally undertaken simply for its intrinsic rewards. Panksepp
(Panksepp et  al., 2003; Panksepp and Watt, 2011) showed how in rats bred
for a neurological propensity for hyperactivity, enhanced opportunity for play
decreases hyperactive behaviours and leads to more self- regulation. He suggests
that the same applies to children, and presumably it is no coincidence that much
therapeutic work with children is undertaken via play.
Yet not all children or animals are able to play. Children are less playful
when under strain, when less confident, or when made anxious (Repacholi et al.,

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2014). Harlow’s (1965) early work on monkeys reared in isolation found that they
were unable to play, unlike those reared by their mothers. Children reared in
orphanages without emotional nurturing or stimulation similarly are less playful.
A study from Har vard showed that men whose mothers had been affectionless
and cold were less likely to play games with friends, play sports, or even take
holidays, later in their lives aged 45 to 65 years old (Vaillant, 2012). The predictive
factor was how loved they felt as children. Feeling secure and at ease allows the
possibility of play, and play in itself can facilitate development.
One of the quotes about play that I like best is that play is ‘training for the unex-
pected’ (Spinka et al., 2001, p.141). Play is rarely rigid and planned; it is gener-
ally spontaneous and has elements of uncertainty and surprise. In classic infant
games such as ‘peekaboo’ often both parties know what is coming next but do not
know exactly when. In such games skills are being learnt, such as taking turns
and understanding and predicting another’s thoughts and actions. Such games
tend to be marked by clear patterns within which spontaneity occurs.
Infants are active partners in interactions, through using imitation and
proto- conversations for example, and by about three months sophisticated com-
munications can occur, such as pleasurable responses to nurser y rhymes accom-
panied by rhythmic use of their bodies. Often a playing pair becomes entrained
to each other’s rhythms, pitching their gestures in time to the other. This helps
to build a sense of agency, social confidence as well as flexibility.
By five months infants can engage in humorous exchanges with peers using
active imitation of posture and gesture. Soon games between parents and babies
can last longer, with a structure, sequence and a crescendo. Songs have a com-
plex pulse, prosody and melody, and infants enjoy timing their own gestural and
vocal responses to salient moments, such as clapping hands at a special instant,
leading to mutual enjoyment and ‘playfulness’ (Malloch and Trevarthen, 2009).
Positive affect is central here, and the lack of musicality in a depressed mother’s
voice can lead to an infant not joining in, but rather acting in a flat way. As early as
three months humour can be seen, and shared pleasure is more openly dialogi-
cal, as beautifully described by Reddy (1991), who experimentally illustrated the
kind of teasing and mucking about which happens later in the first year. By the
end of the first year, as skills such as proto- declarative pointing develop, games
can increase in complexity, with more likelihood of two partners playing together
with a third object. By then ways of interacting and being together are remem-
bered and repeated.
Such play depends on having, and having had, experiences of subtle mutual
attunement, and requires a complex combination of flexibility and predictability
in an atmosphere of mutually positive affect. Exuberance, enjoyment and pleas-
ure are emotional states that perhaps are not given enough credence in develop-
mental accounts. Infants between seven and twelve months have been studied in
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playful episodes, in both dyadic and triadic interactions, and here pleasure and
joy increase and neutral and negative emotions all but disappear (Kugiumutzakis
et al., 2004). From the end of the first year there are exciting developmental leaps,
especially with increased mobility, dexterity and speech, and one sees the begin-
nings of role play, fantasy and imaginar y games. As Daniel Stern writes ‘playing
can only occur in a setting where there is a feeling of ease, of security, of not
having to be vigilant, being free of pressing other needs’ (2001, p.141). He was
commenting on infants and found that even before they can grasp or move, their
interactions are less ‘playful’ when they are not at ease, such as when a stranger
is present, even more so if a stranger feels intimidating (Repacholi et al., 2014).
Playing has a biological and neurological base, and Panksepp and Biven (2012)
argue that we have a play system, alongside systems for fear, sex, aggression, or
attachment, and that rough and tumble (rough- housing) is particularly impor-
tant. Human children across all cultures play, so we must assume that playing has
been positively selected for good evolutionar y reasons. Play seems biologically
linked with a period of high arousal and almost boundless energy seen in many
mammals in mid- infancy. Play can stimulate aspects of brain organisation, devel-
oping what Schore (1994) describes as the explorator y- assertive motivational
system, and Panksepp called the ‘seeking’ system. Playing can ‘solidify social
habits’ as well as developing physical and cognitive capacities, the social circuits
of the brain and executive functioning.
Play is seen in most mammals (Pellis and Pellis, 2013), such as kittens and
their skittish moves, puppies chasing balls or tiger cubs play- fighting. Such play
has similar characteristics to human play. Dogs will signal they are playing by
lowering themselves onto their forelegs, and chimps have their own ‘play face’
that signals to other chimps that an action is play and not serious (Bekoff and
DiMotta, 2008). Play in young animals tends to be hugely energetic, without obvi-
ous ‘point’. A common theor y is that play enhances skills and abilities needed for
later roles. The speedy dashes of the young deer might be play now, but running
fast from predators might later be lifesaving. Experiments with rats reared in
isolation found that without opportunities to play- fight they grew up to be less
mobile and were often harshly attacked by strangers.
Animals do many things strikingly similar to pretend play in humans. An
orangutan, who could sign, was seen to pretend an invisible cat was present
by signing ‘cat’, and acting fearful, while a dolphin was reported to obser ve a
human smoking through an under water window, and then obtained a mouth-
ful of milk from her mother and squirted the milk under water in simulation of
smoke (Mitchell, 2001). More common in animals is mock- fighting and energetic
rough and tumble. Play is seen in species that live in complex social groups, such
as chimps and dolphins, with imitative skills and a degree of social sophistica-
tion. Here the young often play using exaggerated social gestures, tr ying out
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behaviours, sounds, movements and ways of being that will be performed seri-
ously later, such as in fighting or hunting.
Pellegrini (2007) defines rough and tumble play as characterised by pos-
itive affect, a ‘play face’, high energy, exaggerated movements and soft, open
handed hits or kicks’. Such physical play is seen in most young mammals, tailing
off with sexual maturation. It can aid muscular skills, build strength and stamina,
and stimulate brain development.
Rough and tumble is a ver y specific form of play, which superficially looks
like fighting but is different in definite ways. Generally there are not real threats
at the start of it, and after wards the partners renew friendly relations. In child-
hood it generally facilitates closeness, and Pellegrini’s research confirms that
affiliative bonds increase following rough and tumble. Aggression and rough and
tumble in adolescence, Pellegrini argues, becomes more to do with dominance
and gaining status in a pecking order. Pellegrini even found that partner choice is
linked to dominance status in adolescence and that there are direct correlations
between boys’ fighting ability at 12 years and later status, which in turn relates to
successes such as dating popularity.
The gender differences noted in the West are true across most cultures
studied, with boys indulging in much more physical play, and the same is seen in
monkeys and great apes. Indeed exposure of foetuses, male or female, to andro-
gens such as testosterone predisposes children to indulge in more rough and
tumble play later on (Grossi and Fine, 2012). Such rough housing is seen not only
in most cultures studied, but in most mammalian species.
Children play differently in different societies. In most pre- industrial societies
children spent much of their lives in cross- age groups, learning from the older
ones. In most cultures play involves pretending and imagination. Children often
work out the scripts of ever yday life by role playing adults, whether Mayan boys
in a Mexican town play being bar owners at a fiesta, European children pretend-
ing to be teacher and pupil, or Kalahari!Kung children playing at pounding and
digging.
Adult views on the importance of symbolic play differ across cultures.
Americans tend to see play as a way to aid learning whereas Korean mothers are
more likely to see play as amusement. Japanese infants are likely to be encour-
aged in play that has a sociocentric emphasis, with more ‘other directed’ atten-
tion, such as ‘feed the dolly’, whereas US mothers might be more likely to stress
play that promotes individual autonomy or assertiveness (‘yes, you can do that
if you tr y’). In Taiwanese middle- class families influenced by Confucian values,
the roles children were expected to take in play involved ‘proper conduct’ and
addressing elders appropriately (Goncu and Gaskins, 2007). In a study of a poor
rural Turkish community, where children had to contribute to the workforce at an
early age, the same authors found that play was less highly valued and the same
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is true of many other cultures, such as Yucatan Maya children, where play is
actively curtailed to encourage more ‘productive’ activity. Not all cultures value
symbolic play highly.
Many of these examples describe reality- based pretend play, tr ying out
real- life roles and scripts. There can also be more abstract fantasy play, seen
more often in Western cultures that encourage abstract learning in which ideas
are used in a decontextualised way, allowing more ‘playing around’ with concepts
that are less bound by actual roles and realities than in some other societies
(Harris, 2007). Maths questions such as ‘take three pink horses and add four
blue cows’ would be met with incomprehension in cultures where such abstract
thinking was not part of their cultural repertoire.
Many theorists of play have struggled with the paradox that play is indulged
in for its own sake, but must have evolved and exist for some purpose, other wise
why would most children and animals indulge in it? One theor y that goes back
several hundred years is that in play one is practising skills and abilities needed
in adult life. Smith (2004), for example, argues that playing at fighting, cook-
ing, or hunting teaches essential skills but is less dangerous than actually doing
them. The pretend pounding of grain develops all the necessar y skills to actu-
ally do it. In societies studied, play pounding peaked at about six years old, and
tailed off around eight or nine, when the children were expected to contribute
more by actually pounding real grain (Bock, 2002). Although we cannot know
for sure exactly what functions play ser ves, we know that children and mammals
deprived of play are at a disadvantage.
Yet as well as developing practical skills needed later in life, whether
pounding yam or using computers, play can help develop other capacities. Much
Western educational thinking has seen debates about the relative merits of ‘free’
play, in which children follow their own interests, as opposed to structured activ-
ity in schools and nurseries. Much of the thinking behind spontaneous, free play
is the recognition that children learn better when they are self- motivated. For
example in one experiment children who were told to stand still managed only
about two minutes, but when asked to play at being soldiers on guard they lasted
nearer 12 minutes (Bronson and Merr yman, 2009).
It seems that humans need unstructured rest times. We use different brain
areas when we are task- focused. When we stop tr ying or focusing, a series of
brain regions called the Default Mode Network suddenly become active (Kühn
et al., 2014), and has been found to be more developed in creativity (Beaty et al.,
2014). These turn off when we start to actively concentrate on a task. Possibly
in more achievement- based educational cultures and families the importance of
play is under- valued as a source of developing imagination, creativity and learn-
ing, as the task oriented Executive Attention Networks are prioritised over the
kind of goal- less activity seen in children in play, linked to Default Mode Network
activity (Agnati et al., 2013).
Educational researchers such as Sylva (1984) have found that children learn
more, and indeed do better educationally, when tasks are not too structured, and
play is not totally free, but rather when play is organised via scaffolding (Bruner,

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1966), helping children move to the next level of challenge. Such ideas have been
used to good effect in recent programmes in America, such as the Tools of the
Mind program (Aras, 2015) and other guided play approaches (Weisberg et al.,
2013). These harness Vygotsky’s ideas (1962) about zones of proximal devel-
opment, whereby children are facilitated to build on and use current knowledge
and skills to reach a next level, using a child’s intrinsic motivation to learn, gen-
erally via play. For example, in playing hospitals, teachers facilitate children’s
range of roles that they take on (e.g., doctor, nurse, porter), encourage children
to plan the tasks, and help them use a variety of props (e.g., any doll can be a doc-
tor). Such play- based learning can keep children busily active for long periods,
building a range of capacities. These include the ability to plan, concentrate, self-
regulate, as well as engage in complex interpersonal interactions. Such research
links to the thinking of Panksepp and others on how play, and indeed play- based
therapy, may increase the capacity for self- regulation and executive functioning,
conferring both considerable educational as well as emotional advantages.
The way children play reveals a lot about their preoccupations and state of mind.
Much research has linked the meaning of children’s play to what is happening
in their minds and ever yday lives. Child psychotherapists since Klein (1960),
Lowenfeld (1991) and Anna Freud (Midgley, 2012) have used children’s play ther-
apeutically, seeing it as the childhood equivalent to an adult’s free associations.
Sigmund Freud was possibly the first to analyse the meaning of a child’s play, in
his case of his grandson, who he witnessed playing with a cotton reel in his cot,
throwing away the cotton, and reeling it back with a pleased ‘da’ (there). Freud
(1920) understood this to be the boy’s way of managing his mother’s absences,
inventing a scenario of disappearance and return that he was in charge of, despite
not being in charge of his mother’s actual absences and returns.
Children use play to express their preoccupations symbolically. A  child’s
play provides a vital window onto their psychological state. Commonly, children
who have had a tough day at school might return home and act being the strict
teacher with a younger sibling. Child psychotherapists and other professionals
worr y about a child whose play is full of death, violence, destruction or inappro-
priate sexualised contact between children and adults.
There are standardised ways of understanding children’s play that back up
therapists’ clinical understandings. Perhaps best known is the stor y stem tech-
nique (Hodges et al., 2003), taken for ward by attachment researchers of the Anna
Freud Centre in London. Here scenarios from ever yday life are presented to chil-
dren, using dolls and props. Children are shown the stem or start of a stor y and
asked to finish these stories using the toys and their imaginations. A condensed
example is that a child is at school and has made a picture that their teacher
praises and they then take home. The inter viewer uses dolls to enact the child
coming home and asks the child to ‘show me what happens next’. Depending on
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their background and histor y, the children respond in a surprisingly rich variety
of ways. Some describe children who come home and show their parents the
picture and it is praised and ever yone is delighted. However, in other children’s
stories the parents ignore the picture, violence might ensue, the picture can be
forgotten or end up in the bin. The way the stor y is told, its content and how
the various characters are portrayed, as well as the narrative structure, are all
analysed, rated and coded. This has provided clear empirical evidence for the
meaningfulness of children’s fantasy play and its relatedness to their life situa-
tions, attachments and experience. This is something that child psychotherapists
have long known. In particular, children’s expectations of how adults might treat
them are often graphically illustrated in play. Children who have been abused or
traumatised and are about to be adopted often narrate stories full of violence and
neglect. Interestingly, within three months of being adopted many children have
begun to develop more hopeful versions of the adult world, with some caring and
concerned characters creeping into their narratives (Hodges et al., 2003a). Old
versions do not disappear altogether but new ones develop alongside them.
Children will naturally enact their worries and preoccupations, as well as
their hopes and wishes, through play. After 9/ 11 many American children were
reported to enact scenes of trauma and disaster. Similarly, some asthmatic chil-
dren often played doctors and nurses, and much amusement was had when
in a game a big bad wolf is to blow a house down but does not have enough
‘puff’(Clark, 2003). Of course, some children can get stuck in play, often after
trauma, and in these cases we might well not be witnessing symbolic play so
much as a traumatic re- enactment akin to the flashbacks common in trauma suf-
ferers (Osofsky, 2007). It takes care and experience to decipher the difference.
Children play for a variety of reasons. A child who has been bullied might
come home feeling upset or angr y and play a game of bullying their younger
sibling, thereby projecting (Klein, 1975) an unwanted feeling into another. When
people have had a blow to their self- esteem they tend, experiments have found,
to be nastier to others, more prejudiced and to take more pleasure in demeaning
others, in an attempt it seems to bolster their own self- worth. Alvarez reports
(2012) how one severely physically disabled child in a therapy session tied up
her therapist’s legs with sellotape, unwittingly giving the therapist some idea of
what it feels like not being able to move one’s limbs. Sometimes this is less sym-
bolic and more ‘getting rid of’ feelings into another, and play can teeter between
being symbolic and re- enacting scenes in which experiences are ‘discharged’, so
communicating something like ‘see how you like it and learn how bad it feels’.
Experiences can thus be ‘got rid of’, but also shared, and relief gained by some-
one else knowing what an experience is like.
Of course, positive experiences are similarly passed on, and a much loved
child is likely to care fondly for her doll or younger sister. In more hopeful sit-
uations the roles a child takes on are not so stuck, and infinite permutations
and reversals are possible. Such children are prepared to take on the role of a
helpless baby as well as a devoted parent, while other less fortunate children
are not so flexible. What has been learnt from the research, as well as parents

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and generations of therapists, is that in fantasy play important experiences, feel-
ings, worries, and hopes can be expressed, enacted and processed. Some believe
that the experience of play alone is therapeutic when done in the presence of a
sympathetic adult.
Anyone who has experienced a sense of hushed awe on hearing little children
enact a complex fantasy stor y behind closed doors can be aware of witnessing
something magical and rather delicate, a rich bubble that might suddenly burst
with the self- conscious knowledge that they are being obser ved. The three- year-
old whose mother is away and enacts a complex game about journeys and reun-
ions is able to objectify their personal and interpersonal experience, express it in
a form that is both make- believe and true, playing around with such experiences
and processing them. Part of the richness of play is that it can accommodate
ambiguous meanings, unresolved questions, and is rich with multiple interpre-
tations. The player can ‘tr y on’ ways of being, identifying with one party then
another, being both the doctor and the patient, giving an injection that might
be done kindly, sadistically, or with a mixture of both, thus developing skills in
empathising or mentalizing.
The possibilities in such play are almost infinite. Such complex pretend
play is unique to humans. Apes have been described playing games in which they
are definitely attempting to trick other apes into thinking something, such as
that the ball they are playing with has disappeared (Mitchell, 2001). This though
is different from a sustained narrative with characters which requires an ability
to distinguish between a pretend reality and actual reality, to function in a meta-
representational way, and to be able to symbolise, capacities beyond nonhuman
species. Acting in such a genuinely imaginative way is more sophisticated than
the tricker y of deception that some animals manage.
I have described how play can be imitative of adult activities, a way of learn-
ing to understand from the inside how adults think, act, feel and understand the
world. For example, children when playing at hunting, fighting, or preparing
feasts are feeling their way into a role. Sometimes children get so into role that
they believe they have actually become what they are playing. But if a toddler
pretends that a rag is a baby and then pretends to cuddle it, they and others
present know that one cannot really comfort rags, and the pretend aspect of the
behaviour is somehow signalled. A  child similarly knows that the parent is not
just stupidly confusing a rag with a baby.
Toddlers of 18  months of age, when they obser ve pretend play, respond
with pretend play and learn to tell the difference, even more so with playful par-
ents (Hoicka and Butcher, 2015). When they obser ve a mistake, they tend to
correct it. If a child watches an adult genuinely tr ying to write with a pen lid still
on, or pretending for fun to write with the same pen lid on, they know the dif-
ference (Rakoczy et al., 2004). Parents cue pretence in clear ways (Hoicka and
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Butcher, 2015). Pretence involves a different way of being. One smiles more and
the smiles are longer, meaning that the smile is a signal not just an expression of
pleasure. When mothers pretend to eat they look much more at their play part-
ner than when they really are snacking, and they also talk far more in pretend
play, with more repetitive speech, and more variation in pitch. Pretending adults
also tend to move more quickly, perhaps not surprisingly as in pretend play it is
possible to have a major battle, sleep, become a parent and age several years, all
in a matter of minutes!
For a child to be able to play symbolically he or she needs to have reached
certain developmental milestones. To move from being the teacher to the taught,
the doctor to the patient, the attacker to defender, requires an ability to place one-
self imaginatively in another role, and hence have the capacity to ‘feel’ one’s way
into another’s state of mind. In play one can enter a liminal world, where reality is
suspended, where one is on the threshold of a range of potential experience. This
is a skill that can be taken for granted until one comes across children lacking or
limited in this capacity.
Participating in symbolic play with a sophisticated play partner, such as a
parent or older sibling, enhances the ability to symbolise. Cross- culturally, par-
ents who value symbolic play have children who play more symbolically. One
way this happens is via ‘scaffolding’, whereby a slightly more sophisticated play
partner raises the level of the less sophisticated partner.
The ability to decontextualise is central to pretend play, especially with
objects that stand for something else. Object- supported imaginar y play, such as
pretending to drink with a cup, can start at about nine months, and develops
more in the next year and a half, but is more likely to be used in earnest after
three years of age. Children tend not to use substitute objects for imaginar y ones
when actual ones are present until that age. By four children know that if they
are to pretend to be something, say a tiger, they must convey an intention to
simulate or pretend, which again suggests that the capacity to pretend depends
on theor y of mind abilities. Also central is being able to set aside one’s identity
and take on another role; which again requires some ability to understand mental
states in oneself and others, to appreciate different perspectives and have some
fellow feeling.
More complex role shifting takes place from two years onwards. Nadel and
Muir (2005) worked with two- year- old triads and found that there was symmetr y
in terms of how much time each toddler spent either imitating or being imitated,
showing temporal coordination and synchrony and a natural readiness to move
in and out of roles. Not surprisingly children on the autistic spectrum find it con-
siderably more difficult to imitate and switch roles, and lack the skills necessar y
to invite the other to imitate them. Similarly many maltreated children lack the
calmness or ability to empathise to really manage such reciprocal pretend play,
which further disadvantages them as such play also enhances these skills.
Children who play symbolically can stand outside reality, providing a
‘meta’ perspective, something also seen in what the attachment theorists have
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have seen, has a coherent narrative about their experiences and feelings, and
is able to tell a consistent stor y about themselves using such meta- cognitive
capacities. There is a link between stor ytelling and pretend play. Nicolopoulou
(1997) has suggested that there are two separate lines of development that
come together as children get older. In one line the early phases of pretend
play emphasise increasing attention to understanding character representa-
tion, moving towards more understanding of what someone is like, star ting to
understand dif ferent perspectives on people. The second line is more about
early stor ytelling and is less about character but more about plot, and devel-
oping themes of how one event follows after another (e.g., ‘she did that and
then he went bang and then they cried’). These dif ferent skills generally come
together in the early school years, to generate an ability to play out pretend
fantasy play which has both plot sequence and character, using the parallel and
complementar y skills of play and stor ytelling.
Returning to main of the themes of this book, the roots of playing are in
early infancy. Typically relaxed loving attunement and accurate emotional
signalling during the first year of life predicts symbolic play abilities in later
years (Feldman, 2003). The social and intersubjective foundations of not just
play but so many impor tant human abilities lie in attuned interactions. On
the other hand child maltreatment (Valentino et  al., 2011) not surprisingly
negatively ef fects children’s capacity for play and other skills. Playing might
be seen across species but cer tain kinds are unique to humans, par ticularly
that linked to sociality and prosociality. Play is linked to social and interper-
sonal skills such as emotional regulation (Berk and Meyers, 2013), executive
functioning (Barker et al., 2014) and social competence (Lindsey and Colwell,
2013), and playing in childhood predicts all manner of good later life out-
comes (Greve et al., 2013). It in fact helps if it is messy (Perr y et al., 2014),
but most of all if it is fun. Maybe playing touches us so deeply because it is
something that many children and adults in busy post- industrial society have
so little time for; that ability to be in the moment and engrossed in an activity
and in one’s own being.
• Play, particularly symbolic play, is something that marks out humans as
distinctively human.
• Play is undertaken for its own intrinsic sake but it also leads to many other
benefits.
• It is generally accompanied by positive affect and is something one gets
immersed in.
• Play is also indulged in by other mammals, particularly play- fighting and
rough and tumble.
Key points

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• Much play appears to also be building skills for later life and animals
deprived of play show severe developmental deficits.
• Play is differently valued in different cultures. In the West complex sym-
bolic play is often associated with children who are able to understand
other minds, process experience via imaginar y play.
• Play provides a window into the preoccupations and psychic life of children,
enabling their deepest feelings to be expressed and understood.
• The use of symbolism, which seems to occur in all cultures, is a skill and
an achievement. Using symbols, for example in pretend play, means ‘brack-
eting’ here- and- now experience in order to participate in another reality.
A  symbol represents or evokes another world, and is separate from that
which it symbolises.
• Some children never manage this, such as many children with autistic-
spectrum disorders as well as some neglected or maltreated children.
• Play also ultimately is not play if it is not fun, and what seems universal is
not only that children indulge in play, including pretend play, but that it is
mainly undertaken with feelings of pleasure and wonder.

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C h a p t e r   1 3
Boys, girls and gender
Social learning 157
Different cultures, different genders 158
Uncertain genders 159
A weaker sex? Gender and the impact of early experiences 162
Venus and Mars: language and different planets 163
Gender preferences 164
Different genders, different psychological presentations 165
Testosterone again, and other hormones 166
Key points 167

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This chapter examines gender dif ferences and the extent to which they
are the result of society or biology, nur ture or nature. Some think that
dif ferent physiologies, brain structures and hormonal systems lead to
dif ferently gendered behaviours. In contrast others argue that gender
stereotypes and dif ferences derive from cultural influences, such as
parenting styles, role models, and society’s meaning systems. Judith
Butler (1997, p.49) sees gender as per formativity, whereby people are
said to ‘do’ gender. She wrote:  ‘The doctor who receives the child and
pronounces – “It’s a girl” – begins that long string of interpellations by
which the girl is transitively girled’. Quite opposing views are seen from
those arguing that biology is most impor tant, as seen in statements
like this from the book Brain Sex (Moir and Jessel, 1992, p.38) ‘If brain
structure and hormones are dif ferent in men and women, it should not
surprise us that men and women behave in dif ferent ways.’ This can
be a controversial fray to enter, with protagonists often having power ful
allegiances to their views.
In recent decades people have begun to talk of the gender rather than the sex
of a child, to challenge the idea of gender as biologically given, and suggest a
cultural influence on these matters. Of course it is also possible to be, or be
seen to be, either more or less masculine or feminine, irrespective of biological
gender, and many do not identify as the gender ascribed to them. Genders can
be viewed as a spectrum, with some males and females considered more or
less feminine or masculine. Research about gender reveals a mixture of clear
facts and more fuzzy ideas that ask as many questions as they answer. Why
are most violent criminals, mathematical geniuses and political leaders men
while women are underrepresented in fields such as science (Ceci et al., 2009),
are paid less and do dispropor tionate amounts of childcare? Is this nature or
nur ture?
A complication is that it is differences between genders, often ver y small
ones, that tend to be exaggerated and make headlines, and there is less interest
in the similarities. There is also a danger of generalising with insufficient evi-
dence. For example, one can too quickly link an average but small male superior-
ity in visual- spatial ability to stereotypes about men parking cars or reading maps
better, and then attribute this, for example, to spear- throwing hunter- gatherer
pasts. In fact, this average gender difference is mainly in a small subcategor y of
spatial abilities, the ability to do mental rotations, and anyway cultural differences
have an impact on spatial abilities (Neuburger et al., 2012).
If we think of gender in terms of a spectrum, in the middle there are fewer
differences between the genders than at the extremes. Boys suffer more from
dyslexia, learning difficulties, and ADHD than girls, but also most of the highest
scorers for maths are boys. Males make up the majority of university professors
but also of pupils who fail in school, and of the prison population, so from one
perspective males are both the higher- and lower- achieving gender. Again the
role of nurture and culture in this needs unpicking.

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Social learning
Gender is one of the first social categories children understand (Halim et  al.,
2013). Most can identify their gender by about three years old. At this age some
still might assume that another child’s gender is not fixed, and that the child who
puts on a dress after wearing trousers changes from boy to girl. Between four
and six children often still ascribe gender via superficial characteristics, such as
hairstyle or clothes. By six or seven this is more stable, and by this age in most
known cultures children separate into gendered groups for play, and the seem-
ingly universal nature of gender separation at this age suggests at least some
biological predisposition.
Yet it is easy to ascribe biological explanations to behaviours that have
their basis in social expectations. Girls often do worse at ‘male’ subjects in mix-
gendered schools and can become less competitive when boys are present
(Salomone, 2003). The ethos and values of co- educational schools might be a
more important influence than the mere presence of boys (Hughes et al., 2013),
and educational styles greatly impact the likelihood of females achieving in sub-
jects like physics (Shi et al., 2015). Gendered expectations and stereotyping can
exert powerful pressure on females to act in certain ways. For example some
females have been shown to eat less and put on softer voices when talking to a
male they find attractive. Women often do worse on intelligence tests, or describe
themselves in more feminine ways, when meeting a man who states a prefer-
ence for traditional women (Zanna and Pack, 1975). Many also point to how well
women did adapt to previously male- only occupations during both world wars in
Britain as typical of how what is seen as ‘natural’ is in fact socially determined.
Most children identify with gender- appropriate play. Sticking to own-
gender activities or toys comes with a cognitive understanding of gender and its
categories (Halim et al., 2014). Socialisation is important here. A task of thread-
ing a wire through a small space was described to children as either needlework
or electronics. Performance improved when the task was seen as appropriate to
the child’s gender identity (Davies, 1989). In classic studies babies were dressed
in the clothes typical of the other gender, and labelled with a name of the oppo-
site sex to see how adults reacted (Stern and Karraker, 1989). Those thought to
be boys were often played with more roughly, using bigger bodily movements
and the babies were offered gender typical toys. Fathers, especially, are prone to
pushing boys towards being traditionally masculine in appearance and discour-
aging signs of feminine play (Lamb, 2004). In Western cultures, deviating from
gender norms can be a risk factor for depression in boys, as well as for bullying.
Learning from others, whether siblings, peers, parents, teachers or the
media, definitely has an impact. If children have an older sibling of the same
gender then generally they behave in a more gender typical way than if they
lacked such a same- sex older sibling. Similarly only children behave in more
gender typical ways than children with older siblings of the opposite gender
(Rust et  al., 2000). We are influenced by those close to us, and by the culture
we live in. In a Canadian town that had not had television due to transmission

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problems, the children deprived of television had weaker gender stereotypes
than children in neighbouring towns, and this changed when television even-
tually reached this part of the Rocky Mountains (Kimball, 1986). As later
research has found (Br yant and Oliver, 2009), cultural learning, whether from
the media or siblings, definitely makes a difference. For example there is a link
between girls being given Barbie dolls to play with and lower career expecta-
tions (Sherman and Zurbriggen, 2014). Research on the effects of the media
and the marketing of powerfully gender stereotyped toys and clothes suggest
that such effects might be increasing (Holtzman and Sharpe, 2014). Similarly,
exposure to sexually explicit music videos (van Oosten et al., 2015) or pornogra-
phy (Szymanski and Stewart- Richardson, 2014) in adolescence has an effect on
attitudes to gender roles.
Looking at other societies can also challenge biologically led notions of gender
difference. In arguing against the idea that men and women live on the differ-
ent linguistic planets of Venus and Mars, Cameron (2007) describes The Gapun
women of Papua New Guinea. They have an aggressive form of verbal exchange
called kros whereby they vent their rage against those who have annoyed them,
particularly their husbands. Here the target cannot answer back, and kros is a
woman’s prerogative. She describes one irate woman whose husband received a
feisty attack, which in typical fashion lasted at least 45 minutes. A flavour of this
is seen in the following extract (p. 33):
You’re a f****** rubbish man. You hear? Your f****** prick is full of mag-
gots. Stone balls! F****** black prick! F****** grandfather prick! You have
built me a good house that I just fall down in! You f****** mother’s ****!
In this culture women’s language is assertive, direct and aggressive, while men
pride themselves on indirect and careful speech, confounding Western ste-
reotypes. Cameron also described the Malagasy people of Madagascar where
women are more assertive and quicker to anger than men. In this culture people
seemingly believe that women are naturally the assertive, aggressive and com-
petitive gender, and less verbally subtle gender.
Gilmore’s (1990) account of masculinity across cultures describes many
societies where masculinity is hard- won through rituals, exhibitions of strength,
physical prowess, and ‘macho’ acts. Such cultures are common, but there are
also plenty of exceptions. Typical of such a ‘heroic image of achieved manhood’
are the Truk fishermen of the South Pacific who undertake dangerous ‘manly’
actions, like treacherous deep- sea fishing in order to prove themselves. Males
who do not are teased and denigrated. Many cultures have similar rites. Maasai
warriors have traditionally been taken from their mothers and subjected to
bloody circumcision rites, and if a boy cried out they were shamed for life. For
Different cultures, different genders

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the Sambia too, mentioned earlier, masculinity must be ‘made’, by taking boys
away from their mothers and inculcating them into male ways (Herdt, 1994). In
such cultures masculinity must be earned, and there is always a risk of sliding
back into the feminine world. One might think too of the boarding- school sys-
tem devised for males of the British upper classes where ver y young boys were
brought up in a regimented harsh regime by strangers and where toughness and
physical prowess were highly valued and softness and vulnerability denigrated, a
legacy seen in many political leaders (Duffell, 2000; Schaverien, 2015).
There are exceptions that show that such extreme versions of masculinity
are not universal. Horrocks (1994) quotes a social organisation in Tahiti where
women have high status and there is no pressure on a man to prove his man-
hood. Their economy fosters cooperation over competition, and material striving
is frowned upon. Here men do not have to take the role of providers and have no
ideals of ‘proper’ manhood.
One culture that challenges gender stereotypes is the Semai of Malaysia, a
people who sur vived through fleeing rather than fighting (Dentan, 1968). They
believe that to resist the advances of another is tantamount to being aggres-
sive, and that one should accede to another’s requests. They say that they do
not get angr y, and believe that one should run away when threatened. Here
children are not disciplined and they have an interesting concept of bood, which
roughly means to not feel like doing something. If a child says ‘I bood’ then this is
just accepted, since putting any pressure on another is not deemed appropriate.
There are seemingly no competitive, or violent games, or pressure to act ‘manly’.
This is an unusually gentle people where there is no violent crime.
Gender cannot be equated with biology. Alternative potential destinies
exist, as does discrimination and prejudice, understandings which of course
helped fuel the growth of feminism. For many living in multicultural communities
questions about appropriate gender roles can stir up other issues, such as con-
flicts between generations and crises of identity. Seeing gender as partly some-
thing that is ‘done’ (Butler, 1999) can give rise to exciting possibilities, although
sometimes also to confusion and disagreements.
There are some biological differences that, on average, differentiate males and
females. Women produce ova and men produce sperm. Men cannot give birth,
breastfeed, or menstruate. The male body produces more androgens, such as
testosterone, while female bodies produce more oestrogens. Men are more hair y
on average, taller on average, and the genders have different body shapes, with
women generally having bigger hips and men wider shoulders. Males generally
have bigger brains, whereas females generally have more complex neuronal
connections in their brains. In the West at least, in males language takes place
more in the left hemisphere, and visiospatial tasks in the right. Examining the
effects of strokes on men and women’s language suggests that women use the
Uncertain genders

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right hemisphere for language more than males (Kansaku and Kitazawa, 2001),
but we also know that such differences are small (Hirnstein et al., 2013).
One of our 23 pairs of chromosomes (packages of genetic material) is the
sex chromosomes. If the pair consists of two X chromosomes then we become
female, and if we have both an X and a Y chromosome we become male, although
there are rare variants leading to less clear- cut differentiations. Mothers pass
their X chromosomes to all their offspring whereas fathers pass their Y to their
sons and their X to their daughters. Interestingly both genders start their in-
utero existence with the same sexual organs but at about six weeks male gonads
differentiate into testes. These produce androgens such as testosterone, which
are released into the bloodstream, affecting gender development. When suffi-
cient testosterone is released a penis and scrotum form, recognisably so by the
third month. In the absence of testosterone release these ver y same structures
become the clitoris and labia. Such facts have led some to argue that femininity
is the ‘default’ human position and masculinity needs to be ‘formed’. Such hor-
mones also impact directly on the brain and ner vous system, which then develop
in line with biological gender. At puberty further penile growth occurs, stimu-
lated by testosterone and its related hormone, dihydrotestosterone, while girls’
breasts are stimulated to grow by oestrogen.
Baron- Cohen’s research (2003) suggests that girls tend to make more eye
contact than boys, a propensity linked to prenatal testosterone levels; irrespec-
tive of gender, the higher the testosterone levels the less the eye contact. He
presented one- day- old babies with a mobile and a face. The experimenters were
unaware of the gender of the babies, and the mobile was designed with the same
colours as the face, even having the face’s features inscribed on it in scrambled
form. Interestingly – boys looked longer at the mobile than the girls who looked
longer at the face. Fine (2011) and others though urge caution about such con-
clusions, arguing that the methodology was flawed. Of course even if there are
gender- based biological propensities, many girls, for example, make poor eye
contact and play with cars and vice versa for boys. Furthermore, while gender
identity has a biological component, even one often reflected in brain structure
(Spies et al., 2014), this too can be affected by culture and the causal direction
always has a chicken and egg aspect.
Many people do not have a clear gender identity, and sometimes this is for
biological reasons. If the levels of hormones released are different from usual,
then less typical results ensue, challenging our preconceptions about gender.
Boys without working androgen receptors, whose testosterone cannot get to
work in the usual way, can look female, have small penises, and perform much
like females on visual- spatial, verbal, and other personality tests (Hughes et al.,
2012). Reductase- deficient males, whose hormones act unusually, develop female
genitalia. Their brains have been masculinised but they are generally reared as
girls. Sometimes they are raised as females, having been born without a penis,
as seen in a study of over 25 boys who mainly later showed typical male behav-
iours such as rough and tumble play, and half later independently declared them-
selves to be boys (Reiner and Gearhart, 2004).

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Girls with congenital adrenal hyperplasia or CAH have androgen levels
similar to boys and ambiguous genitalia, sometimes a clitoris so enlarged that
they are misidentified as male at bir th. This condition can lead to a propensity
for increased aggressive tendencies, disliking stereotypical female play, more
rough and tumble play, a greater likelihood of being either lesbian or bisexual
(Pasterski et  al., 2015) and more likelihood of typically male career choices
(Beltz et al., 2011), although even in these cases parental socialisation has an
ef fect (Wong et al., 2012). Infants with another disorder called complete andro-
gen insensitivity syndrome (CAIS), have both an X and Y chromosome but
can be identified and reared as girls, and cannot easily be ascribed to either
gender.
Although these presentations have historically been seen as ‘disorders’,
there is an increasing awareness of the complexity of gender issues. Many
who do not identify with the sex they were assigned at birth see themselves as
transgender, some having a more fluid identity and others feel more clearly
like the opposite of their assigned gender. Transsexuals are those who are
making the physical transition to the other gender, via medical and hormonal
inter ventions, and theirs is a physical not just psychological identification. These
positions are independent of sexual orientation, whether heterosexual, bisexual,
asexual or gay or lesbian.
We see challenges to the conventional binar y division of genders in
many other cultures. The Xanith, found in Omani, an Arab Sultanate, act like
a third gender (Wikan, 1991). These biological males sell themselves in pas-
sive homosexual relationships, become domestic ser vants, have male names,
dress as females, and practise female rites such as purdah. They are allowed
to speak intimately to women in ways that men cannot, and they never sit or
eat with men. They are highly per fumed and speak in high- pitched voices,
while women wear their hair long and men shor t, theirs is medium length.
They occupy a cultural space that, albeit an oppressed one, is that of a
third gender.
Another well- known example is the Native American Berdache, repor ted
in over 150 tribes. The Berdache were often called Two- Spirits, a male and
female spirit in the same body, and have sexual relationships with either gen-
der. The Berdache was a respected and honoured role. They might take on
male activities such as fighting or joining men in sweat lodges, or traditional
female actions such as cooking (Jacobs et  al., 1997). Such examples, along-
side issues such as transgender identities, challenge preconceptions about
gender.
Unpicking biology and culture in this is complex. For example male- to-
female transsexuals show some clear functional (Kranz et al., 2014) and structural
(Hahn et al. 2014) brain features more typical of females than males. Few would
nowadays disagree that gender identity is a spectrum, or that attempts to impose
gender such as via so- called ‘reparative therapy’ are not only inef fective but also
damaging and abusive (Moss, 2014). However the field remains replete with
controversy, especially with regard to inter ventions for those young people and

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children who might identify with another gender (Wren, 2000), specially in rela-
tion to the extent to which early identifications are stable or likely to change.
Research and obser vation shows that in most societies males gain unfair advan-
tage in multiple situations. Much inequality remains, such as employment glass
ceilings and males being paid more for doing the same jobs. In playgrounds
boys tend to dominate physical space (Karsten, 2003), and on average boys are
reported to demand and receive more attention in classrooms. Most leadership
positions are held by men, there are huge levels of violence towards women from
men, and of course it is only in the past centur y that females have even been
allowed to vote in most of the world.
Yet research shows that in other ways boys are vulnerable (Kraemer, 2000).
Although var ying over cultures and historical periods, accounts suggest that
about 140 males are conceived for ever y 100 females, and on average for ever y
106 male babies born there are 100 females (Davis D et al., 1998), so many more
males do not even make it to birth. Higher male mortality rates means that by late
adulthood there are equal numbers of men and women and by old age women far
outnumber men. Male foetuses succumb to far more congenital abnormalities,
premature and still births and cerebral palsy. Boys born prematurely do less well
than girls, are more prone to childhood illness, and are more likely to die from
these. Girls are born developmentally ahead, some say about four to six weeks
even at birth, and if anything their relative maturity increases through childhood.
Boys are more likely to suffer from disorders such as autism, Tourette’s syn-
drome, or reading delay. Throughout the lifespan men are more prone to disease
and early death, possibly due to issues with the Y chromosome (Jones, 2002).
From birth onwards girls respond better to social stimulation, seem better
equipped on average to regulate their emotions, and are less badly affected by
disruptions in parenting. Mothers tend to work harder to imitate and respond
to their sons than their daughters, and researchers have suggested that boys
need more input in order to feel emotionally regulated (Tronick and Weinberg,
2000). Following postnatal depression it seems boys tend to fare worse, having
less capacity for object constancy at 18  months and showing more behavioural
problems at school age (Murray et al., 1993). Sander (2007) looked at new- borns
separated from their parents and placed with new carers. After a few days the
girls had all entrained to their new carers’ day– night rhythms but the boys took
several days longer to adjust, suggesting they were more vulnerable following
disruptions of care. Many accounts suggest that boys on average are more sus-
ceptible to poor care and more emotionally labile.
Tronick (2007) found that depressed mothers consistently showed angrier
emotional expressions to their sons than to their daughters. By six months the
boys were gesturing more anxiously, and were three times more likely than
A weaker sex? Gender and the impact of
early experiences

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female babies to resort to self- comforting strategies such as sucking their
thumbs. It seems that boys generally are more demanding of their interactive
partners. A  French study showed that mothers with a propensity for depres-
sion were more likely to actually become depressed if they had male babies (de
Tychey et  al., 2008) who were presumably more demanding than female ones,
despite the sex bias towards males so often seen (Jain et al., 2014).
One classic study casts light on how weakness can look like strength in
boys. Six- year- old children were exposed to the taped sound of an infant cr ying.
The girls were sympathetic, whereas the boys were more likely to turn away,
or tr y to turn the sound off. Interestingly though, when their heart rate was
measured, the boys were more anxious than the girls, their turning away due to
being less able to tolerate the distress (Adam et al., 1995). This might be a typi-
cal example of male fragility masquerading as toughness. Boys tend to be more
active than girls from earliest infancy onwards (Campbell and Eaton, 1999). Such
increased muscular activity is something that ill- at- ease babies often resort to
too, what some psychoanalytic researchers describe as a second- skin defence
in which infants hold themselves together by physical movement (Bick, 1968).
Boys seem to be more affected by poor- quality childcare, especially if the
poor care is both at home and at nurser y (Hungerford et al., 2000), as well as by
parental absence, disharmony and divorce, showing more externalising behav-
iours (Wallerstein et  al., 2000). Of course, as children get older it is harder to
know if one gender is worse affected, as they respond differently, with girls tend-
ing to internalise; this is less noticeable than the acting out and aggression of
boys but equally serious.
Later on, too, males react more strongly to stress and trauma. In male
adolescents trauma leads to more adverse brain development than in girls and
De Bellis (2003) even suggests that just being male might be a neurobiological
risk marker for stress- related vulnerability. Another researcher looked at adults
in their seventies and found that almost 40 per cent of the physical and mental
illness of the men could be accounted for by early childhood experiences, but
much less in the case of the women (Patterson et  al., 1992). Males occupy the
odd position of seeming to be both stronger and weaker. They have more power,
are more violent (including to women), perpetrate more abuse and dominate in
all kind of ways but are also in other ways more vulnerable.
Girls in the West typically develop higher verbal competence than boys, but it
is not clear whether this is to do with biology or nurture. Clarke- Stewart (1973)
found that American girls’ language skills were better, but also that mothers and
daughters spent more time together, and had more mutual engagement, and
later research suggests that mothers talk to girls more (Johnson et al., 2014). On
this basis one could make an argument for either nature or nurture making the
difference.
Venus and Mars: language and different planets

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In many popular psychology and self- help books we read that men
withdraw when under pressure while women want to talk. Women are said
to be more verbal in contrast to men being more physical, men supposedly
being better at reading maps but worse at reading people. Much of the actual
research suggests that the dif ferences are smaller than are often made out
(Hyde, 2005; Fine, 2011).
As Cameron (2007) points out, language use differs according to social
context. Females in the West are more likely than men to use ‘hedges’, words
expressing a tentative meaning, such as ‘perhaps’, or ‘you know’. Yet such con-
ventions can change, depending on who is speaking to whom, and what power
relations exist between them. In Japan a more restricted linguistic range has tra-
ditionally been available for female use, with women using fewer deprecator y
words and more polite speech. Yet such politeness is not seen, for example, in the
behaviour of the increasing numbers of girl gang members in the UK or USA. In
many cultures females use higher status linguistic variants, and males use more
non- standard slang and swear words (Coates, 2004). Different ways of speaking
are available to those in different social positions, including different genders.
Girls might use more ‘hedges’ like ‘isn’t it’, but are perfectly capable of more
direct, less tentative conversational modes, if the context allows it.
Much learning is from same- sex peers, and research shows that in play-
grounds girls tend to use more talk while boys more often engage in activity.
Gender appropriate linguistic styles can thus be learnt so that one performs
according to gendered expectations. In the West, for example, girls are given the
message that to be loud and dominating is unfeminine, and teachers often have
this expectation as much as children, unwittingly being more tolerant of boys’
boisterous assertiveness in classrooms than girls’ and giving more of their atten-
tion to boys, presumably unconsciously (Einarrson and Granstrom, 2002). These
are difficult patterns to change. One head of science who managed to work hard
and achieve a balance between the attention he gave to boys and girls said that
‘he had felt as if 90 per cent of his attention had been devoted to the girls’ (Whyte,
1984, p.196). This is, perhaps, a chastening example of how gender is at least
partly something that is ‘done’, as Judith Butler (1997) stated, and so also can
sometimes be ‘undone’.
In many cultures boys are preferred by parents, but not always. While the usual
birth ratio is about 105 boys to 100 girls, in China during its long years of one-
child policy, the ratio for second born children on paper looks like 125 to 100, and
many girl babies just disappeared, especially in rural areas where male labour
was at a premium. Hrdy (1999) similarly reported that in one Indian clinic of 8000
abortions, 7997 of them were female foetuses.
In more patriarchal societies where males control resources and females
leave their community to marr y, having a male child is advantageous. The attempt
Gender preferences

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to control the ratio of boys to girls is partly about ideology, but also has much to
do with which gender brings the most rewards. Other species indulge in gender
preferences in certain circumstances. For example alligators can determine the
gender of their offspring by ensuring its eggs will hatch at a particular tempera-
ture. Triver’s (2002) evolutionar y theor y seems to most successfully explain gen-
der preference in humans, stating that if one gender brings more rewards then
it is more highly valued. The Mukogodo people of Kenya are lower ranking than
neighbouring Maasai, and acquire bride- wealth by becoming second and third
wives to Massai men. They preferentially invest in their daughters and ignore
their sons (Cronk, 1993). It is rarer for daughters to be preferred but there are
other examples, such as Hungarian gypsies, or the Tonga of Zaire where wealth
is inherited through matrilineal lines, and the custom is two cries to celebrate a
girl but only one for a boy. Infanticide and early death, possibly from neglect, is
higher for the least preferred gender in many cultures studied.
The balance of gender desirability is not static. In some monkey species,
where rank is inherited via mothers, in tougher conditions more daughters are
produced (or less sons are killed or die young), but as conditions alter so does
the birth sex ratio. Interestingly in times of serious economic and social diffi-
culty in humans fewer male foetuses sur vive (Catalano et  al., 2012). In Europe
and America there are generally less strong conscious gender preferences, with
research studies (e.g. Andersson et al. 2006) suggesting that most families prefer
a child of each gender, and preferences for the third child being more variable
across countries than many of the extreme examples I have quoted. Indeed, in
some societies preferences are changing towards girls, and the form gender bias
takes is often a response to specific cultural conditions.
In the West, certain kinds of mental disorders, known as internalising ones, are
more common in girls; these include depression, anxiety and eating disorders.
More children with externalising disorders, such as ADHD or conduct disor-
ders, are boys, and adolescent males are more likely to commit suicide, while
girls are more likely to self- harm. Some caution is needed, as the likelihood of
presentations in one or other gender varies by culture, and for example issues to
do with self- regulation are more common in US males than Asian ones (Wanless
et al., 2013).
On average it seems that girls are better able to self- regulate. Even
in utero boys and girls respond dif ferently to stressors (Tibu et  al., 2014),
and we know that males tend to be more active in pregnancy (Campbell and
Eaton, 1999). In most studies boys move from activity to activity much more
frequently than girls. Rough and tumble play is similarly seen more in boys
than girls, and more in male primates than females. Cross- culturally boys and
girls from about age four tend to play in same- sex groups where cultural and
biological patterns are likely to be reinforced. Infants will make assumptions
Different genders, different psychological presentations

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about gender simply by obser ving body movements. The play of boys and
girls tends on average to be dif ferent, with boys’ play being much more active
(Pellegrini, 2007). In the West, girls’ play is generally more verbal, less physi-
cally active, more symbolic, and is more likely to have a nur turing component
such as looking after pretend babies. The wish to play with those of the same
sex seems to be as much to do with the gendered style of play as actual gender,
as boys seem to prefer girls with masculine play styles over boys with a femi-
nine style (Alexander and Hines, 1994).
Males generally take more risks, especially young men (Charness and
Gneezy, 2012), which of course does not mean that all men are risk takers and
women are not. Young males die more often from activities like motor racing,
bungee jumping, mountain climbing, and violent incidents. Even in pre- school
the genders show dif ferent levels of aggression, and some research suggests
that boys show more violent themes in their fantasies (Ostrov and Keating,
2004). In most mammals males are more violent, an exception being more
aggressive female hyenas which interestingly have higher testosterone levels
than males.
Evolutionar y theorists have argued that risk taking evolved in males as
a result of sexual competition. In humans and other primates some males can
monopolise several females, so not all males have an equal chance to procreate.
Human females can produce far more children in a life time than males. Studies
of human DNA show that in human histor y some men have produced many
offspring while many more men than women have entirely failed to become
parents. Risk- taking is often higher when attempting to attract sexual partners
(Greitemeyer et  al., 2013) and as Lippa (2005, p.92) argues, it is due to such
competition that some young men are literally ‘dying’ to attract young women
through risk taking.
However, evolutionar y theories also postulate that different strategies can
be adopted. A commonly given example is of the bluegill sunfish, where there is
a dominant male with distinctive colouring, but also many other males who main-
tain female colouration and sneakily mate with females (Magurran and Garcia,
2000). Something similar is seen in primates such as male orangutans, where
there is generally one huge, brawny, and hair y male with a harem, and other
males often remain in a ‘Peter Pan’ adolescent body for decades, while occasion-
ally indulging in underhand copulation (Utami et al., 2002). However, when the
alpha male dies or disappears one of these Peter Pan males will transform into an
alpha male, its body becoming as large, hirsute and powerful as its predecessor.
There are diverse ways of being male.
Most violent criminals are male, most murders are male- on- male and generally
males are more violent than females, although there are exceptions. High levels
of testosterone are associated with increased aggression. Prisoners with higher
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levels of testosterone commit more violent crimes, Vietnam veterans with high
testosterone levels had more behavioural difficulties as children, and college fra-
ternities with lower than average testosterone levels were more polite and less
rowdy (Dabbs and Dabbs, 2000). Yet high testosterone also leads to less success
in jobs, less likelihood of successful marriages, less politeness, and even less
smiling in company. In women high testosterone levels are also associated with
more dominance, aggression and competitiveness.
Men with low testosterone show lower than average visio- spatial skills but
when given increased doses of testosterone such abilities improve. Foetuses
exposed to high levels of testosterone in the second trimester of pregnancy
become more masculine when they grow up, and those with lower testosterone
levels tend to have more flexible gender identifications, becoming more femi-
nine when their mothers encourage them to be so (Udr y, 2000). Those with high
testosterone interestingly were less influenced by their mothers, which raises a
fascinating question about whether high testosterone levels might make children
less amenable to parental influence.
Other hormones also show up in gender differences. Males with low sero-
tonin levels tend to be more reactive and violent, and social deprivation or abuse
leads to lower serotonin levels (Cirulli et al., 2009). Low serotonin in females is
linked to increased anxiety and depression rather than violence.
Much research points to the impact of hormones on gender develop-
ment, but importantly our hormones are not set in stone, and levels can change
in response to social stimuli. For example male sportsmen have considerably
higher testosterone levels when playing in front of their home crowd, or when
playing against bitter rivals (Allen and Jones, 2014), and after the American elec-
tion results in 2008 McCain supporters and not Obama supporters had lowered
testosterone levels (Stanton et  al., 2009), showing how levels of hormones can
change when the context changes. Male infant’s testosterone levels seem to
be affected by parenting style (Caramaschi et  al., 2012). Adult males in Texas
respond with more aggression than males from Northern US states to exactly
the same stimuli, such as a deliberately but unsuspectingly administered insult in
an experiment (Nisbett and Cohen, 1996). Here it is the more machismo culture
that is central, and probably leads to higher testosterone levels. Aggression and
testosterone might be linked, but as in so much of the research I  discuss, the
relative influence of nature and nurture is not always clear.
• Gender differences are statistically relatively small, even if it is differences
that grab headlines.
• Men can var y in their masculinity and women in their femininity and one
can be either low or high on both.
• Culture and prejudice can have a profound effect on gender roles.
Key points

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• Uncertainty and debate remain about the relative roles of biology and cul-
ture in gender differentiation.
• Peer and parental pressure for gender appropriate behaviour can have a
profound effect.
• Hormones can influence how gender roles are taken up.
• In many ways males are the more powerful gender, at least in certain socie-
ties, but they are also weak and vulnerable in other ways.
• Emotional development occurs differently for males and females in most
cultures, but such gender differences occur in a variety of ways across
cultures
• Ultimately males and females are more alike than different, but we are
nonetheless still different, and whether we stress the similarities or differ-
ences is partly a matter of personal choice or bias.

169
P a r t   I V
NOT JUST MOTHERS

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C h a p t e r   1 4
Nonmaternal care and
childcare
Adoption is common in some societies 173
Purchased nonmaternal childcare: nurseries 174
Nurseries, nannies, grannies and childminders 178
Key points 180

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In this chapter I  examine nonmaternal childcare in Western and other
societies, including more formal organised childcare such as nurseries.
Humans have been described as a cooperative breeding species (Hrdy,
2009), in which childcare has historically been shared by available adults.
Yet this happens in different ways in different cultures, accompanied by
ver y different beliefs about the right way to care for children. Bowlby
(1969) received harsh criticism, particularly from feminist thinkers, when
his theories about attachment were interpreted as arguing that mothers
should stay at home with their children. On the other hand working moth-
ers can still be publicly maligned and politicians tr y to win votes by arguing
for the importance of what they call the traditional nuclear family.
Yet non- parents have always looked after children. It is likely that evolutionar y
processes selected infants who developed ways of attracting adults who were
not parents, such as with big eyes or symmetrical features, optimising their
chances of sur vival by gaining wider sources of care. Humans, but certainly not
all primates, have an evolutionar y histor y of breeding cooperatively, or in other
words there have always been people other than mothers who have shared in the
task of childcare. Although paying for childcare is a recent phenomenon, moth-
ers leaving children at nurseries or with childminders is part of a long tradition
of nonmaternal care. Humans produce some of the costliest infants, in terms
of the required investment of time and energy, and by the time the next child
comes along, it is extremely unlikely that the previous one will be anywhere near
independent. A  human infant requires more physical and emotional resources
than a mother alone can provide, and the cooperative nature of human childrear-
ing allows more offspring to sur vive and also allows reduced inter vals between
births.
The best predictor of infant sur vival, Hrdy (2000) and others argue, is
maternal commitment, and this in turn is strongly influenced by a mother’s con-
scious and unconscious perception of the degree of social support and alterna-
tive care available. Such nonmaternal care is sometimes termed alloparenting
by biologists and primatologists, ‘allo’ having its roots in the Greek for ‘other’.
This includes close relatives, whether grandparents, fathers, aunts, siblings, non-
related adults and older children. Grandmothers traditionally have played a cen-
tral role. In a study of the Hadza, a hunter- gatherer group in Tanzania, in times of
food shortages children were more likely to sur vive when they had grandmoth-
ers alive and on hand (Hawkes and Coxworth, 2013). Hazda mothers could leave
their infants while they went to forage and return in time for the next breastfeed.
Higher rates of sur vival of children, and shorter spaces between births, have
been found in many societies where grand- maternal support is strong (Kramer,
2015). German, Finnish and Canadian children were also found to be more likely
to thrive with grandmothers present, although the same was not true for the
presence of grandfathers (Sear and Mace, 2007).
Much alloparenting is undertaken by adolescent girls, who in many pre-
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care for infants and undertake tough physical work (Hewlett and Lamb, 2005).
Societies var y in the amount of nonmaternal care used, but some form of it is
almost universal. In Efe society (Tronick et al., 1987) babies are likely to be trans-
ferred between about eight people in an average hour. Efe infants still have a pri-
mar y attachment to their mothers, but when asked ‘who cares for the children?’
an Efe adult would answer ‘we all do’.
In human and many cooperative breeding species, maternal commitment
to new- borns depends on a mother’s assessment of their support systems. The
historical literature detailing the histor y of abandonment of infants, such as
in European foundling homes, and the frequency of human infanticide in his-
tor y, is a challenge to the assumption that maternal instinct is universal (Hrdy,
2009). This again might explain why infants seek out faces and gaze from the
first moments of life, to elicit the positive responses that aid sur vival. As they get
older, human infants become adept at working out who might be able to provide
care and support by using the kind of mind- reading skills detailed in earlier chap-
ters. Humans, compared with other apes, have highly developed altruistic and
cooperative capacities (Warneken and Tomasello, 2009), presumably something
which has aided sur vival. Infants’ propensity to ‘babble’ occurs primarily in spe-
cies which cooperatively breed. For example pygmy marmosets babble at just
the age that alloparents come on the scene, presumably because such vocalisa-
tion helps to maintain contact with important adults.
Long childhoods are the other clue to the human evolutionar y propensity
for cooperative care and are seen in many cooperative breeding species with
whom humans other wise have little in common, such as wolves and many spe-
cies of birds. The logic is perhaps that one does not have to rush a job like chil-
drearing when there is help around. Humans seem to have evolved to nurture
infants in a community context, in which social support is central for infant sur-
vival and growth.
An extreme form of nonmaternal care is adoption. Historically in Europe a high
proportion of adoptions were of babies who for various reasons were ‘given up’
at birth. In some Western countries adoption has taken on a new form and is
increasingly used as a solution to finding homes for children removed from
their birth parents following neglect or abuse. Such children often come with
extremely complicated, often traumatic, histories and can be a huge challenge to
care for (Kenrick et al., 2006).
In fact adoption has been much more common across the world than peo-
ple may realise, and the view that children ‘should’ be raised by their birth par-
ents is by no means universal. In many cultures, for example, clans or descent
groups ‘own’ children, who are circulated within lineages. As the anthropolo-
gist Bowie (2004) has found, adoption and fostering are often seen as posi-
tive and useful. In the Wogeo society of Papa New Guinea in some villages as
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many as half the children are adopted (Anderson, 2004), while in Eastern
Cameroon about 30 per cent of children between four and ten were not living
with their biological parents. Sometimes the motivation for adoption is to better
a child’s opportunities, and in parts of Brazil it is common for poor families to
send their children to live with better- off foster parents (Fonseca, 2004). In these
cultures one can have more than one mother, and new ones do not cancel out the
biological mother’s importance. Such practices do not always mean transferring
all rights over children to a new parent, something that can cause conflict and
confusion in contemporar y cases of overseas adoption.
We tend to use words like ‘real’ and ‘natural’ to describe biological parents,
and cross- cultural comparisons can be helpful in challenging assumptions about
the sanctity of the blood ties. For example, the Baatombu in Northern Benin do
not have terms for biological parents, and the term which translates as ‘giving
birth’ is used by both adoptive and birth parents (Alber, 2003). In areas of West
Africa women discriminate between children by whether they are part of a line-
age, not on the basis of whether they are biological children, grandmothers being
actively competitive in building matrilineages. In some West African cultures
babies are regarded as belonging to the wider kin group, and in some traditional
Japanese households a child is viewed as belonging to the house (Hendr y, 1986),
both typical of societies where children are not necessarily seen as ‘belonging’ to
a biological parent. Indeed ‘ownership’ of children by parents has clear limits in
Western countries as well, as seen for example when children are taken into the
care system, or placed with relatives who are not parents in kinship care arrange-
ments. (Music and Crehan, 2013). As Bowie (2004) makes clear, while it is never
easy for a mother to give up a child, nor for children to experience such changes
of attachment figures, anthropological evidence suggests that where this is cul-
turally sanctioned then the effect is not as obviously damaging as some disrup-
tions to care seen in Western societies.
In contemporar y societies completely new forms of non- parental care have devel-
oped in the form of organised purchased childcare. In the UK, for example, over
1.5 million mothers of under five- year- olds work full time, and 75 per cent of these
had their own mothers at home in their own infancy, so this is a relatively new
phenomenon (Leach, 2009). Increasing numbers of young children are placed in
various forms of childcare while parents go out to work. There has been debate
as to whether such childcare helps or harms children, but the issues are too
complex to simply ask whether nurseries per se are good or bad for children, or
whether children would be better off at home with their mothers. Some nurser-
ies seem on most criteria better than others, and for some children the move to
nurser y might give access to more stimuli and emotional care than received at
home. I use words like ‘good’ or ‘poor’ guardedly to describe quality of childcare,
aware that ‘quality’ is partly a question of judgement and is elusive to measure.
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I follow the definitions of studies that suggest that good ratios, well- trained staff,
continuity of staff, and especially those who invest time and energy and who
are emotionally responsive, all contribute to better outcomes, whether behav-
ioural, emotional or academic. A  useful definition by Scarr from the NICHD
Early Childcare Research Network states that ‘quality child care is warm, sup-
portive interactions with adults in a safe, healthy and stimulating environment,
where early education and trusting relationships combine to support individual
children’s physical, emotional, social and intellectual development’ (Scarr, 1998,
p.375).
Early attachment research stressed that prolonged separations from
attachment figures could be harmful. Bowlby had seen the effects on children of
wartime separations from parents, and his colleagues such as James and Joyce
Robertson had studied in detail the moment- by- moment impact on children
of being separated from parents. Perhaps the most famous and indeed heart-
rending of the Roberstons’ studies is the film made of an 18- month- old boy, John,
whose caring parents were having another baby, and placed him for a week or
so in a residential unit (Robertson, 1971). The film graphically shows a normal
and happy little boy tr ying hard to find the internal resources to cope with an
over whelming new situation, unsuccessfully competing with hardened peers for
the matron’s attention, then becoming upset and tearful, protesting hard for a
few days, and in time becoming hopeless, listless, given- up and depressed. The
nurser y setting was not cruel or abusive, but simply did not have the staff ratios
or emotional capacities to give him the attention he needed or expected.
Although such research was used by some to argue that children should
be at home with their mothers, maybe the main lesson was that a child needs to
be able to depend on known and reliable attachment figures, which need not be
a biological parent. Such understandings in principle could have a big impact on
childcare practice if taken more seriously (Bowlby, 2007).
There is no doubt that going to a nurser y is a stressful experience for chil-
dren. Toddlers starting nurser y after being at home since birth experience high
levels of stress, with cortisol levels between 75 and 100 per cent higher than
when they were at home (Ahnert et al., 2004). Both secure attachment and good
quality childcare buffers this a bit (Badanes et al., 2012). Indeed children from
high risk homes have lower cortisol levels in good nurser y care (Berr y, Blair,
et al., 2014). Yet even securely attached toddlers show high cortisol reactivity and
‘chronic mild stress’ five months after starting nurser y. These children showed
little outward sign of stress or anxiety, which is possibly why nurser y staff often
reassure parents that their children are ‘fine’.
To make sense of the impact of childcare we need to take several factors
into account, such as the nature of the childcare provision itself, factors in a child,
such as temperament, and the quality of family life. No single factor tells the
whole stor y. The risks are far higher if a child is born into a chaotic family, per-
haps with a psychiatrically ill mother, and then attends poor- quality childcare.
In other words, having unresponsive caregiving both at home and in a nurser y
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whether nurseries, childminders, nannies, or grandmothers, can buffer the
effects of a riskier home situation, leading to better than expected outcomes, and
helping children develop social and coping skills that they might not other wise
have gained (Melhuish, 2004). However, children from loving and encouraging
families can lose out through attending poor- quality childcare.
A child’s temperament also has an effect. Young children with one (short)
version of a serotonin transporter gene are more influenced by either good or
bad childcare (Belsky and Pluess, 2013), as are children with one variant of the
DRD4 dopamine receptor gene (Berr y, McCartney, et al., 2014). Temperament
affects not only on how children cope with day- care, but even whether they are
placed in it. One large British study suggested that children with more fussy tem-
peraments were left in day- care for longer than other children (Sylva et al., 2007).
Most research shows that family factors, such as a stable home and sensi-
tive parenting, are far more likely to predict later outcomes than the quality of
childcare. Nurser y care generally has less of a negative effect than many have
assumed, but has an effect nonetheless. For example, securely attached children
who had been in childcare longer were more hostile in structured interactions
with their mothers at 42 months, and were rated by teachers as more aggressive
(Egeland and Hiester, 1995). The differences might be small but are still signifi-
cant. Children who start low- quality nurser y care earlier are more likely to be
rated as distractible and less task oriented at pre- school than children who enter
nurseries later (Barnes et al., 2010). Lamb (1996) found that children in day- care
were more likely to have an avoidant attachment than those being looked after at
home, even if statistically the difference between the two groups was not huge.
Belsky and colleagues (2007) in particular have amassed research suggest-
ing that longer hours in childcare have a persistent, small but measurable effect,
such as more externalising problems. Such small increases in behavioural prob-
lems in turn might spread to other children in classes, having a subtle but clear
knock- on effect. Some effects of childcare, such as increased risk- taking are seen
right up until adolescence (Vandell et  al., 2010). What clearly makes the most
difference, as previously suggested, is the ‘dual risk’ of low parental sensitivity
coupled with low- quality and/ or longer periods in day- care (Huston et al., 2015),
in addition to infant temperament or genetic inheritance.
There is a danger of exporting the findings from institutional care, where
outcomes are often ver y bad (Oliveira et al., 2015), to day- care, where the effects
are far smaller (Rutter and O’Connor, 1999). It is true that long days in nurser y
from an early age lead to a less secure attachment with mothers, and that being
placed in day- care full time, before the age of one, especially where there is insta-
bility and a lack of continuity of care, are real risk factors (NICDH, 2004). Overall
though, the research shows that the effects are real, but not huge.
Yet with such vast numbers in day- care of one form or another, an under-
standing of these matters is crucial. The biggest ever study of childcare was
American, by the National Institute of Child Health and Human Development
(NICHD Early Child Care Research Network, 2005) and found that 50 per cent
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for at least 10 hours. This again is not an issue for moral judgement. The amount
of time a child spends in childcare is generally related to how much a family
relies on a parent’s income, particularly a mother’s, with many mothers not hav-
ing the luxur y of choosing to stay at home. Political support for parents to care
for children can make a big difference. A study across 20 Western countries led
to the startling finding that just by increasing paid maternity leave by 10 weeks
infant mortality decreased by over 4 per cent, and presumably might decrease
more if more leave were granted (Tanaka, 2005). More paid maternity leave in
European countries is linked to long term health benefits to mothers (Avendano
et  al., 2015), and in Nor way increasing maternity leave showed benefits to the
children right up until the age of 30 (Carneiro et al., 2015). Research also shows
the beneficial effects of higher paternity leave (Cools et al., 2015).
Going out to work need not be either good or bad for mothers. Employed
mothers who are less satisfied with their work roles, and who have less support
at home, in fact tend to be more controlling of their children, who in turn tend to
become more defiant. While many employed mothers who get satisfaction from
their work are reported to be happier and more responsive parents (Grzywacz
and Bass, 2003), work– family conflict can have adverse effects (O’Brien et  al.,
2014), especially if working environments are stressful. Mothers who go out to
work often compensate for the time they are away by spending more so called
‘quality time’ interacting with their child. In many cases the total amount of
time spent together adds up to the same as that spent by stay- at- home mothers
(Br yant and Zick, 1996), and the amount of time a mother spends with her child
has a clear effect (Milkie et al., 2015).
Most studies show that quality of childcare does make a real difference.
For example children between two and four years old have less behavioural prob-
lems the higher the quality of day- care provided. Children from chaotic homes
in fact benefit hugely from childcare, showing better emotional regulation and
academic skills (Berr y et  al., 2016). For such children we see emotional, and
cognitive boosts particularly if the childcare is of a ver y high standard (Finch
et al., 2015).
Workers in group childcare rarely become substitute mothers. Analysis of
over 2000 cases found that, more often than not, in nurseries attachments were
of an avoidant or ambivalent rather than a secure kind (Ahnert et al., 2006). Most
of the children studied had secure relationships with their mothers and their
response to their day- care staff is a testament to their capacity to develop differ-
ent kinds of attachment styles with different carers. Even though some sensitive
and well- trained nurser y workers can potentially be more sensitive than many
parents, even the most sensitive staff member inevitably becomes less sensitive
when activity is geared to the needs of the group as a whole, rather than to spe-
cific children. It might be for this reason that secure attachments are more com-
mon when childcare is provided in home- based settings, such as by nannies and
childminders. Childcare providers in day- care settings are often unable to modu-
late infant distress, and consequently are less often sought out for comfort. Lamb
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providing a learning environment and minimising misbehaviour in the interests
of group harmony. Richard Bowlby is one voice among many who has argued
firmly that attachment needs in nurseries are underestimated, to the detriment
of children’s future wellbeing (Bowlby, 2007).
Some years ago Trudy Marshall, while working for a London local author-
ity, did a study of childcare that brought many of these sometimes upsetting
issues to life. She found that most staff were young, little trained and had a fear
of getting close to the children or of ‘spoiling’ them. A typical comment made by
one staff member was ‘if they cr y and it is just because they want to be cuddled,
then I would tr y not to do it’ (Marshall, 1982, p.28). Dependence was feared and
discouraged, and as Marshall wrote ‘there appeared to be an underlying belief
that to nurse a child was to spoil him, particularly if he was cr ying’ (1982, p.24).
In these nurseries a child was never held for more than a few seconds, except
on arrival, and few received ongoing sustained attention as staff would drift from
child to child quickly, concentrating on the group as a whole. Anxious and with-
drawn children received even less attention than cr ying ones, and when children
cried, non- mind- minded reasons were generally sought, such as the child being
‘dirty’ or ‘cold’ rather than emotional reasons, such as being sad, homesick,
scared, or unhappy.
Elfer and Page (2015) under took detailed obser vational research in nurs-
eries, in order to bring the child’s perspective more centrally into view. They
have described the contrasting experiences of children in nurseries where
emotional understanding and attachment is or is not central to the practice
and philosophy of the institution. He found that in many nurseries staf f actively
defend themselves against being aware of the emotional and attachment needs
of ver y young children in their care, and for example may discourage a child
from becoming dependent on them. The children in turn learn to adapt to the
expectations of the staf f. Secure attachment relationships often will not be
formed in such environments. Nurser y life is often characterised by a lack of
mind- mindedness; which may be as much a function of working in such an
institutional setting as the psychological capacities of the workers. Although
Marshall’s and Elfer’s studies are relatively small they illustrate some of the dif-
ficulties that toddlers have to manage when their childcare environment is less
than ideal. Yet for many parents, a day- care setting, often full time, is the setting
of choice, preferred over childminders and nannies, albeit sometimes for finan-
cial reasons. Nurser y care has generally not yet not taken on- board the benefits
of developing an attachment bond with a known and trusted adult who can
buf fer anxiety levels in ver y young children (Bowlby, 2007), nor of valuing the
training and suppor t of staf f in what is an emotionally taxing role (Elfer, 2014).
One of the biggest decisions parents often have to make is what kind of day- care
to use. In a large British sample mothers were asked, soon after having their first
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child, what kind of childcare they would choose in an ideal world (Leach et al.,
2006). Nearly half stated that their ideal was to stay at home with their children,
far ahead of the next choices, grandparents or nurseries, both of which scored
about 10 per cent, with nannies and childminders coming in at about 6 per cent
and fathers rock bottom at a shockingly low 0.5 per cent. In fact over half of the
mothers in this, the largest ever British study of childcare, did not end up with
the childcare that they had anticipated.
This study looked at the quality of the dif ferent forms of childcare,
comparing nurseries, childminders, nannies and grandparents. Attuned and
empathic carers made a big dif ference (Leach, 2009) and the stability and
availability of caregivers are par ticularly impor tant as well as the ratio of
adults to children, the experience and training of staf f, and how stimulating
the environment is. Interestingly, Leach’s study suggested that parents might
not always be the best judge of how good childcare is, par ticularly of nurser y
care, and might sometimes make judgements on the basis of factors such as
how well they get on with the carers rather than what actually goes on while
the child is in that care.
A central finding from this study was that at 10  months, on just about all
counts, nurser y care came out worse than care from one main carer in a home,
and was consistently associated with less positive interactions and less emotional
responsiveness from adults. In comparison, the results for nannies, childminders
and grandparents were fairly similar, and better than nurseries, with grandmoth-
ers coming out slightly lower than the others for the amount of positive interac-
tion, but not significantly so. Health and safety and quality of equipment were
better in nurseries, but not the quality of interactions and emotional relating.
Maybe more worr ying for parents was that there seemed to be ver y little rela-
tionship between the cost of childcare and its quality.
Childcare in UK and American nurseries is often provided by young staf f
with few qualifications, unlike for example in some Nor thern European coun-
tries where such workers have higher pay and status (Dulai, 2014). Interestingly
older staf f tended to be less punitive and have more positive interactions with
the children. Nurseries do provide good stimulus for cognitive development
as children get a little older, and cer tainly provide better physical environ-
ments and more facilities. However, the emotional environment of group care
generally is less suppor tive. Maybe slightly surprisingly, grandparental care
on average showed slightly more punitive behaviour than the other forms of
home- based care, and the grandparental homes were also slightly less safe.
Yet overall Leach’s study found that home- based forms of care of fered the best
forms of attention. As ratios got better in nurseries, then there were also some
improvements on all these scales. Such findings, I  think, fit well with others
in this book. Children benefit from consistent, positive, warm and ongoing
relationships with stable figures who provide security, safety and stimulation,
and who are interested in their minds and emotions. Children feel safer, as
attachment theor y attests, when they can be confident of gaining a response
from a carer who helps them manage anxiety and worr y. As well as needing

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safety and security, children thrive in environments where they feel confident,
are cared for, feel at ease, and where they are stimulated. Maybe most impor-
tantly, it is the quality of life at home that has a much bigger impact than child-
care (Stein et al., 2013).
• Nonmaternal care has been a central part of rearing children in almost all
known societies.
• Humans fit into the class of animals designated as cooperative breeders,
and have always needed more than just mothers to bring up children.
• Human adults seem biologically primed to respond to children other than
their own, and similarly young children are born primed to interact with
and attract other human adults.
• The degree and kind of nonmaternal care varies hugely across societies.
In monetarised Western societies this increasingly takes the form of pur-
chased childcare.
• Higher- quality care can improve cognitive and linguistic skills, but rarely
social and emotional skills, and the more time a child spends in childcare,
the more likelihood of later behavioural problems.
• Some children have more genetic susceptibility to be adversely affected by
poor childcare
• The quality of relationship a child has with its parents is a far better pre-
dictor of children’s academic performance and social functioning than the
quality of childcare.
• Institutional day- care environments such as nurseries can have a less posi-
tive effect than home based forms of care, but this in part depends on the
quality of care.
• This research back up other findings in this book, about the importance of
consistent attachment figures and attuned sensitive attention to children’s
psychological and emotional states in order to enable children to thrive.
Key points

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C h a p t e r   1 5
Middle childhood,
siblings, peers and
group life
Siblings and earlier interactions 183
Switch points: peers, parents and attachment 184
Power of the group 186
Peers: are they most important? 189
Temperament 190
Key points 192

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This chapter examines how children’s development is influenced not just
by parents but also other children, both peers and siblings. I  look par-
ticularly at middle childhood, a period that I  am defining as roughly 6 to
12  years old. This is a transformative time, akin to what in other species
is called juvenility, and its significance has been underestimated. Here we
see a huge rush of hormones in a still too little understood process called
adrenarche (Campbell, 2011). Adrenarche particularly involves the release
of androgens, hormones which seemingly stimulate brain development as
well as sex differentiation, all well before puberty. We also see a big shift
away from parental influence, as important interpersonal skills are learnt
and honed, emotional regulation takes a step for ward and group life comes
to take centre stage
In Western societies the nuclear family plays a more central role than in many
cultures, and much developmental research focuses on parent– child interac-
tions, and less on siblings or peers. In many other cultures children are part of a
larger social group from much earlier on and are regularly interacting with, and
influenced by, others across the age range. In many hunter- gatherer communi-
ties infants were kept with their mothers until the next child was born, and then
spent more time with peers, siblings and other adults, and socialisation occurred
in such groups. For example, one study showed that Polynesian children, once
they could walk, were ‘released’ into the care of three or four- year- old siblings
(Martini, 1994), with mothers and other adults nearby. Often when the older sib-
lings left them with their mothers, they would cr y with disappointment, such was
the bond and reliance on peers and siblings.
By school age, children are beginning to find a place for themselves in
groups, separate from their parents. Fitting in is easier for some children than
others. Whether or not a child is popular or invited to birthday parties can be
powerfully important, and children who are bullied or shunned are a cause for
concern. Some are introverted or loners, others are often involved in fights,
while luckier ones develop sophisticated social skills and become popular. Part
of the purpose of this chapter is to think about why children tend to move along
such trajectories.
We know that a child’s attachment status is likely to impact on what kind of
relationships they develop in nurser y and even later in school. A child’s capacity
to empathise and understand other minds will similarly affect their ability to get
on with others, even if some, such as Harris (2009), argue that the influence of
parents as opposed to peers has been overestimated.
Many factors affect children’s capacity for social interaction. Much social
development takes place in middle childhood, when the inbuilt propensity for
social and group life generally comes increasingly to the fore. This period sees
much brain change such as increased grey matter in cortical areas and axonal
growth. Much social learning takes place through interaction with peers,
especially via play. Cognitive and social skills are developing fast, children
become more reflexive, more capable of abstract thought; they develop better

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memories and can hold onto several different ideas at once. They also develop
better self- regulator y skills, mentalize more and their moral reasoning develops
(Del Giudice, 2014).
Children can by now compare themselves with others, working out where
they fit into a peer group. They might understand that they are better at maths
than some but worse at football than others, or liked by some but not by others.
They can become more emotionally self- aware, describing feeling states with
increasing subtlety. They can also often manage conflicting emotions towards the
same person or event, and understand that others, too, can have mixed emotions.
Such developing interpersonal skills mean that children, if all goes well, are more
able to understand others by predicting their actions and making sense of their
states of mind. They learn how to behave in order to gain group acceptance, and
the group is increasingly important, in terms of role models to emulate.
Not all children are equally successful at this, and children with few social
skills and an inability to understand other minds are particularly vulnerable, such
as those who have suffered serious maltreatment and neglect, who often struggle
to form friendships.
Learning how to be with other children often begins with siblings. Having an
older sibling generally enhances capacities such as theor y of mind and executive
functioning (Slaughter, 2015) and aids learning (Howe and Recchia, 2014), espe-
cially if the siblings are close in age.
Dunn (2014) has particularly stressed the important role played by sib-
lings in emotional development, arguing strongly against focusing too much on
parent– child relationships. For example, children who engage in pretend play
and role enactments with siblings in their early years display more sophisticated
social understanding later. Children learn from interactions, even interactions
in which they play no active part but simply obser ve. Of course, sibling relation-
ships are often also fraught with rivalr y and aggression, although research sug-
gests that in moderation even such rivalr y enhances social skills like negotiating,
understanding feelings and regulating emotions (Hughes, 2014).
Dunn’s (2004) research found that talk with other children about feelings
and mental states quadrupled between 33 and 47 months, whereas such talk with
mothers almost halved. Children’s talk with other children is different, develop-
ing skills in engaging with those they are on an equal footing with. In Dunn’s
studies children who had spent more time interacting with siblings interacted
best with other children, played more cooperatively in pairs and used more state-
ments that referred to the thoughts and feelings of others. Those who had more
emotional understanding at three years old continued to be ahead in these capac-
ities at six, leading to less interpersonal conflict and more cooperation.
In fact the capacity for peer relationships and group life can start even
earlier. Ur win and others (Bradley et  al., 2012) researched how young babies
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are surprisingly equipped for interchanges with other babies. Selby and Bradley
(2003, p.213) described eight- month- old babies placed in groups of three, without
an adult present, and here is a typical sequence captured on video:
Ann began to make frequent staccato vocalizations, predominantly whilst
looking at Joe … Ann’s vocalization rate increased markedly after Joe vocal-
ized back to her once (from 2 sounds in 20 seconds prior to his vocalization
to 10 in 10 seconds after; throughout all this Mona was mute). After watch-
ing Ann make this flurr y of vocalizations, Joe then turned to Mona to make
a huge initiation, as if bringing her in to the conversation. He reoriented his
body towards her, leant towards her, waved both his arms up and down, all
accompanied by an 8- second- long wide- open smile and raised eyebrows.
This attracted Mona’s attention, who had also been watching Ann
vocalize. In contrast, as Ann saw Mona and Joe make mutual gaze, her legs,
which had been stretched out towards the other two, drop down and she
looks down at herself, seemingly deflated. Joe looks briefly back at her, still
smiling and they make mutual gaze. But then he turns back to Mona, still
smiling. After this, 30 seconds pass before Ann and Joe make mutual gaze
again. Five seconds after Joe’s big initiation to Mona, Ann turns and scowls
at Mona, an expression she never made to Joe.
There can be little doubt that these are complex social interactions, including
mutual regulation, rivalr y, assertively demanding attention and playfulness, illus-
trating how infants can manage multiple relationships, not just dyadic ones, and
are able to participate in group life. In these brief excerpts one sees an acute
awareness of the pressures of belonging, of being ‘in’ or ‘out’, even in young
babies. As they get older, children tend to invest a lot in group identities and
seem to have a natural tendency to divide the world into ‘them and us’. The seed-
bed for interpersonal interaction is already there as early as infancy, but these
skills really come into their own in middle childhood.
Adrenarche can be seen as a developmental switch- point (Del Giudice, 2015), acti-
vating biological and psychological changes based on information both about the
external environment and life- histor y up until this point. For example, depending
on whether one’s current environment and earlier experiences were abusive or
kindly, different changes will take place. We might see more emotional dysregu-
lation in a threatening environment and more enjoyment and playfulness in a
safe, secure one. Thus different life- histor y strategies (Del Giudice, 2015) will get
amplified or minimised at such points.
How children relate to their peers is influenced by previous experiences.
Dunn and others described how infants and toddlers in ordinary non- abusing
homes show concern and empathy for other children in distress. Main (1985)
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studied a small sample of toddlers from less advantaged backgrounds, some of
whom had been abused, and found that not a single abused toddler showed con-
cern or sympathy for another child in distress, whereas over half the non- abused
sample did. Nearly all of the abused toddlers responded with aggression or anger
to other children crying. Typically, they described one toddler as making a ‘fero-
cious, threatening face at another toddler in distress with whom she had had no
recorded previous interactions’ (p. 409). These young toddlers seemed already to
be part of an intergenerational cycle, whereby abusive experiences are passed on to
others. They were aggressive to caregivers in the daycentre, and avoidant of adults
and peers who made friendly approaches. Children with a disorganised attachment
categorisation, who have been subjected to frightening and inconsistent parenting,
are very likely to show all kinds of difficulties with peers when they reach school
age (Seibert and Kerns, 2015). Disorganised attachment predicts both violent and
controlling behaviour in children who often come from backgrounds of severe psy-
chosocial deprivation, influencing the developmental switch- point.
The converse is also true, and by school age securely attached children
are better liked than their insecurely attached peers, who in turn are perceived
as more aggressive. Securely attached children are more responsive and flex-
ible in their interactions with other children (Groh et al., 2014). Children with
ambivalent attachments are more prone in general to being victimised and
having social dif ficulties. Attachment theorists (Sroufe, 2005) suggest that
social skills learnt at home through attuned reciprocal social interactions
translate into better capacities for peer relationships. Children develop repre-
sentations of themselves in relationship to others that become templates for
future relationships. In addition psychobiological influences will take ef fect,
such as the extent of autonomic ner vous system arousal, stress reactivity,
emotional regulation and the high or low functioning of the ventral vagus sys-
tem (Porges, 2011).
Longitudinal attachment studies (Sroufe, 2005; Grossmann et  al., 2005)
suggest that young children with secure attachments to either parent are more
likely to develop high- quality friendships as they get older and that secure attach-
ment predicts social competence, and participation in reciprocal friendships
(Groh et al., 2014).
Mothers who are demanding or show aggressive behaviours often have
children who struggle to get on with other children. Coercive parent– child rela-
tionships are associated with children who are more aggressive towards peers,
and perhaps not surprisingly, when parents are more controlling or use a lot of
physical discipline then their children have more friendship difficulties (Lansford
et al., 2011).
Children who are socially competent tend to have mothers who display
more positive emotions, and respond more thoughtfully to feelings. Considerable
similarities have been found between the ways a child interacts with parents and
peers, showing similar expressions and ways of talking (Attili et al., 2015). Where
parents are more responsive to children, the children become more responsive
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It is clear that what happens early on with parents has a big impact on how
children function in other relationships. Not surprisingly other stressors such as
poverty affect parenting skills which in turn affects peer relationships (Newland
et al., 2013).
Emotionally abused and maltreated children often struggle to form good
relationships, sometimes being shunned by other children, and high levels of
conflict in the home are linked with more likelihood of children becoming bul-
lied or bullies (Lereya et al., 2013), as well as interacting with other struggling
children. Harris (2009) makes the important point that children who interact
with other children with few social skills then cannot model themselves on more
competent peers, and worr ying behaviours can be reinforced by peer groups. Yet
early family relationships influence how children relate to peers.
It is easy to see why this might happen. Popular children have more capac-
ity to accept interactions initiated by others, and respond in an appropriately con-
tingent way. When they receive an initiation that is unwelcome they will often
offer an alternative possibility rather than just being rejecting. These tend to
be the same children who are able to play well in a social and imaginative way.
Popular children are by no means all sweetness and light, as this period is also
one when there is much competition for status. High status children are also
able to be aggressive and assertive but in a way that tactically ser ves their inter-
ests (Hawley, 2014). Most studies show that ver y popular children can often be
tough and ruthless but also socially attuned and prosocial (Wolters et al., 2013).
Such popular children have confidence, and are more extroverted than their less
popular peers, some of whom can be controlling, bossy and contrar y (Hay et al.,
2004). Such behaviour is of course ver y linked to earlier experiences, such as
stress or trauma. In middle childhood, with adrenarche, we see brain changes in
areas central to recognising and responding to social and emotional cues, such
as in the insular cortex and cingulate, allowing leaps in social development. The
positive developmental shifts though only occur if, at the time of this switch- point,
the child’s histor y and current environment make it seem safe enough to be
responsive to such peer group interaction.
The propensity to become part of a group is a central human trait that leaps for-
ward during this period. We humans evolved to sur vive in small hunter- gatherer
groups, are influenced by others from the first months and are like barometers
of emotional atmospheres. A  four- month- old is likely to smile when the atmos-
phere is jolly, and become fretful if things become tense. An infant’s capacities
for communication and imitation and their propensity for social interaction are
by no means reser ved simply for attachment relationships (Nash, 1995). Peers
are rarely attachment figures, but mutual interaction is powerful from early on.
Much research has shown how children want to belong to groups. In one
experiment boys were shown pictures comprising only of dots and asked to
Power of the group

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estimate how many dots the pictures contained. They were then told randomly,
with no grounding in reality, that they had over- or underestimated, and were either
‘over- estimators’ or ‘under- estimators’. They were then asked to interact with other
boys who were described to them as either over- or under- estimators. Interestingly
they tended to favour and be more generous to others in their own, in fact spurious,
group of over- / under- estimators (Tajfel and Turner, 1979). Belonging and being
part of a group has always been important for human survival.
Beebe reported LaFrance’s (1979) work examining postural matching
that found that those who shared similar postures had more mutual rapport.
Some students unwittingly mimicked their teacher’s posture. When the teacher
placed his right hand under his chin, the students mirrored this by placing their
left hand under their chin. Those who reported having good rapport with their
teacher were the ones who unconsciously mirrored his posture, suggesting that
feeling good is partly a function of being in synchronous harmony with those
around them. Indeed moving in synchrony with others increases pain thresholds
as well as bonding (Tarr et al., 2015). Many brain networks synchronise when we
are sharing affective stories (Nummenmaa et al., 2014). Furthermore when we
are imitated we are also more likely to engage in helpful prosocial behaviour with
strangers (Müller et al., 2012). This is even true of toddlers (Cirelli et al., 2014).
Imitation seems to oil the wheels of social life.
Birdwhistell (1970) found in various cultures that not only language but
postures and ways of moving are culturally distinctive. For example French
speakers tend to bulge their lips for ward, and tilt their heads while undertak-
ing specific hand gestures. A  bilingual Native American Kutenai tribesperson
consistently moves in a different way according to whether they are speaking
Kutenai or English. Children pick up and non- consciously imitate such cues and
learn to act in culturally expected ways, not just according to the norms of their
parents.
Children are learning at a young age about what is necessar y to be ‘in’,
such as with which nuances are used in speaking, what games to play, or what to
wear. Infants as early as three months prefer faces of their own ethnic group (Liu
et al., 2015), and who speak their own language (Shaw et al., 2015). Intergroup
‘bias’ and believing in the coherence of one’s own group increases self- esteem
(Benish- Weisman et al., 2015), so it might be good for us to feel that we belong.
Prejudice about ethnicity, class, or nationality are the worr ying counterpoints to
this need for group belonging.
In a classic experiment, a teacher divided her class into brown- and blue-
eyed pupils and announced that the brown- eyed pupils were better in various
ways (Peters, 1987). The children with the low- status eye colour showed a
marked deterioration in many ways, while previously well- functioning friend-
ships between blue- and brown- eyed children were suddenly at risk. We might
speculate that this need for group belonging has sensible evolutionar y roots due
to serious risks that could arise from straying into the territor y of strangers.
Yet this human propensity can have shocking implications, as seen in the
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to play the role of either prisoners or guards. In a ver y short time the so- called
prisoners became distrustful of, and angr y with, the guards who in turn became
surprisingly vindictive and cruel, leading to huge anger, hatred and mutual vio-
lence (Zimbardo et al., 2000). This is typical of a human propensity to identify pro-
foundly with our group and the concomitant tendency to see those in an ‘other’
group as ‘alien’.
Milgram’s (1974) work demonstrated the shocking way humans can act
unethically if they feel it is expected of them, especially by those in authority.
Subjects were told they would help students learn by giving mild electric shocks
after a wrong answer. Alarmingly around 65 per cent of the subjects were pre-
pared, under pressure from a white- coated male in authority, to administer what
they believed were potentially fatal levels of electric shock in order to conform
to the experimenter’s wishes. Such experiments have often been replicated and
nearly always over 60 per cent of subjects were prepared to administer potentially
fatal doses. This confounded all predictions, and is a stark example of the power
of social pressure.
Children are similarly influenced by peer pressure, answering questions
in a certain way in class because ever yone else does it that way, or joining in
the scapegoating of a child who others are ganging up on, as experiments have
shown (Morgan et al., 2015; Bond and Smith, 1996). The felt wish to be ‘in’ and
belong starts early. Working out who is a stranger or who is safe is something
that babies as young as six months do. A  different part of our brains lights up
when we look at a familiar face as opposed to a stranger (Krienen et al., 2010),
albeit not necessarily in some, such as autistic children (Dawson et al., 2002).
Group biases, then, can have unfor tunate consequences. In a typical
experiment in America, white subjects were shown both black and white
faces for 30 milliseconds, too shor t a time for the conscious mind to register.
When shown black faces, scans revealed that there was heightened amygdala
response, suggesting a non- conscious fear reaction. When the pictures were
then shown for long enough to register consciously what they were seeing,
the scans showed activation in brain areas involved with conflict resolution
(Cunningham et  al., 2004), suggesting that the subjects now were grappling
with their own racism. Familiarity with other races has been shown to reduce
such bias and the amygdala activation that can go with it (Cloutier et al., 2014).
Equally hopefully, various practices designed to enhance compassion practices
seem to reduce bias against out- groups such as other races (Hunsinger et al.,
2014) and the homeless (Parks et  al., 2014). Our biases are non- conscious,
implicit, generally develop early in childhood and play a power ful role in terms
of how we define ourselves, but thankfully they can also be altered.
Learning to fit in has profound social consequences for children. Whether
we are accepted or rejected by our peer group in childhood and adolescence
predicts aspects of social adjustment right into adulthood (Bagwell et al., 1998).
This in turn depends on skills like mentalization which helps make and maintain
friendships (Fink et al., 2015). Interestingly, children even adjust their tempera-
ments in these middle childhood years in order to fit into a group. For example

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timid boys become less shy and more outgoing, presumably because timid boys
might suffer socially (Kerr, 2001), and we also of course see much more conform-
ity to expected gender roles. Middle childhood is an age when such social adapta-
tion develops apace, and when influences outside the family become increasingly
important.
Harris (2009) argued and probably overplayed the idea that parents have little
influence on their children, but her work demands that we rethink the relative
balance of influences. Important environmental influences include the impact of
siblings and other adults, as well as the communities children live in. Seeing a
child’s environment as synonymous with their mother is a notion that puts tre-
mendous pressure and blame on mothers and ignores other central influences.
The prototypical example that Harris describes is how children use language.
Immigrant parents who speak little of the local language have children who soon
speak just like locals rather than in the often stilted way that first- generation
immigrants can.
Harris argues that what a child learns in one context, such as with parents,
is not necessarily useable in other contexts, and what works at home does not
necessarily work in school. In middle childhood children increasingly learn that
different ways of behaving are effective with different people and that different
environments have different rules. Harris gives many persuasive examples such
as that Polynesian children are raised to be subser vient and modest with adults,
but pushy and assertive with peers.
Parents might prefer to believe that their attitudes have the biggest influ-
ence on their child, but Harris warns against this. Children tend to have similar
attitudes about their studies to their peer group, and not only because children
from similar backgrounds choose each other, or because parents facilitate certain
kinds of friendships. In one study of children who switched peer groups, they then
also changed their attitudes to study to fit in with their new peer groups, and this
affected their academic performance (Kindermann, 1993). As Harris points out,
neither their IQs nor their parents had changed, only their peers. Children want to
be like the children they associate with, and adopt their attitudes, dress code and
behavioural styles, and this tendency increases as they reach middle childhood.
Children learn to speak, make gestures and dress like peers, as well as
taking on their social nuances, enabling them to fit in. Children quickly learn
from each other about skills. This is seen in children’s efficient uptake of new
technologies that parents struggle with. Harris described how a young macaque
monkey on a Japanese island chanced upon a way to separate out grains of wheat
from grains of sand by throwing the grains into water and seeing what floated.
Soon all the other young monkeys were doing this, but not the older ones (2009,
p.202). It makes evolutionar y sense that the young must learn from each other,
not just from their parents, if they are to ‘stay ahead of the game’.
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Thus much social learning in middle childhood is from peers, which is why
parents so often worr y about bad influences on their children. There is increas-
ing evidence that effective inter ventions for youth at risk of criminal behaviour
work best when they address the peer group (Henggeler, 2012). When boys are
moved away from worr ying peer groups then crime and behavioural difficulties
diminish (Youngblade et al., 2007). The neighbourhood a young person lives in,
and the people they associate with, are ver y influential. Young African- Americans
living in inner- city areas have a higher than average tendency to get involved in
youth crime. Yet children from similar socioeconomic backgrounds were less
likely to be aggressive when living in more middle- class areas; adapting their
behaviour in part to neighbourhood norms (Wikström, 2000).
In some research on gender and sociocultural influences, girls were play-
ing dodgeball competitively. Then some boys came on the scene and joined in
and the girls became less competitive, standing around or joking more (Weisfeld
et al., 1982). This is typical of research suggesting that girls change their behav-
iours according to group and gendered expectations (Drur y et al., 2013).
The effect of peer group experiences can last right into adulthood. Taller
men generally have higher status, get better jobs, and hold more leadership posi-
tions. Yet it is not their height as adults that has this effect. Some children were
small in childhood but later in adulthood caught up with those peers who had
matured earlier. Nonetheless, they never caught up in terms of status. Adult sta-
tus and confidence was more linked to relative status earlier in life. Males who
were smaller than others in adolescence when their peer group status was being
worked out, kept their lower status despite catching up with their adult peers in
height (Hall, 2006).
Thus early group learning can last, and the timing of influences is all impor-
tant. Minoura described a situation in which some Japanese children were trans-
planted to California (Minoura, 1992). Their parents ensured that the culture in
the family home retained its traditional Japanese ethos, as they were intending
to return and wanted their children to manage the transition back. Yet if the chil-
dren stayed too long, they became completely assimilated to the local culture
and struggled to re- adjust on their return. If children had not returned by the
age of about 12 or 13 they struggled much more, whereas the younger ones
remained more malleable and could still adjust more easily. This makes sense in
part because the period of middle childhood is such an important time for social
learning from peers and the wider culture rather than just from parents.
An important research question concerns whether a child’s in- born tempera-
ment accounts for differences in how they get on with other children. Children
who are more positive, and have a milder temperament, do get on better with
peers. Children who are more emotionally labile and struggle to regulate emo-
tions have worse peer relationships, as do ver y withdrawn children (Ladd et al.,
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2014). A child’s temperament might influence how they respond to others, and
also how they are responded to by parents or peers. Children with aggressive
temperaments will elicit different reactions from children who have easy- going
temperaments, and these will in turn evoke different reactions than shy and
anxious children. However many definitions of temperament imply an inherited,
even genetic tendency, but could also partly be explained by parenting and family
experiences. For example prenatal stress or violence in the home will predispose
to emotional dysregulation.
It is possible that in time more gene- environment research might clarify
some of these issues. Some research, for example, suggests that in friendship
groups we see more genetic similarities than one would expect to happen by
chance (Fowler and Christakis, 2010), and also possibly that popularity (Fowler
et  al., 2009) and problematic peer relationships (St Pourcain et  al., 2014) have
some genetic components. Others though have disputed these findings, and sug-
gest that the influence of genes on friendship groups remains weak (Boardman
et  al., 2012). Still other research about the risk of becoming involved in delin-
quent peer groups not surprisingly suggests an important role for both genes
and social learning (Boisvert et al., 2013).
Of course it can never simply be a case of either genes or environment.
A  toddler may have temperamentally lower capacities for emotional regula-
tion, but when combined with insensitive parenting then some, especially boys,
become more aggressive. Sensitive parenting goes a long way to mediate temper-
amental risks (Kim and Kochanska, 2015). Also children will often find a niche
for themselves in a family or peer group that suits their temperament, yet the
roles that they take on might then be socially reinforced by interactions with oth-
ers around them, so that nurture reinforces temperament.
Children who are distractible, low in mood and easily aroused tend to be
less popular than the norm (Walker et al., 2001). Ver y active children engage less
in interpersonal or pretend play than other children and research with American
schoolchildren has shown that high activity can lead to popularity in boys but not
in girls, who often favour less active peers (Gleason et al., 2005). High levels of
emotional expression and poor emotional regulation have an adverse effect on
peer relationships, and there seems little doubt not only that temperament has
an impact on a child’s capacity for peer relations, but also that this is moderated
by factors such as parenting style. To add to the complexity, children with dif-
ferent temperaments elicit different kinds of parenting, and while inconsistent
discipline might increase negative emotionality in children, children’s irritability
can evoke inconsistent parenting in its own right (Laukkanen et al., 2014).
Inter vention studies show that social influences and not just genetic des-
tiny have an effect (Ladd, 2005, p.338). Inter ventions that aim to increase chil-
dren’s social competencies and inhibit acting out behaviours result in improved
peer relationships and more acceptance by other children. The same changes are
not seen in the untreated control groups, suggesting that social competencies are
at least partly learnt and not just due to temperament. Such studies suggest that
real change is possible, and that some forms of help can lessen the likelihood

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of children becoming victims, end cycles of bullying and give hope that, despite
a child’s temperamental endowment, they are not condemned to a particular
model of interacting with others.
These are serious matters and important to unravel. Currently the research
field is not able to separate out temperament, parenting styles and genetic inherit-
ance sufficiently to make much more than tentative claims. Yet we know that chil-
dren’s lives are blighted by poor peer relationships. As Ladd states (2005, p.331)
‘a picture emerges of socially incompetent children as having thought patterns
that motivated, justified and perpetuated behaviour that undermined the forma-
tion and maintenance of positive peer relationships’ (2005, p. 331). Research with
children shows that belonging to and identifying with groups, whether peers,
school, clubs or family, hugely decreases the risk of later mental health issues
(Miller et al., 2015). For this reason inter ventions that facilitate a child’s ability to
appropriately interact with peers can be vital.
• There is a natural human propensity to fit into groups, to imitate and to be
influenced by those close to us.
• Children will learn from peers and siblings and others apart from their par-
ents, which aids the ability of new generations to adapt and change.
• Other children become the main route to social learning from middle
childhood, as parental influence begins to lessen, even if parents remain
important.
• Early parenting and attachment relationships have a large impact on chil-
dren’s interpersonal capacities and how they relate to peers, at this life- stage
• Middle childhood is marked by the important endocrinological event,
adrenarche, with linked changes in the brain, and this is possibly a ‘switch-
point’ for life- histor y strategies.
• The social competencies that develop in middle childhood have residues
that can last right into adulthood,
• Children who are socially less competent are more likely to experience
rejection and act in ways that flout social norms, are less likely to see the
world from another’s point of view, and are also less likely to fit in with
other children.
• Children’s development cannot be understood without taking into account
parental, peer and a range of sociocultural influences.
Key points

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C h a p t e r   1 6
The place of fathers
Biological priming 195
Children with a father and a mother 197
Children without a biological father present: single mothers,
lesbian parents and step- fathers 199
Practical lessons from research on fathers 201
Key points 203

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Questions about the role of fathers can stir up controversy. Most of us
have a view about what a father should be or do. Some think that children
should be raised in heterosexual marriages, others that fathers should do
much more for their children, while still others think fathers are becom-
ingly increasingly irrelevant. The role of fathers  has undergone shifts in
the West, alongside demographic changes such as many more babies
being born outside marriage – up to 40 per cent in the US (Hamilton et al.,
2013) – higher divorce rates, and more children living in ‘blended’ families,
as well as more women working full or part time. This has all impacted on
paternal roles. A British study looking at nearly 20,000 children (Dex and
Ward, 2007) suggested that the old idea of stay- at- home mothers and work-
ing fathers was true in less than 30 per cent of families. The most common
pattern in Britain (35 per cent) now is of a full- time working father and
a mother working part time, whilst in 11 per cent of cases both parents
work full time. In the West generally fathers have become more involved
with their children in recent decades, although the bulk of childcare still
falls to mothers (Lamb, 2004), and the trend towards mothers working
full- time has increased, particularly since the economic downturn (Wang
et al., 2013).
This chapter looks primarily at fathers’ involvement with, and effect on, their
children. As Lamb suggests, fathering can take many forms in contemporar y
societies, such as moral overseer, breadwinner, gender role model, and father
as nurturant/ participant parent. Societies have been organised in a multitude
of ways, and fathers have played a vast array of roles. There is no one ‘natural’
paternal role.
What a father is and does varies enormously from society to society and
epoch to epoch. Anthropological studies suggest that as nomadic existences
shifted into settled pastoral life, and then into moneyed wage- earning economies,
fathers became more absent from the day- to- day care of children. Yet even in
contemporar y Western Europe, men’s participation in childcare differs widely.
Swedish men, with the longest paternity leave, are the most involved with their
children, considerably more so than British fathers, for example, who in turn
contribute more than fathers from many other European countries (Cabrera and
Tamis- LeMonda, 2013).
The greatest known involvement of fathers is seen in the Aka forager com-
munities in Central Africa. Here a father is holding or within arm’s reach of an
infant for about half of a 24- hour period, is near the baby 88 per cent of their wak-
ing time and holding an infant for about a quarter of the waking time (Hewlett,
1991). An Aka father is expected to be physically affectionate to his child, and
ver y supportive of the mother, and Aka males can slip into more traditionally
female roles with no loss of status.
The opposite extreme is families with little male presence. In America the
proportion of children raised by single mothers has grown exponentially in the
last 50 years (McLanahan and Jencks, 2015), while there has been a huge rise in

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mothers as the primar y breadwinners in Europe (Cor y and Stirling, 2015).
The highest rates of female- headed families are seen in African countries.
Botswana tops the bill with nearly half headed by women (Flouri, 2005), and
interestingly in Botswana, a society based on strong matrilineages, it is often
the mother’s brother who becomes the important male in a child’s life (De Wit
et  al., 2014). Ways of conceptualising masculinity and femininity, and fathers
and mothers, that are accepted in one culture do not necessarily have universal
significance.
Given the cultural and historical variations, it is not possible to say what a
father’s role is or should be, but it is possible to look at the effects of different
kinds of fathering, and of the presence or absence of fathers. Much psychologi-
cal thinking, such as in psychoanalysis, has emphasised the role of the father in
helping to separate symbiotically bonded mother– infant pairs, and also in pro-
viding support or ‘holding’ for the mother so that she can in turn emotionally
support the baby. It is clear that a father’s emotional support for a mother can
enhance a child’s care, even when the father is less directly involved in childcare
(McHale and Fivaz- Depeursinge, 1999). The importance of fathers in supporting
mothers is less relevant for those living in different constellations, such as when
there are lesbian parents, or in matrilineages where biological fathers live away
from children and maternal relatives are ver y involved in the childcare. Research
on Western populations shows that father involvement is often associated with
good outcomes, but like much research cited in this book, research about fathers
is increasingly complex and multidimensional, which means there are no easy
answers, or even easy questions, about whether having a father present is a good
thing or not for a child.
A widely held view is that looking after children is ‘naturally’ done by mothers,
and it is worth asking whether there is any truth in this idea. After all, in nearly
all known societies it is mothers who do the bulk of the childcare. Hrdy notes
(1999, p.109) that females are more primed in most species to respond to infants,
in terms of neurocircuitr y and hormonal predispositions, whereas males in most
species remain more aloof from infants. Yet males, even in the least nurturing
species, such as patriarchal hamadr yas baboons or languors, can be induced to
care for infants, and there is an unanswered question about why male parenting
does not happen more. Hrdy suggests that different biological propensities need
not lead to the childcare gender divide often seen in humans. Rather she thinks
that slight biological predispositions, due perhaps to factors such as hormonal
systems or the ability to breastfeed, might turn into ongoing patterns. Thus
socially expected roles can become the default way of being, through taking the
line of least resistance, much like water tends to run down well- worn channels.
In fact the evidence that we have suggests that fathers biologically have
no less potential to be sensitive to infant signals than mothers. Given the right
Biological priming

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circumstances they interact and imitate in much the same way as mothers
(Lamb, 2004), are equally able to identify their children by touch as mothers
when blindfolded and not able to use smell (Bader and Phillips, 2002), and have
been shown to be as sensitive as mothers at feeding, allowing appropriate pauses
and recover y time. Securely attached children are related to by their mothers
and fathers in extremely similar ways, for example with more mind- mindedness
(Palm, 2014). Such research does not suggest that fathers do anything unique. In
research in Western samples fathers relate to their children more physically and
playfully on average, but there is no evidence that this is a biological given, and
for example the Aka fathers mentioned above, who spend more time with their
children, indulge in less of this kind of active play than Western fathers.
Cultural ideals contribute fundamentally to paternal practices. The Kipsigis
of East Africa do not feed, dress or carr y infants for about four years and believe
that infants can be damaged by their masculine gaze (Hewlett and Lamb, 2005).
It is likely that it is both female and male attitudes that play a role in the lack of
paternal input into families in the West. Leach’s sample of 1200 British mothers
were asked, soon after their first child’s birth, what their ideal childcare arrange-
ment would be, if money and other factors were not an issue. Fathers were right
at the bottom of the list, the preferred choice of only one in 200 mothers, scoring
eight times lower than childminders, the next worst choice (Leach, 2009). In
reality by 18 months nearly eight per cent of the children were being looked after
primarily by their fathers. This might suggest mixed feelings in members of both
genders about the other gender taking on roles that are less traditional.
Males in many species tend to be less nurturing of infants, but retain a pre-
disposition to become nurturing if given the right triggers. Many men who seem
reluctant to become parents can become adoring fathers the moment a child is
born. This has a biological root. In human and other primate males prolactin
levels rise when males care for offspring. Men living with pregnant partners, as
well as having higher prolactin levels, which increase protective feelings, also
develop lower testosterone levels after the birth, suggesting a biological ten-
dency to become more protective and less sexually active (Gettler, 2014). We
also see brain changes as men start to parent (Abraham et al., 2014), particularly
in circuitr y linked to emotional understanding and attachment.
One obvious disincentive for male participation in childcare is that until
the recent advent of genetic testing fathers could never be 100 per cent certain
of paternity. Hrdy (1999) shows that paternal care across species increases the
more certainty there is about paternity. For example, male dunnocks (sparrow-
like birds) provide food to infants more or less in proportion to how frequently
they copulated with the mother, and male baboons similarly tend to help children
more if they think paternity is theirs. Males are biologically capable of having
many more children than females who tend on average to invest more in each
one. Analysis of the human genome shows that in evolutionar y histor y males are
more likely to have had multiple partners than females, and a higher proportion
of men than women have had children with more than one partner, but also a

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higher proportion of men than women have not been successful at having any
children at all (Hammer et al., 2008).
Most studies suggest that infants generally fare better with paternal sup-
port. Hrdy and others have even shown that in some societies having children
with more than one male is a way of eliciting useful extra help. Particularly in
an environment where male life expectancy is low, this increases the chances of
children being provided for and protected. For example the Canela, a matrilineal
Brazilian tribe, not only sanction women having intercourse with more than one
man but are seen as selfish if they do not (Crocker and Crocker, 1994). This
society has a belief in what is called ‘partible paternity’, the idea that a child can
have several fathers, something that can confer advantages on children in certain
societies (Walker et al., 2010). In some variants it is even believed that more than
one man’s sperm is needed for a foetus to grow properly. For the Bari people of
Venezuela those who had a primar y and secondar y father have sur vival rates in
late adolescence that are considerably higher than those with only one father.
Pregnant Bari women accept sexual advances from higher- status males, such as
successful fishermen, giving themselves and their children a better chance of
flourishing. Presumably such practices are less necessar y in Western monoga-
mous cultures where males live longer.
From studies of American and European samples we have learnt a lot about the
effect of a father’s presence in children’s lives. A major British study followed all
children born on one day in 1958 (Flouri, 2005), and asked how much fathers
were involved with their children at 7, 11 and 16  years old. The study asked
straightfor ward questions such as how often did a father take a child on an out-
ing, or read to them. It found that fathers were more involved with their children
when mothers were also highly involved and when the quality of the parents’
relationship was better. Social factors also strongly influenced behaviours, and
there was less father involvement, and more behavioural problems, where fami-
lies were of low socioeconomic status, presumably linked to economic and social
stressors.
Analysis of the research by Flouri and others suggests that father involve-
ment is protective. The children of fathers who were not living with them were
more likely to have ADHD and conduct problems. The presence of a father is
also linked to a child’s sense of happiness, and to less likelihood of antisocial
behaviour. Many of these effects are lasting, and for example Flouri shows that
early paternal involvement predicts educational attainment in adulthood for both
genders. Where the couple relationship is stronger, fathers tend to be more com-
mitted to their children (Waller and Swisher, 2006). Indeed, one study showed
that children benefit more from parents working on their couple relationship
in counselling than from receiving direct parenting skills trainings (Cowan and
Children with a father and a mother

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Cowan, 2003). Having a better parental relationship seems to pay dividends for a
child’s later development.
Having more father involvement is not necessarily a good thing, though,
as different fathers have different effects. As many as 10 per cent of new fathers
suffer from postnatal depression (Sethna et al., 2015). The children of depressed
fathers show emotional and behavioural difficulties, such as hyperactivity, at
three- and- a- half years of age – affecting boys more than girls. Fathers who show
mental distress in pregnancy also often have children with poor later socioemo-
tional and behavioural outcomes (Kvalevaag et  al., 2013). Thus we have to be
careful about suggesting that fathers in general are either a good or bad thing,
without looking more closely at what kind of fathers. Depression diminishes a
father’s ability to be empathic and attuned with his child, and to manage a harmo-
nious couple relationship.
One interesting study looked at the effect of having a father who indulged
in antisocial behaviour (Jaffee et  al., 2003). Fathers with antisocial tendencies
were less likely to be involved with their infants, or to be living at home with
them. Striking a blow against the idea that two- parent families are always best
is how, when antisocial fathers were living at home, their children were much
more likely to show behavioural difficulties than if such fathers were absent.
Of course violence by fathers against their partners has bad effects on children
(Lamers- Winkelman et  al., 2012), as well as on brain development and genes
expression (Radtke et al., 2011). Some but not all fathers foster children’s posi-
tive development.
Generally when fathers are nurturing, playful and encouraging, advantages
are conferred (Lamb, 2004; Flouri, 2005). Children starting school with such
fathers on average have higher IQs, better vocabular y and cognitive skills, and
more readiness to manage the demands of a school environment. This can pay
dividends right up until adolescence, when such children attain higher grades
and generally achieve better. Cognitive and emotional developments are finely
interlinked.
Children achieve better academically when they feel good about them-
selves, and nurturing active parenting, including fathering, helps achieve this.
Children from a loving home who feel attuned to, encouraged, and understood
tend to be more confident and have fewer mental health or behavioural problems
(Peters et al., 2014). However the relationships can be bi- directional and hard to
tease out. In one Chinese study it was found that more father involvement pre-
dicted social competence in young children but also that less social competence
could lead to worse child– father relationships, so influences can work both ways
(Zhang, 2013). More fine- grained research is also throwing up all manner of find-
ings, such as that fathers who do more housework have daughters who are more
ambitious! (Croft et al., 2014).
Children whose fathers are highly involved are less likely to suffer from
depression or anxiety, to get involved in drugs or delinquent behaviour, are
more likely to have high self- esteem and indeed they do much better on many
academic scores (Dubowitz et  al., 2001). Of course the opposite is also true;

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maltreatment and delinquency in fathers leads to worse outcomes for their chil-
dren (Gault- Sherman, 2011).
Better outcomes occur when the fathers actively choose to be more
involved. Just spending time with a child need not necessarily confer the same
advantages, such as when fathers are involved by default rather than choice,
maybe when mothers reluctantly become the main breadwinner, and in such
cases children do not tend to do so well (O’Brien et al., 2005). Father involvement
increases when mothers encourage this, but mothers can also be gatekeepers of
paternal involvement (Puhlman and Pasley, 2013). When both parties actively
value the closeness in the parental relationship and co- parenting, then all seem to
reap rewards, but if there is resentment, such as unwilling childcare by fathers,
or unwilling labour by mothers, then this is likely to create a less harmonious
family atmosphere.
Children seem to benefit most from authoritative, rather than authoritar-
ian, parenting (Morris et al., 2013), which includes dimensions of being caring
and accepting, showing appropriate discipline, and fostering autonomy. Although
in many families such tasks can be divided according to gender stereotypes, with
fathers dispensing the discipline and playfulness, the research does not suggest
that this is in any way inevitable, or that fathers necessarily do anything unique
that mothers or other adults cannot do. What it does suggest, as stated through-
out this book, is that good relationships, empathy, nurturing and playfulness,
among other things, breed happier children who feel more confident, secure and
held in mind. The key to good relationships is not surprisingly the ability to be
intimate and emotionally involved (Dermott, 2014).
One way of working out how important biological fathers are is to see what
happens when they are not around, such as with children brought up by sin-
gle mothers, lesbian couples, or step- fathers. Most data suggests that children
do worse when they are brought up by lone parents. They often have worse
health outcomes (Scharte et  al., 2013), achieve less educationally, and are
more likely to have behavioural and emotional difficulties. On the face of it sole
parenthood looks like a major disadvantage. One American study found that
three- year- olds of single parents were more likely than children in two- parent
relationships to have lower social and cognitive skills, more behavioural issues,
worse relationships with adults, and a greater likelihood of insecure attachment
(Clarke- Stewart, 2013).
There is plenty of similar research that can be used by those opposed
to single- parenthood. However, extreme caution is necessar y in interpreting
these findings. Economic and social factors such as pover ty exercise more
influence on child outcomes than whether a father is present (Bornstein and
Bradley, 2014). Single parents often come from lower socioeconomic groups,
Children without a biological father present:
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have many social disadvantages and are more likely to be socially excluded.
For example, children from single- parent households have lower attendance at
college except when family income was taken into account as a factor (Huang
et al., 2000). It seems that low socio- economic status, pover ty and lack of sup-
por t, rather than single- parenthood, has the strongest ef fect on the poor out-
comes for such children.
In such studies, when factors such as income and social disadvantage are
screened out, the differences between the children of single parents and two-
parent families tend to almost disappear (Spencer, 2005). Financial difficulties
and poverty affect the capacity to parent (Pearce et  al., 2012), and this is com-
pounded when there is less adult support around, something which, even with-
out the economic disadvantages, is likely to lead to less ability to parent with
both authority and sensitivity. Overall the research suggests that it is poverty and
socioeconomic factors rather than single- parenthood which are the biggest risk
factors for children. A  15- year- old, single mother living in a deprived inner- city
community is likely to fare far worse than a middle- class, wealthy single- parent
living in an affluent area with social support.
Longitudinal research comparing children brought up in female- headed
households (i.e. lesbian or single parents) with children brought up in hetero-
sexual couples has found that as they enter adulthood the children of female-
headed households were functioning emotionally as well if not better than their
counterparts on all scores (Golombok, 2015). Children of lesbian and heterosex-
ual couples show more similarities than differences, and the overall consensus,
examining many studies, is that children do no worse in such parenting con-
figurations (Adams and Light, 2015). In adoption for example it is the quality
of the couple relationship which is the best predictor of child outcomes, irre-
spective of sexuality (Farr and Patterson, 2013). Another large- scale research
study (Patterson and Wainright, 2007) found that there was no effect on overall
emotional adjustment, school outcomes, substance use, family and peer relations
from living in a lesbian- headed household. Any differences in adolescent func-
tioning were not as a result of family type (i.e. lesbian, heterosexual couples, or
single parents) but rather were related to overall emotional functioning in the
families. In general it would appear that growing up in a female- headed house-
hold is not a risk factor.
However, children living with a step- father and their mother, compared
with those living with a biological father, can have worse outcomes, including
lower academic achievements, more criminal behaviour, substance misuse and
teenage pregnancy (Hofferth and Anderson, 2003), and in the worst instances,
more risk of physical abuse and injur y (Nepomnyaschy and Donnelly, 2015).
This might partly be explained by the likelihood of children in ‘reconstituted’
families having already often lived in less harmonious circumstances, and suf-
fering dislocations. But also step- parents have been consistently shown to be
on average less warm, nurturing and attached to their step- children (Pr yor and
Rodgers, 2001). One hypothesis is that on average parents invest more in genetic
children. More extreme and worr ying, bodies of research have shown that child

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abuse and violence is more common when living with a step- father (Hilton et al.,
2015). Yet of course many children also do extremely well in step- families (King
et al., 2014), especially when the new relationship is close and stable, and there
is family cohesion and bonding. We certainly need to avoid the danger of type-
casting step- fathers.
Studies suggest that not having a biological father present can be a disad-
vantage in some, but by no means all cases. Children of lesbian couples seem to
do as well as children in heterosexual couples. Children brought up by single
mothers do seem on average to be handicapped, but economic and social pres-
sures are the major cause of this. Children brought up in ‘blended’ families with
step- fathers are more likely to do worse, but once again this depends ver y much
on the particular step- father and the state of the adult relationship.
Given that so little can be said about what a father ‘naturally’ is or should be,
it might seem hard to use the evidence available to think about what practices
might seem preferable, at least in Western cultural contexts. In so- called ‘high-
risk’ groups parenting inter ventions are increasingly used in which specific
paternal roles are encouraged that could be construed as supporting gender ste-
reotypes, such as ‘father as disciplinarian’. Much therapeutic literature, such as
some psychoanalytic thinking, defines the paternal role as one which provides an
outside perspective or ‘third position’, a view which fits well with the widespread
conception of the father as ‘outside’ the mother– child relationship, represent-
ing the external world (Music, 2004). Fathers in much parenting literature are
encouraged to act in such traditional roles, as provider, as a bridge into the wider
world, encouraging autonomy and also providing discipline. Research does not
show that fathers are any better at these tasks than mothers, but it certainly
seems that when such ideas are put into practice in targeted inter ventions then
the outcomes are often good.
It is also clear that many parenting inter ventions are more effective when
fathers participate, even if this can be hard to achieve (Ramchandani and Iles,
2014). One not surprising yet consistent finding is that a positive relationship
between fathers and mothers helps children, and inter ventions which help the
couple relationship also help the children (Cowan et al., 2009). Thoughtfulness
and respect in a couple can be modelled and passed on to the next generation,
just as violence, hatred and disrespect can also be transmitted. Fathers who are
negative, critical, who withdraw or attack too quickly, have been shown to have a
negative effect on family life (Almeida et al., 2001).
Some children are brought up only by their fathers and research with these
relatively small samples is showing that they tend to do ver y well (Pruett, 2000).
One might surmise that given the cultural expectations, these fathers were likely
to be particularly committed. Children of such single- father families had stable
gender identifications and good friendships with children of the opposite gender,
Practical lessons from research on fathers

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and were active and curious. Such parenting practices challenge gender stereo-
types, and are becoming increasingly common in Europe and America.
Consistent with the themes of this book, children do better in relationships
with peers when they have had good relationships at home, and fathers can be
important in this respect. When fathers spend time with children in a playful and
enjoyable way this can build bonds and enhance good feelings. Furthermore,
fathers who are able to remain calm under pressure, manage children’s upset
and remain supportive and nurturing, are likely to have children who are more
popular in school, with boys being less aggressive and girls getting on better
with peers (Parke et  al., 2002). Children whose fathers are not ver y involved
with them have a greater likelihood of problems such as poor educational perfor-
mance, delinquency in adolescent boys, and teenage pregnancy in girls (Flouri,
2005). In other societies the disadvantages can be more extreme, and as Hrdy
(1999) points out, in hunter- gatherer societies children without fathers are more
likely to simply not sur vive.
It was once believed that infant– mother attachment was all important, but
increasingly it has become clear that a child’s attachment to their father is often
central, sometimes having almost as much effect on the child as the relation-
ship with the mother, such as on wellbeing and peer relationships (Palm, 2014).
A secure attachment with a father can offset an insecure one with a mother and
vice versa, and of course best of all is having a secure attachment to both. The
characteristic ways that fathers of securely attached children relate to their chil-
dren are seemingly ver y similar to those of mothers of securely attached children.
Ultimately what counts is a father being there for their children in the con-
text of harmonious relationships. A father’s influence does not just magically rub
off, but depends on actual interaction with his children, and whatever the father’s
character traits, they are unlikely to influence a child if he rarely sees them.
Fathers in two- parent families, who are present in their children’s lives, add more
benefits the more they put in. One early study showed that when both parents
visited their child’s school, as opposed to only the mother, the children’s reading
and maths scores were up to seven months ahead (Lambert and Hart, 1976).
When neither parent visited their children were on average 13 months behind,
although of course there might be other explanations for this as well.
When fathers have more warm contact with their children then their chil-
dren do better, even if ‘doing better’ can have different meanings in different
times and cultures. I mentioned previously the research from the 1950s that sug-
gested that involved fathers tended to have sons who were more ‘masculine’, in
American studies at least. At the time it was thought that this was a father’s cen-
tral influence. Contemporar y studies suggest that involved fathers lead to happier
and more fulfilled sons, but sons who are often more sensitive than their more
masculine forerunners from the 1950s and 1960s (Lamb, 2004). Children want to
be like the people they admire, whatever the current cultural ideal, whether the
admired fathers are warm and involved or more distant and ‘macho’.
Overall, children benefit from good, loving, thoughtful relationships with
their caregivers, ones that offer nurturing and clear boundaries and a relatively

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harmonious and stimulating environment. Fathers can play a crucial role in this,
and in most societies they do this in a different way to mothers. However, fathers
are not essential to this happening, and in some circumstances their presence
can hinder rather than help children. Overall though research over whelmingly
suggests that on average the presence of an active, nurturing father is likely to be
beneficial to many aspects of a child’s development.
• What it means to be a father varies hugely over historical periods and
cultures.
• In recent decades fathering in the West has over time undergone changes,
from the strict patriarch to the distant wage- earner to more involved dads,
although mothers still undertake the bulk of parenting.
• Most research shows that the presence of a father benefits children, albeit
with exceptions, such as antisocial fathers.
• It is unclear whether there is anything a mother can provide psychologi-
cally and emotionally that fathers cannot, and vice versa, even if they tend
to do different things.
• In Western research samples fathers tend to use humour more or to indulge
in more rough- and- tumble play, but this varies across cultures.
• We live in a society where a stable parental relationship and the presence of
more than one caring adult in the home can confer advantages on children.
• The research clearly suggests that being parented without a father need
not be a disadvantage to children.
• Monogamy may be an advantage in some Western societies, while partible
paternity or polygamous relationships with high- status men might be more
likely to enhance child outcomes in others.
• There are too many different ideas about what a father should be to argue
that one way is any better than another.
Key points

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C h a p t e r   1 7
Moving towards
adulthood
The adolescent brain 208
Screens, the connected world and other addictions 211
Becoming less attached 214
Sex and romance 216
Risks, problems and resilience 217
Key points 219

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Children move further away from their parents as they shift into adoles-
cence, a time of huge and exciting developments. In this chapter I outline
some of the main developmental challenges of this period. Adolescence is
sometimes seen as a transitional time, a stepping- stone between childhood
and adulthood, a view which underestimates how important it is in its own
right. It is marked by biological and neuroendocrine changes. From the
first signs such as breast buds in girls and larger testes in boys, there is a
cascade of development lasting well over a decade. Something akin to ado-
lescence is seen in most primates and mammals. For example rodents and
primates also engage in more peer- directed social interaction during the
equivalent period (Brenhouse and Andersen, 2011), as well as increased
risk taking and novelty seeking, and there is increased mortality in most
species, including humans, during adolescence (Steinberg, 2007). Human
adolescence is marked by major hormonal and brain changes, startling
physical transformations, particularly into distinctive male and female bod-
ies, new capacities for abstract thinking, the development of a conscious
and autonomous identity, all of which set the stage for adult life by putting
clear developmental capacities in place.
During adolescence one tends to see an abandonment of many attachment and
dependency needs, although these continue to exert more influence than many
adolescents admit. Real changes take place that adults can be slow to recognise,
such as strides in cognitive, emotional and social abilities, a push for developing
independence, and the locus of identifications moving further away from family,
towards peers.
It is often described as a period of emotional upheaval, G.  Stanley Hall
(1904, p.306) as early as 1904 calling it a time of ‘storm and stress’. However,
parents often find adolescence at least as, if not more, stressful than teenagers
(Holmes et  al., 2008). Research has questioned Hall’s idea that adolescence is
always a painful and difficult time, but during adolescence the effects of child-
hood experiences can come home to roost, with early stress, trauma, or family
difficulties often leading to turbulent teenage years.
Some, such as Mead (1943) argued that adolescence is more a culturally
specific than a universal phenomenon, and certainly in some cultures adolescence
is less of a time of turmoil. A  study of over 170 societies (Schlegel and Barr y,
1991) showed that most cultures had a clearly defined period between childhood
and adulthood, often with accompanying rites and rituals. For example, the males
of tribal Okiek of Kenya (Kratz, 1990) undergo various rituals between the ages
of 14 and 16, including circumcision. They live secluded from adults of the oppo-
site sex for up to 24 weeks, are painted with white clay and charcoal to appear
wild, and esoteric knowledge is imparted to them by elders. Many societies have
rituals whereby youth become integrated into expected roles and values. One of
the best- known is the Native American Vision Quest, whereby boys of about 14
undergo a process that includes ritual purification and a sweat lodge (Foster and
Little, 1987). Assisted by a medicine man, the adolescent partakes in prayers and

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chanting and then will be brought to an isolated place where he stays alone, and
fasts, for about four days. Once there he awaits a vision, which will illustrate his
future path in society.
Adolescence is both a social and biological phenomenon, turned on by a
rush of hormonal and other changes, but its form is also much influenced by
cultural factors. The Nso of Cameroon are considered adult by virtue of marriage
and parenthood as young as 14 years old, whereas for them a 24- year- old childless
person would be considered immature. Different rites, rituals and expectations
mark transitions into adulthood across the world. Even the timing of menarche
varies across cultures, from 12 years old on average in middle- class city- dwelling
Venezuelan girls to 18 for girls living in the Burundi Highlands of New Guinea.
In Western Europe the average age for the onset of menarche dropped over
the last centur y. Such changes are probably influenced by changes in diet and
affluence, and some think that age of menarche has now stabilised in the West
(Bourguignon et al., 2015).
Adolescence is often divided into early (11– 14) middle (14– 17) and late
(17+) phases, and many textbooks state that there are different developmental
tasks at each age. For example, in early adolescence the primar y task is often
seen as developing autonomy from parents, leading to struggles over separa-
tions and reunions. In middle adolescence young people are said to be struggling
with master y and competence, and in late adolescence, to be working out issues
of intimacy and closeness. While these can be useful working models reflecting
common developmental processes, the ‘tasks’ of adolescence are conceptualised
differently across cultures, social classes, and historical periods. For similar rea-
sons it is hard to talk about ‘adolescent states of mind’ in a universal rather than
a culturally and historically specific way.
A recent change in the West is that, while the timing of adolescence has
shifted slightly earlier, the age when adulthood is ‘taken on’ has got later. People
marr y or settle down on average later and also enter the workforce later, if they
manage to get work. Thus a young person’s biological readiness to both repro-
duce and become part of the adult world is increasingly out of kilter with social
norms. Arnett (2014) describes this as a new life stage he calls ‘emerging adult-
hood’, when many young people regard themselves not as adults, but as on the
threshold of adult commitments.
There is no definite time that adolescence starts or stops. Puberty can be
earlier or later and this has different causes and effects. Earlier puberty in girls is
clearly linked with early trauma and adverse experiences (Bleil et al., 2013), par-
ticularly sexual abuse (Mendle et al., 2015), high stress levels in infancy as well
as being adopted from maltreated backgrounds or abroad (Brooker et al., 2012).
This is typical of how trauma speeds up the life- course (Hochberg and Belsky,
2013). Evolutionar y theorists explain this in terms of a psychobiological ‘choice’
to reproduce earlier and more often when there is expectation of a less safe world
and a shorter lifespan. Of course purely physiological factors such as a ver y poor
diet can lead to later puberty as well, and in one interesting Polish study both
factors were obser ved and it was found that poverty led to later puberty, but this

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was sometimes counterbalanced by stress and father absence, which led to girls
reaching menarche earlier (Hulanicka, 1999).
Adolescence is marked by massive brain development and hormonal upheaval,
brain changes that almost rival those of early childhood (Mills et al., 2014). There
is a major process of pruning, loss of grey matter and an increase in myelination,
the white wrapping around neurons leading to brain signals travelling about 100
times faster. Pruning enables specialisation and honing of skills, in preparation
for the adult life tasks that young people might be preparing to take on. Ever y
society has different skills to prepare for, from hunting with spears, to pounding
yam, to working on computers, to living in forests or arctic snow. These cultural
differences will affect how the brain develops, and for example brain develop-
ment in American and Chinese adolescents show some clear differences (Xie
et al., 2015). Nonetheless, in general, adolescence sees leaps in cognitive skills,
working memor y, and the ability to manage competing information, all aided by
pruning and myelination.
Prefrontal brain areas, so central for executive functions and emotional
regulation, are some of the last to fully develop, with changes occurring until
the mid- 20s (Powers and Casey, 2015). Not surprisingly, impulsivity and pleasure
seeking is often more intense than in other life stages (Urošević et al., 2014) as
is sensitivity to threat, perceived or real. These issues (threat sensitivity, reward
seeking, lower emotional regulation) tend to be even more exaggerated in ado-
lescents from maltreated backgrounds, their relevant brain areas showing clear
differences to non-maltreated young people (Hummer et al., 2015).
The brain areas involved in social understanding are reorganising in ado-
lescence (Blakemore, 2012). Teenagers need to negotiate complex relationships,
which is essential if they are to find a place in peer groups. This is often a time
of acute sensitivity and many areas of the social brain are changing and are ver y
responsive to the social environment (Blakemore and Mills, 2014). For example
the medial prefrontal cortex is much more active at this time than later or earlier
in life, enhancing mentalizing capacities, including awareness of how young peo-
ple are viewed by others.
Adolescents often interpret social cues differently to adults (Casey et  al.,
2014), and we are more likely to see amygdala reactivity in young people to stim-
uli that adults respond to with more prefrontal activation. This maybe makes
sense of why some teenagers over- react and erupt so quickly. Scans show that
adolescents have a much more reactive limbic system, leading them to often mis-
interpret facial expressions, generally negatively, in ways that adults and children
do not (Kragel et al., 2014). Thus they can respond with amygdala- led and other
subcortical reactivity rather than the as yet underdeveloped prefrontal cortex and
also struggle more to screen out fearful stimuli (Pattwell et al., 2013). One thesis
is that the time lag between the onset of emotional reactivity and later prefrontal
The adolescent brain

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regulator y capacities has become more marked as puberty has shifted earlier,
meaning that an earlier maturing body develops even further ahead of the imma-
ture adolescent brain.
In adolescents exposed to trauma the amygdala often becomes even more
over- reactive (Thomason et  al., 2015b), and adolescents anyway show greater
activity and vulnerability in their amygdala than adults. Anxious adolescents find
screening out vicarious stimuli harder than less anxious young people. For exam-
ple adolescents who have been subjected to trauma are much more likely to react
powerfully to pictures which suggest any kind of threat, such as an angr y face,
again showing higher amygdala activation (Masten et al., 2008), and scans sug-
gest that their prefrontal areas, central for calming and regulating, are less active
(Monk et  al., 2008). Anxious and maltreated teenagers spot danger incredibly
fast, seeing an angr y face in the crowd much more quickly than others (Sladky
et al., 2015), but are normally responsive to neutral or positive emotional expres-
sions. Most teenagers, with still- maturing brain structures, are driven more by
immediate emotional stimulus and are generally more easily distracted than
adults. Sometimes it is hard to distinguish ‘ordinar y’ adolescent behaviours from
more worr ying ones.
Yet impulsiveness and risk taking, often bemoaned by parents, open up
important developmental possibilities. In many species one sees increased inter-
actions with peers, risk taking and more fighting with parents. Increased novelty
seeking and risk taking might be developmentally appropriate as adolescents
need to tr y out new ways of being and prepare to leave the safety of parents and
make their own way.
The fast reconfiguring teenage brain is vulnerable and easily damaged.
Excess adolescent use of substances such as alcohol or recreational drugs can
have a lasting effect on structural and functional aspects of hippocampal function-
ing (Risher et al., 2015). This affects memor y so that teenagers who drink more
than average consistently recall less on memor y tests. Excessive alcohol use also
affects the frontal cortex and cerebellum as well as the hippocampus (Johnson
et  al., 2015). Nicotine, can have a profound effect (Yuan et  al., 2015), changing
brain function and connectivity in a variety of areas, and potentially predisposing
adolescents to other forms of addiction (Smith et  al., 2015). Other recreational
drugs such as marijuana can affect pruning and white matter development and
can impact on memor y, psychomotor speed, attention, verbal memor y and plan-
ning ability (Lubman et al., 2015). The stor y goes on with other drugs, and for
example cocaine use is more likely in risk- taking teens but also in itself increases
risk- taking as well as the likelihood of other addictions (Mitchell et  al., 2014)
in adulthood, while MDMA similarly has an effect on a range of brain regions,
including the hippocampus and prefrontal cortex (Costa et al., 2014).
We have our own innate endocannabinoid system, as well as the dopamine
circuitr y central to reward seeking, and these areas are already heightened in
adolescence and can be hijacked by a range of recreational drugs. These areas are
also highly active in other forms of addiction, such as gambling, pornography or
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can seem to be in overdrive in young people, especially more vulnerable ones.
Nearly all addictive drugs (cocaine, heroin, nicotine, alcohol, marijuana) work
on this system. Ordinarily dopamine stimulates novelty seeking, which pushes
for ward development, aiding the learning gained from experimentation. If one
blocks dopamine receptors in rats, they no longer experiment and get stuck in
old patterns (Bevins, 2001). In some ways contemporar y adolescents cannot win,
as parents can worr y if teenagers take risks but also if they unadventurous and
rarely leave the home. Dopamine- stimulated novelty seeking evolved for good
reasons and can be adaptive and aid learning, but can also go into over- drive with
excessive risk- taking as well as addiction.
Of course some teenagers take more risks than others. Especially prone
are those subjected to early emotional and neurobiological insults (Lambert
et  al., 2013) or living in stressful environments (Furr- Holden et  al., 2012). On
the other hand adolescents raised in unstimulating institutional care often take
fewer risks (Loman et al., 2014), and presumably their dopamine system is dulled
down in the way we see in depressed mothers and babies (Field et  al., 2004).
Yet it is also true that some young people may have more of a genetically influ-
enced predisposition for risk- taking (Harden and Mann, 2015), and indeed for
using substances such as alcohol (Hines et al., 2015), a predisposition that only
comes online if they also had adverse early experiences. Adolescents, particu-
larly males, are much more likely to be influenced into risk- taking by peers than
adults or children (Knoll et al., 2015).
Hormonal and brain changes can also lead to increased aggression. In one
classic study a group of adolescents whose physical/ sexual development was
late were given hormonal treatment, testosterone for the boys and oestrogen for
the girls (Finkelstein et  al., 1997). For three months they were given the hor-
mones and for other periods they received a placebo. For the period that they
took the hormones all the adolescents became more aggressive. The hormone
treatment also coincided in boys with more masturbation, nocturnal emissions
and ‘touching’ girls; and in girls more kissing boys and sexual fantasies. Similar
hormones are increasingly released in most adolescent bodies anyway, with
their attendant levels of mood changes.
Yet there is an important interrelationship between biological and psycho-
social experiences. Boys with high testosterone and poor family relationships are
more likely to take risks and act antisocially (Peckins and Susman, 2015), while
girls with high testosterone levels show more risk taking when parent– teenage
relations are poor (Booth et al., 2003). Adolescent boys with low serotonin levels
often become aggressive, while adolescent girls with low serotonin levels are
more likely to be depressed. However, when family relationships are good then
serotonin levels tend to be nearer the norm.
A final biological change that worries adults, but might well be natural, is
the adolescent propensity to sleep longer and on a slightly different time clock
(Crowley et al., 2014). It seems that adolescents need more sleep, and their body
clocks might be shifting the timing of their melatonin release, meaning that
they ‘naturally’ sleep and wake up to two hours later than adults (Carskadon and

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Tarokh, 2014), something that also seems to happen in other mammals. This is a
possible biological explanation for parent’s perception that adolescents are ‘being
lazy’. Indeed some schools have experimented with later start times for adoles-
cents, and early results suggests that this leads to better performance, less sleep
deprivation and lowering a range of risks (Kelley et al., 2015). On the other hand
sleep is made worse by more time on screens, or indeed just having a screen
nearby (Falbe et al., 2015).
Overall physiologically and neurologically, adolescence is a period of huge
shifts. Mood swings and personality changes are often seen as ‘down to hor-
mones’, but now we know that accompanying the physiological changes and rush
of powerful hormones there is major brain reorganisation making adolescence
both a time of huge potential but also massive vulnerability.
In recent years adolescents’ lives have been affected massively by the growth of
the internet, social media, gaming, mobile phones and screens generally. Most
parents of adolescents worr y about the amount of time spent on screens. Like
all technology, screen use is neither good nor bad in itself. Most research shows
distinct gains for some adolescents, such as increased self- esteem, ability to
experiment with identity and self- disclosure, whereas for others there are risks
of cyberbullying, isolation, addiction and exploitation (Best et al., 2014). In many
headlines about the effects of media there is a danger of confusing correlation
with causality. For example, high cell phone use is linked with worse academic
performance (Lepp et al., 2014), but both might be caused by other factors like
trauma or stress in the home.
There is some controversy about whether addiction is the right description
for high use of mobile phones (Billieux et  al., 2015) or other technology. While
Internet Gaming Disorder has been recognised as a psychiatric diagnosis by DSM5
(Petry et al., 2015), a wide range of experts have also been arguing that internet
addiction is all too real and should also have been included (Kuss et al., 2014).
This links with newer understandings about the reward system outlined in
the previous section, particularly the brain pathways for addiction and dopamine,
sometimes called the mesolimbic pathway. The centrally involved brain areas are
the nucleus accumbens, involved in dopamine release and part of the ventral stri-
atum, and the VTA (ventral tegmental area), a central site of dopamine neurons.
Most recreational drugs work on these pathways which are central to wanting
and craving. Removing the nucleus accumbens in other animals seems to inhibit
addictive cravings and has even led to surgical treatment in humans with some
success (Li et al., 2013).
These areas are fast developing in adolescence, which makes this a par-
ticularly vulnerable time for addictions of any kind (Chambers et al., 2014). This
risk is increased by diminished prefrontal and emotional regulation skills, again
especially in more vulnerable youth.
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Adolescent internet use tends to be high, but more so in those with psy-
chological issues and a propensity for riskier behaviours generally (Dufour et al.,
2014). Risk- taking adolescents, for example, have higher connectivity between
the nucleus accumbens and prefrontal areas (DeWitt et al., 2014). There are clear
links between addiction, early childhood problems and activation of this circuitr y
when cued by substances to which young people can become addicted (Leyton
and Vezina, 2014). For example in sexually compulsive behaviour we see higher
activation of the ventral striatum as well as the amygdala in response to sexual
cues (Voon et al., 2014), just as one sees in other forms of addiction.
High use of social media such as Facebook seems linked to lower self-
control (Wilcox and Stephen, 2013). Interestingly there is also a link between
receiving facebook ‘likes’ and nucleus accumbens activity (Meshi et  al., 2013),
‘likes’ presumably giving a dopamine buzz that is then sought again and again.
Over- activity of the dopamine circuitr y is linked to what is called hypofrontality,
or in other words less activity in prefrontal brain areas and less emotional regula-
tion. This has been shown in pornography (Hilton and Watts, 2011; Voon et al.,
2014) and other addictions. Any cue suggesting the imminent presence of the
thing craved, whether a drug like cocaine or pornography or other online addic-
tions such as gambling, gives rise to this circuitr y firing up, and in time leads to
lessening of executive functions (Brand et al., 2014). The ventral striatum, central
to the mesolimbic pathway, is much more activated in high internet users, as
it is in other forms of addiction (Kühn and Gallinat, 2015). In one recent large
study over 50 per cent of participants considered themselves to be addicted to the
internet in some form (Pontes et al., 2015). We see something similar in ‘problem
gamers’ who also show less inhibitor y control and more impulsiveness (Luijten
et al., 2015).
Internet use anyway might lead to such brain changes even without the
addictive elements. Computer use, for example, is marked by much more so-
called multi- tasking, jumpier mind- sets and less concentration, which deplete
working memor y (Miller and Buschman, 2015). Carr (2011) suggests that this
is giving rise to brain changes such as poorer working memor y and less pre-
frontal activity. So- called digital natives seem to be more prone to such buzzy
mind- sets (Music, 2014) as seen in what many see as internet addiction, which
in turn leads to less prefrontal activity, more distractibility, and altered reward
processing (Loh and Kanai, 2015). Indeed it has been found that internet addic-
tion shares with alcohol dependence lessened working memor y, less self- control
and more impulsivity (Zhou et al., 2014). Adolescents more dependent on texting
and screens have worse sleep, more depressive symptoms and poorer executive
functions (Ferraro et al., 2015).
Turkle (2012) in her aptly named book, Alone Together, found in her
research that students often sit in lectures skipping around multiple websites,
some relevant to a lecture, but also doing email, shopping and watching videos.
Of course parents worr y about their children’s use of screens, but as Turkle
shows, the worr y works both ways, as many parents are constantly checking
their smartphones rather than being emotionally present to their children,

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whether at the school gates or dinner table. Email has been shown to raise blood
pressure and also increase distractedness (Mark et  al., 2012), and electronic
alerts raise arousal levels and increase skin conductance or sweating, especially
at the point of ‘switch’ between tasks (Yeykelis et al., 2014) This all suggests that
our tethered ‘always on’ world, with constant promptings from email, Instagram,
Facebook, twitter, RSS feeds and the rest, might well be having a profound effect.
Multitasking is really speedy switching between tasks, generally paying super-
ficial attention only to stimuli, and it can lead to extreme alertness to incoming
stimuli, rather as we see in trauma, and can lead to an inability to concentrate
on one thing, or person (Ophir et  al., 2009). As Carr suggests, companies like
Google aim to constantly tempt us with exciting information, with the new, with
what is immediately of interest, enhancing our speedy, jumping- around mental
skills. Such overload of information inhibits working memor y and the kind of
frontal lobe activity necessar y for concentrating, for relating in depth to others,
and indeed for empathy.
Bigger controversies center on the ever- increasing use of video games.
Gentile and colleagues have studied thousands of cases, finding that the more
time spent playing such games, the more impulsivity and the poorer the concen-
tration, and maybe surprisingly factors such as socioeconomic status have no
bearing on the result (Liau et al., 2015). Again though there are chicken and egg
issues here, as impulsive children seem to play more video games, and kids who
play more video games become more impulsive.
Many argue that violent video games are even more worr ying. Some stud-
ies suggest that exposure to violent media, whether games or film, leads to more
emotional reactivity and less prosocial behaviour (Coyne et  al., 2011), priming
young people to respond swiftly to any hints of aggression. Not surprisingly
this has a detrimental effect on school work, but perhaps most importantly, on
peer relationships and the more violent video games people play then the worse
are these kind of effects (Hassan et  al., 2013). Although contested by some,
the evidence for worr ying effects of violent video gaming is quite convincing
(Warburton, 2014).
Playing such violent games is linked to heightened amygdala activity
(Montag et al., 2012) so central to fear and strong emotions, and desensitisation
to violence (Brockmyer, 2015). This again is also what we see in trauma. There is
of course a risk of embracing a Luddite fear of the new, and it is true for example
that some video games can increase forms of concentration (Green and Seitz,
2015) and enhance attention and even social skills (Cardoso- Leite and Bavelier,
2014). For most young people there is little evidence that average amounts of
gaming or use of social media are damaging, but this is not the case for more
worr ying risk- taking adolescents. For example in Facebook use, young peo-
ple tend to follow their attachment patterns, avoidant youth keeping a distance,
ambivalent attachment linked to being solicitous, secure young people using it
as a healthy addition to their social lives (Nitzburg and Farber, 2013). It is the
most worr ying young people, who presumably would have been a worr y prior
to the explosion of cybespace, who are most at risk, such as from cyberbullying,

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sexting, porn use and gambling (Livingstone and Smith, 2014) and related peer
pressures (Vanden Abeele et  al., 2014). Family factors, such as close parental
monitoring of internet use (Khurana et al., 2014), or even regular family meals
(Elgar et al., 2014), can be hugely protective.
The stor y is not all about doom and gloom. Many new affordances have
arrived with the internet which have greatly enhanced the social and network-
ing lives of many young people as well as boosting a range of other skills. The
downsides are also there, though, even for well- functioning young people, such
as risks of more internalising issues (Tsitsika et al., 2014). The jur y remains out
about the relative costs and benefit of screens and the internet, but what is clear
is that for young people who are anyway at risk, these risks can be compounded
by these new technologies.
Adolescence is a period when young people tend to identify increasingly with
their peer group and become less dependent on families. Adolescents (human
and animal) are more adventurous and risk taking, and have higher levels of
conflict with parents (Steinberg, 2007). Yet dependency and independence can
be seen as two sides of the same coin. Winnicott (1958) once described the ver y
young child’s capacity to be alone as deriving from a safe experience of being
alone with their mother, and something ver y similar can be seen in adolescence.
Becoming autonomous is not established at the expense of attachment relation-
ships, but rather the earlier attachment relationships can act as a solid platform
from which independence grows. The ways in which adolescents approach new
relationships, including romantic and sexual ones, are strongly influenced by
earlier experiences of closeness and intimacy, such as in their families. With
good parental support adolescents are generally more secure in attachment
terms, but also better manage peer- group negotiations and studies with more
confidence. Despite being more autonomous, at times of crisis most still turn to
their parents as a ‘secure base’, albeit less frequently for certain issues (Allen
and Loeb, 2015).
Because adolescents seem to have become ‘detached’, parents can strug-
gle to believe that they continue to play an important role, but most studies show
the centrality of parental input. Having a problematic relationship with parents
increases the likelihood of problems with peers, and good adolescent peer rela-
tions tend to go with better relationships with parents (Kretschmer et al., 2015).
Disorganised attachment not surprisingly is often linked with poor peer relation-
ships, violence and a range of psychopathology (Obsuth et al., 2014). One huge
meta- analysis, examining studies including over 55,000 subjects, found a clear
link between early attachment and delinquency (Hoeve et al., 2012).
Such research challenges Harris’ (2009) claim that parents have less
influence on children than peers. It is complicated to tease out their relative
influence. While good relationships at home aid an adolescent’s transition into
Becoming less attached

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independence, peer groups also assert their own separate influences. Some ado-
lescents move in circles that are supportive, and helpful in developing new con-
fidence in ideas, beliefs and abilities, and in which experimentation feels safe.
Others are not so lucky. Adolescents from backgrounds of maltreatment are
more likely to be attracted to peers involved in delinquency and drug use. But,
also, adolescents can ‘fall into’ a peer group more by chance, taking on their ide-
als and values, irrespective of parental ideals, and a peer group’s aspirations can
be more influential than parents. Parents who tr y to get their children into good
schools intuitively know the importance of peer group influence, and indeed
‘authoritative’ parents who are able to benignly influence their teens’ peer groups
also end up with less risk- taking adolescents (Shakya et al., 2012).
Adolescents are especially influenced by peers as they tr y to establish a
new identity away from their families. Social networking sites can be central in
this. New teenage identities can be fragile and fluid, and in the contemporar y
West it is not unusual for young people to change hair and clothing styles regu-
larly, as they identify with new groups, each with their own norms, cultural styles,
music and ideas. The in- group and out- group phenomenon described earlier is
often seen even more strongly in adolescence. A classic experimental example of
this was seen in the famous ‘Robbers Cave’ experiment (Sherif, 1961). Here 24
young adolescent boys, indistinguishable in terms of class and background, were
randomly split into two groups, and unbeknownst to each they set up camp near
each other. Unlike the anarchy of Lord of the Flies, these groups became organ-
ised but extremely separate, each devising their own names, and developing
their own identity and sense of ‘groupness’. These ordinar y, well- adjusted young
people showed enormous competiveness, aggression and prejudice against the
other group. They demanded competitions, made their own flags and chants, and
refused to eat with the other group’s members. These children separated into
groups on ver y insubstantial grounds, the real differences between them being
almost non- existent. Adolescents often form into distinct uniformed groupings.
Some research even suggests that young people drawn to more extreme looking
groups, such as Goths and Punks, are often shyer than average and tr y to over-
come this by finding a sense of identity (Beši and Kerr, 2009).
Humans are group creatures, and adolescence is a stage when peer influ-
ence can be particularly high, especially in relation to risk- taking (Albert et al.,
2013), in part due to the kinds of brain reorganisation that are occurring. One
small study examined the relative influence of parents and peers, and a detailed
look at 14 personality variables showed that adolescents were more influenced
by peers on many variables (Bester, 2007). Interestingly there was also a gender
difference, with boys less influenced by their parents than girls. The primacy of
the direction of influence is somewhat chicken- and- egg. When parents are threat-
ened by their child’s peer group, and there is conflict, then adolescents withdraw
even more from their parents and their peer group becomes more important.
There is often more conflict in adolescence when early attachment relationships
are poor, and this in turn can lead to antisocial behaviour patterns (Kochanska
and Kim, 2012). Most research shows that parents retain an influence, in both

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direct and more subtle ways, but they may have less influence than they either
think they have or would like to have.
Although peers begin to take on many of the attachment functions that
were previously played by parents, the styles in which relationships are nego-
tiated are linked to previous learning. If one has received a dismissive style
of parenting one is more likely to treat both peers and romantic par tners in
a similar way. Similarly if one has had secure early relationships then adoles-
cence tends to be marked by more autonomy and flexible peer relationships,
and more open communicative styles (Laursen and Collins, 2004). Impor tantly
parents with clear ideas of what an adolescent ‘should’ be doing, and with
more extrinsic goals linked maybe to achievement rather than encouraging
autonomy and self- determination, tend to have more conflict with their teen-
agers who in turn become less prosocial and indulge in more externalising
behaviours (Hollmann et al., 2015).
No discussion of adolescence is complete without mentioning sex, love and lust.
With the explosion of hormonal and bodily changes and growing sexual maturity
one often sees a massive surge in powerful emotions, and almost definitely also
the release of pheromones that affect courtship (Mildner and Buchbauer, 2013).
For example the steroid androstadienone that is present on men’s skin produces
physiological relaxation in women who are given it intra- nasally (Grosser et al.,
2000), and a range of studies suggest the powerful effects of scents on patterns
such as ovulation (Smith, 2015). Careful studies showed that lap dancers earn
more money when they are ovulating (Miller et al., 2007)! Lesbian and gay peo-
ple in turn seemingly respond to pheromones differently but equally strongly
(Berglund et al., 2006). Such sex drives are developing powerfully in adolescents
who find themselves in the throes of hormonally driven urges and desires.
Fierce if unspoken sexual competition and rivalr y can mark adolescence
(Zwaan et  al., 2013), with overt and covert aggressive features seen in both
genders. Socially and sexually successful boys tend to be attractive and athletic
(Weisfeld and Woodward, 2004). High status adolescents, who can also act aggres-
sively as well as having good peer relationship skills, tend to be more successful
in romantic relationships (Houser et  al., 2015). Young people who worr y about
losing their friends tend to be the ones who also worr y that their intimate relation-
ships will fail. Depression is linked to boys having fewer sexual partners, and girls
having more. Just having a lesbian or gay orientation in itself hugely increases the
chances of mental health problems (Blosnich and Andersen, 2015), which in turn
can be mediated by good attachments with parents (Starks et al., 2015).
In the West, the age of first sexual encounters has been lowering (Rosenthal
et al., 2001), while average age of first sexual intercourse varies from countr y to
countr y (Mackay, 2000). For example for females, the average age is 15 in the
Czech Republic, 16 in the USA and 20 in Egypt and Italy. Most adolescents in an
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American sample reported having had a romantic relationship in the previous
18 months (Car ver et al., 2003). Young people can spend a lot of time thinking
about real or potential romantic relationships. While the ways adolescents relate
to romantic/ sexual partners has links with earlier relationship styles and attach-
ment patterns, adolescent sexual relationships are of course more reciprocal,
both parties potentially having a similar need of the other, unlike parent– child
relationships.
Worse family relationships predicts earlier sexual activity in girls (Graaf
et al., 2011) and there is also a link between casual sex and mental health prob-
lems (Sandberg- Thoma and Kamp Dush, 2014). The quality of caregiving in the
first 42 months of life significantly predicts the ‘quality’ of romantic relationships
in early adulthood (Sroufe, 2005), and whether an individual is in a romantic rela-
tionship between 23 and 26 can be partly predicted by peer competence in middle
childhood. Adolescents who experience a ‘secure’ model of parenting generally
have a greater capacity for intimacy in romantic relationships (Dinero et  al.,
2008). Young people with an insecure preoccupied attachment style are more
likely to struggle and suffer in relationships, often developing mental health
problems such as depression (Davila et al., 2004) and more worr ying attachment
styles lead to more mutually aggressive sexual relationships (Seiffge- Krenke and
Burk, 2015).
There are exceptions to these patterns, but findings definitely show an
interrelationship between adolescent relationship patterns and earlier attach-
ment experiences (Furman and Simon, 2004). Once again we find that good
experiences tend to breed good experiences.
Adolescence is generally an even more unstable time for young people from trau-
matic or highly stressed backgrounds, who have the highest risk of emotional
disorders. Most adult mental health problems, such as antisocial behaviour,
depression, self- harm, eating disorders, substance misuse, and sometimes psy-
chosis, are first seen in adolescence. As one might expect, relationship problems
are profoundly linked with a range of psychiatric issues (Whisman et al., 2014),
and indeed relationship break- up is often the immediate precursor of adolescent
depression and suicide attempts (Joyner and Udr y, 2000). As many as one in five
adolescents have a mental health disorder in Britain (Collishaw et al., 2004), and
similar patterns are seen in the US, with significant recent increases in medica-
tion use (Olfson et al., 2014) and a huge increase in major depression (Avenevoli
et  al., 2015). There is often a link between childhood presentations, such as
ADHD and adolescent issues such as academic failure, criminal behaviour, and
substance misuse after puberty (Babinski et  al., 1999). However we also see a
whole new set of young people with mental health issues in adolescence. In girls
one sees more internalising disorders such as depression, anxiety, or eating
disorders, and these often are precursors of adult mental health issues. In boys
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one is more likely to see externalising disorders such as conduct disorders, as
well as ADHD, autism, Tourette’s Syndrome and antisocial or criminal activity.
These are typical gender differences but there are historical and cultural vari-
ants, such as the increase in violent behaviour in girls in the USA and Britain,
many of whom come from backgrounds of abuse, conflict and low parental moni-
toring (De La Rue and Espelage, 2014). Poor social conditions, poverty, inequal-
ity and the lack of support ser vices can all exacerbate the increase in mental
health problems. Mental health in adolescents in Britain and America has been
getting worse in recent years, and this is an age associated with psychological
risks as well as gains.
A good predictor of adaptation in adolescence is the social capital accrued
in early childhood, such as the gains from a caring home, good social and aca-
demic skills, a close peer group, better schools and safer neighbourhoods,
all of which stand young adolescents in good stead for the next stage of life.
Socioeconomic disadvantage can increase the likelihood of mental health issues
by a factor of three (Reiss, 2013), having an effect right down to a neurobiological
level (Kim and Sasaki, 2014). Just living in an area with more boarded up shops
can predispose adolescent boys to develop higher testosterone levels (linked
with more aggression), more risk- taking and drug use (Tarter et al., 2009). Again
this is not by any means about blaming parenting, and community inter ventions
too can have a big impact (Kessler et al., 2014).
We also need to note that what might be a good strategy for parenting
adolescents in one environment might not be so helpful in another. Parents in
violent crime ridden neighbourhoods who use high monitoring and discipline
have children who do better (Karriker- Jaffe et al., 2012) and take less risks (Lee
et al., 2014). Democratic parenting that facilitates autonomy might be a more suc-
cessful strategy in safe affluent areas, but less so in neighbourhoods rife with vio-
lence and crime. Parenting remains crucially important in adolescence, though.
An adolescent who is understood by their parent/ s shows better psychological
adjustment, and also healthier psychobiological markers such as cortisol levels
(Human et al., 2014). A huge Canadian study even found a clear link between good
mental health and simply attending regular family mealtimes (Elgar et al., 2013).
Research consistently shows that the riskier the setting, and the worse the
poverty, then the less resilience factors one finds. Highly intelligent and compe-
tent children, as assessed at four years old, living in high- risk environments do
much worse than less competent children who happen to live in lower- risk ones.
Adolescents who had high intelligence and good mental health as children still
fared worse than young people with lower intelligence and worse mental health
who lived in better neighbourhoods (Sameroff et al., 2003). Psychological help
and good families as well as favourable genetic inheritances can help, but only so
far, and in serious environmental adversity these are less protective.
Much longitudinal research attests to continuity from childhood to
early adulthood. Disorganised attachment at a year is perhaps the best predic-
tor we have of serious psychopathology in adolescence (Cassidy and Mohr,
2001). When there is serious early trauma then the long- term effects are clear.

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Inter- parental conflict and early insecurities predict mental health problems in
teenagers (Davies et al., 2014). When the situation is less serious a more complex
analysis of potential influences is needed, as shifts and more hopeful adaptations
can occur at different stages, and the influences are many and subtle. As Sroufe
(2005, p.202) says, ‘adaptation at the edge of adulthood builds on a cumulative
histor y beginning in early life’.
Such findings have led researchers to suggest the idea of a cascade of
effects, a theor y that allows for the possibility of building resilience at differ-
ent stages of development. A presenting symptom or behaviour at one age spills
over into and influences another phase and domain of functioning. For example
(Dodge et al., 2008) many children who later become violent are born into poor,
unsafe neighbourhoods, and also have difficult temperaments as infants. This
means that they are harder to care for, which means more likelihood of parent-
ing difficulties. This in turn affects their ability to manage peer relationships and
learning in school and nurser y. They often then show behavioural disturbances
and conduct problems earlier in school, which can give rise to negative reactions
from teachers, and their academic achievements can be undermined. As they get
older they can begin to drift into more delinquent peer groups. Each symptom,
such as conduct issues early in school, can be seen both as predictive of later vio-
lence, but also as a potential moment for inter vention. Help at the right moment,
such as supporting parents when their children were young or inter vening in
peer groups later, might move a child from one potential trajector y to another.
Our previous experiences affect how we approach new ones, but each new expe-
rience also presents new opportunities.
• Adolescence takes diverse forms in different cultures and periods.
• It can be experienced differently depending on factors like social class, gen-
der and sexual orientation, cultural values and whether early experiences
were safe or traumatising.
• Many non- Western cultures have had ritualised ways of managing the move
into young adulthood which are lacking in contemporar y Western cultures.
• In contemporar y Western cultures the transition into adult roles is later,
slower, and with less adult involvement than in traditional societies, and
there seems to be a new later phase of ‘emerging adulthood’.
• Adolescence is a time of huge brain and hormonal changes, and might rep-
resent as a second chance for developmental changes.
• Brain changes include increased myelination, much pruning, an enhanced
dopaminergic system, development of regions central to mentalizing, and a
late development of prefrontal areas.
• Adolescence sees the increased importance of peer relationships, and wan-
ing parental influence.
Key points

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• Increased screen use, social networking, pornography, gaming and other
aspects of internet use have changed adolescence, bringing many risks
alongside some clear benefits.
• We often see increases in more risk taking and experimentation, including
sexual experimentation, as adolescents prepare to move away from families
and begin an independent existence.
• In adolescence, alongside major brain changes, cognitive and intellectual
strides are possible, and an increased capacity for complex interpersonal
relationships.
• While the ways adolescents approach tasks, such as peer group interaction
or academic work, are influenced by earlier experiences within families,
new influences can open up new trajectories.
• Mental health worries often arise or become much more prominent during
adolescence, such as depression, anxiety disorders, psychosis, eating dif-
ficulties, as well as antisocial behaviours and violence.
• The adolescent brain is reorganising and re- forming and is vulnerable, both
to the impact of substances such as alcohol or cannabis, as well as to levels
of stress and anxiety, and a cocktail of hormonal, psychological, and bodily
challenges.
• Maybe most importantly this is a period of exciting developmental possibili-
ties, and for many it is the most intense and memorable period of their lives.

221
P a r t   V
CONSEQUENCES OF
EARLY EXPERIENCES

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C h a p t e r   1 8
Trauma, neglect and
their effects
Neglect 224
Maltreatment, trauma and abuse 227
Disorganised Attachment 229
Long- term effects 231
Key points 232

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In this chapter I discuss the effects of childhood abuse, neglect and trauma,
Earlier I looked at some of the defensive processes infants resort to when
under strain and I build on this by describing how abuse and neglect impact
on children’s lives and minds. I  make a distinction between neglect and
abuse because I think they describe different kinds of experiences. I define
neglect as the absence of experiences that a child is primed to receive, such
as consistent care, love or a safe attachment figure. Neglected children can
learn to rely on their own emotional resources rather than other people,
and can seem ver y self- contained. In contrast, children whose experiences
are primarily of abuse live in a world that is likely to seem a much more
terrifying place, with considerable uncertainty and fear about what might
happen next. Of course some children experience both.
A trauma is an experience that our normal defences cannot protect us against
and so is over whelming, and both abuse and neglect can have this effect. Some
children are unfortunate enough to suffer both neglect and abuse and I  think
the word trauma can be applied to both. The original medical meaning of trauma
is literally a piercing of the skin, and we might think of psychological trauma as
piercing a psychic skin or membrane. Some forms of abuse and neglect are likely
to leave any child scarred, such as living in a concentration camp or being gang
raped. Other events may be traumatic for one person but not for another, and
some people develop symptoms of post- traumatic stress disorder (PTSD)
after an event that others quickly recover from.
Neglect, particularly emotional rather than physical neglect, is hard to define
and not always easy to spot. Social workers act more speedily on seeing bruises,
parental drug use or violence, than neglect. It is not always clear what is neglect-
ful, particularly as neglect is the absence of something rather than its presence,
and it is always a question of judgement. It is also a question of timing; infants
need holding, touching and soothing in a way that adolescents do not, and what is
neglectful at one age is not at another. We know though that the lack of basic nur-
turing can lead to serious psychological, emotional and physical delay, and even
death, as the pioneering studies of institutional life by Spitz (1945) showed. Spitz
filmed infants in institutional settings who displayed excruciating behaviours to
witness, staring into space, rocking, turning from side to side, and lying still for
long periods with glazed expressions. They had given up hope of human contact
and had withdrawn into a self- contained world, becoming ver y hard to reach.
Spitz’s abandoned orphans are an example of what happens when the mini-
mum basic expected interpersonal input does not arrive. Deficits are often seen
in language or social skills which simply do not develop without good early care
in the way that hair or nails, for example, grow anyway, for example, with hair or
organs growing.
Neglect

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Probably the most extreme forms of neglect studied have been those seen
in institutional settings. In Romania in the 1980s about 65,000 infants were placed
in orphanages, mostly in the first month of life. Their tragic children became a
spectacle that shocked the world. They also became a source of important sci-
entific information, as their development could be compared with children with
more usual upbringings. These infants could spend up to 20 hours a day in their
cribs unattended. Many showed serious cognitive and social delay, stereotypical
or self- stimulator y behaviours (Julian, 2013).
Early neglect has profound effects on brain growth (Perr y et al., 1995). For
example institutionalised children in Romania were shown to have less cortical
thickness (McLaughlin et al., 2014) and less white matter growth (Hanson et al.,
2013), and the lack of input also affected the growth of vitally important glial
cells (Long and Corfas, 2014). The lack of certain experiences ‘on time’ means
that some capacities might not develop properly. Severely neglectful early envi-
ronments can lead to medical problems, impairment in cognitive and language
abilities, social and communication skills and issues with emotional regulation.
Behavioural and attachment difficulties often follow neglect, which at its worst
can lead to symptoms similar to autistic ones, such as stereotypical rocking and
self- soothing (Levin et al., 2015). Early neglect can lead to poorer startle reflexes
and a dampened down system (Quevedo et al., 2015), lower IQ, and a range of
other effects on brain development, hormonal functioning, and general emo-
tional development (De Bellis, 2005).
In other species something similar is found. Harlow’s early studies with
rhesus monkeys showed that those reared without maternal care and in relative
isolation were fearful, easily startled, did not interact or play with other monkeys
when introduced to them later on, and overall showed chronic difficulties. They
indulged in much of the behaviour seen in human orphanages, such as rock-
ing, blank staring, walking around in circles and self- mutilation (Harlow et  al.,
1965). When rats are separated from their mothers their growth becomes seri-
ously impaired, and it is believed that the lack of touch inhibits growth hormones
(Caulfield, 2000).
Stimulating premature infants with massage has been shown to increase
growth compared with children left in incubators (Dieter et al., 2003), and touch
has been show to aid growth and reduce illness in orphaned infants (Kim et al.,
2003). One ver y early study (Widdowson, 1951) examined children in orphan-
ages. Those who were looked after by a kindly generous matron grew physi-
cally much more than children in the other orphanage, even though food intake
was kept identical in both. Indeed when the loving matron was transferred to
the other orphanage, the growth of the previously deprived children caught up!
Such cases are now technically known as ‘non- organic failure to thrive’ (Shields
et al., 2012).
Generally the more severe the deprivation, the worse are the ef fects.
Many adopted from Romanian orphanages showed serious attachment issues,
such as indiscriminate sociability, but those with the worst symptoms had spent
much longer in institutional care (O’Connor et  al., 1999). The longstanding

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Bucharest Inter vention Project found huge dif ferences between fostered chil-
dren and those remaining in orphanages (Smyke et  al., 2014). Those placed
in foster care dropped much of their symptomatology such as rocking, devel-
oped better social skills and became more able to accept help. A  batter y of
tests showed that in many respects those placed in good foster care did not
dif fer from children who were never institutionalised. This contrasts with the
children who remained institutionalised, who were more withdrawn, unre-
sponsive and disinhibited. Maybe most excitingly, researchers found hopeful
brain changes such as growth in white matter, in those placed in foster care
(Bick et  al., 2015), signifying that if caught earlier many of these ef fects can
be reversed.
Neglect impacts on brain development and the developing ner vous system.
Children adopted from these Romanian orphanages showed smaller amygdala
volume (Mehta et al., 2009) and abnormalities in a range of brain areas central
to emotional development and interpersonal relating (Kumar et al., 2013). Many
had cognitive and emotional impairments, as well as difficulties in concentrating
and in regulating bodily and emotional states. Other research showed that chil-
dren adopted from orphanages produce higher levels of cortisol (Dozier et  al.,
2012), and possibly lower levels of hormones that promote loving feelings, like
vasopressin and oxytocin (Fries et al., 2008). Not surprisingly we also often see
lower dopamine levels (Strathearn, 2011), as excitement and enthusiasm rarely
developed in these children. Such neglect remains a serious issue. Unicef esti-
mated that there are 1.5 million children living in institutions in central and east-
ern Europe (Browne et al., 2006).
Less extreme forms of neglect are often seen by professionals such as
social workers, and are described by Howe (2005, p.113) as ‘chronic parental
failure to meet some developmental need, either physical or psychological …
neglectful parents tend to avoid, disengage and de- activate their caregiving under
emotionally taxing conditions’. Not surprisingly rates of neglect are considerably
higher when unemployment and social deprivation are present (Barnett et  al.,
2010). Indeed abandonment rates have increased since the economic downturn
in countries such as Greece (Buchanan, 2015).
Highly neglected children are often passive and listless. This might
be expected because, as Howe graphically stated, ‘the psychological traf fic
between minds has all but stopped’ (p.  137), and these children can seem
lost in an empty world of their own. Their carers can be unresponsive too,
unaware of any signals being sent out, and there can be a defeated look to
these children. Crittenden (1993) found that neglect can take various forms,
from parents not perceiving infant signals, to perceiving them but assuming
no response is needed, to simply being unable to find a response. A  study
of neglectful mothers found that they were less sensitive to infant cries, and
the brain areas involved in such cue recognition were ver y dampened down
(Rodrigo et al., 2011).
Neglected children, par ticularly those who have been in institutional
care, can show little desire to interact with peers or caregivers. Some can

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wander of f with total strangers indiscriminately, without any sense of fear or
danger, and the contact they make with adults is generally super ficial. Such
children do not have an idea of adults who can provide comfor t at times of anxi-
ety, and some of the most seriously af fected orphans from the Bucharest study
did not form normal attachment relationships with subsequent carers (Zeanah
and Smyke, 2008).
These studies echoed earlier research showing that the effects of insti-
tutional care persisted into late adolescence, when the young people were less
able to form friendships and lasting relationships, even when adopted into emo-
tionally supportive families (Tizard and Hodges, 1978). Neglected children
generally interact less with other children and show less aggression but more
passivity under stress. They are not surprisingly less able to recognise facial cues
(Moulson, Westerlund, et al., 2009), and are often flattened emotionally and hypo-
aroused. They also can indiscriminately and inappropriately approach strangers,
which links with the lower amygdala discrimination often seen in such children
(Olsavsky et al., 2013). Maybe this is not surprising given that, unlike children
threatened with violence, highly neglected children often turn in on themselves
rather than become vigilant.
Despite their poor prognosis they often do not come to the attention of
professionals as much as overtly maltreated children. They draw less atten-
tion to themselves, and can easily ‘fade’ into the background, becoming further
neglected by professionals and other adults. Neglect can be neglected (Music,
2009). This is unfortunate, as the prognosis after neglect is often far worse than
after active maltreatment. On a more hopeful note, many adopted early on from
the most deprived orphanages made a good recover y, especially those adopted
younger, even if still retaining some signs of disturbance.
Neglected children have not had an experience of a parent sensitive to their
bodily and emotional states, who psychologically holds and contains them, and is
attuned to their gestures and experiences. They do not learn to experience that
wide- eyed delight so often seen between infants and their carers. Nor do they
have anyone to help them with anxious or frightening moments. Their signals
are not read by others, and they can stop communicating, becoming out of touch
with their own emotional states. They often do not believe that they can have an
impact on others. Tragically the experiences that normally help build emotional
confidence and resilience are lacking in such severely neglected children who
can live in a flat and desultor y world.
The effect of abuse and active maltreatment is profound but different to neglect.
It often leads to high stress levels, a difficulty in focusing and concentrating,
problems with executive functions and regulating emotions, a hyper- alertness
that can make it difficult to relax, and many interpersonal difficulties. Young
children who are victims of abuse, with no safe adult to rely on, often resort to
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desperate measures to sur vive. Some are highly reactive, many identify with the
abusive caregiver and become violent, while others sur vive through dissociation,
an extreme form of psychic numbing often seen in trauma victims.
Traumatised people who are later exposed to frightening images show
extreme arousal in brain regions such as the amygdala, and a deactivation of the
prefrontal regions necessar y for self- reflection, empathy and emotional regula-
tion (De Brito et al., 2013). These limbic brain areas can then become the default
pathways for responding to stimuli. If the trauma or abuse starts early then a
child’s repertoire to deal with such affronts is more limited. Children and adults
who have been subjected to trauma and abuse are generally not able to use their
emotions and bodily reactions for effective guidance about what is or is not safe.
Their bodies can become geared to acting fast to avoid danger, this being a useful
sur vival reaction in times of immediate threat but one that when overly relied on
does not help in ordinar y social interactions.
The sympathetic ner vous system prepares our bodies for action, such as
in fight or flight. In the face of threat our heart rate goes up, as does our blood
pressure, adrenaline is pumped around our systems and stress hormones are
released (Porges, 2011). While this is happening there is a deactivation of other
systems, such as digestion and immune responses, as the need for immedi-
ate sur vival over- rides ever ything else. In the most serious cases one sees the
activation of the dorsal vagus parasympathetic ner vous system, as described in
Chapter 8. This is seen in freeze or numbing responses, as when animals ‘play
dead’. Here heart rate can go right down, systems slow down, and the thinking
parts of the mind shut off. Trauma victims often have inhibited capacities for
executive functioning, and struggle to plan for the future, to manage strong emo-
tions or be aware of the consequences of their actions.
It is possible for both of these seemingly so dif ferent emergency
responses to occur in the same person at the same time. Post- traumatic stress
disorder (PTSD) suf ferers seem to tragically suf fer this, showing both hypera-
rousal and lower hear t rate (Sahar et  al., 2001). Many trauma victims suf fer
from PTSD and its symptoms, such as flashbacks and intrusive thoughts. The
most damaging form of trauma is interpersonal trauma, which is far more
likely than other traumas, such as car accidents, to give rise to PTSD symp-
toms (van der Kolk, 2014).
Maybe the worst form of interpersonal trauma is that inflicted by a child’s
carers. When a carer turns abuser, then the world feels unsafe and unpredictable.
Serious abuse often leads to fear, helplessness, shame, rage, betrayal and resigna-
tion. Not surprisingly many children who have been maltreated are seen as ‘prob-
lems’ in schools and elsewhere, and are oppositional and aggressive (Shackman
and Pollak, 2014). Such easily aroused children can seem particularly ill- suited
to the structured and ordered learning environment of the classroom or chaotic
playgrounds. Stimuli such as the loud voice of a teacher, the stare of a peer, or
the humiliation of not understanding something, can quickly trigger disturbed
behaviour. They can quickly see threat where there is none, leading to an escala-
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Early stress and trauma causes serious changes in brain circuitr y and hor-
monal systems. It is linked to higher amygdala activation, smaller hippocampi
in adulthood, less activity in prefrontal brain areas, a smaller corpus callosum,
which links right and left hemispheres (McCror y et  al., 2011b), and areas of
the left hemisphere’s thinking capacities going offline. These brain and behav-
ioural differences become patterns, or as Perr y and colleagues writes, ‘states can
become traits’ (1995, p.271). Trauma thus can impair a child’s ability to manage
ever yday life, in particular impacting on the ability to benefit from relationships
with others, whether adults or peers. Children who have been deprived often
tragically reject the help that they so badly need, a phenomenon the child psy-
chotherapist Henr y described as double- deprivation (Henr y, 1974). Maltreated
children too often struggle with peer relationships, are aggressive and also show
less empathy to other children in distress. One might hypothesise that such chil-
dren are not able to be in touch with their own distress and so are unlikely to have
sympathy for other upset children.
It can be difficult enough to contemplate a child being maltreated and abused by
an adult, but even worse if the adult is the person who the child relies on for sol-
ace and care. The group of children Main and Solomon (1990) were to define as
disorganised in attachment terms suffered this. They do not develop a coherent
strategy to deal with being with their unpredictable caregivers and show many
odd and unusual behaviours. In the Strange Situation Test they might move
towards their mother but then veer off, or become dazed, as if uncertain whether
they want to approach. Their movements are often incoherent, with many mis-
timed and awkward actions, often falling over or becoming disoriented. Other
responses include freezing, or huddling on the floor. For example, Main and
Soloman (1986, p.119) wrote ‘One infant hunched her upper body and shoulders
at hearing her mother’s call, then broke into extravagant laugh- like screeches
with an excited for ward movement. Her braying laughter became a cr y and
distress- face without a new intake of breath as the infant hunched for ward. Then
suddenly she became silent, blank and dazed’.
Such traumatised children can be ver y chaotic but can also become con-
trolling and rigid. Professionals who work with fostered or adopted children are
often surprised at how difficult such children find changes in routine or transi-
tions, and how much they need to control interactions. Events that most children
look for ward to, such as holidays or trips, can be disconcerting for children who
fear being out of control.
Such children have had ver y unpredictable and complicated early lives,
and have often developed a controlling strategy as a desperate attempt to predict
a volatile world (Solomon et al., 1995). These patterns are often already develop-
ing in the early months and can be predicted by maternal behaviours as well as
infant vagal tone (Holochwost et al., 2014). Beebe (2012) found that disorganised
Disorganised attachment

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attachment could often be predicted as early as four months old. In such cases
mothers tended to be ver y intrusive, making looming movements at their infant
and offering little support to signs of distress. The infants already were less
able to self- sooth, and would placate their mothers, for example swiftly turn-
ing an expression of distress such as a whimper into a positive looking facial
expression.
When one looks below the surface at what is going on in such children’s
thoughts and fantasies as they get a little older, their worlds are frightening,
chaotic and unpredictable. In their stories and play they tend to enact scenes in
which adults are untrustworthy, dangerous and likely to cause damage. The self
in such play tends to be depicted as powerful and dangerous, or as ver y help-
less and desperate. Beneath a controlling and rigid presentation, the minds of
these children can be filled with dangerous and frightening thoughts, disasters
and tragedies, and a belief that the world is unsafe and unpredictable, something
shown by attachment based analysis of children’s stories (Hodges et al., 2003a).
Many children traumatised by their parents show oversensitivity to their
parents’ signals. It can be vital for them to work out things like whether a violent
father is angr y, tired, drunk, or in a rare good mood. One ver y common way of
coping that is different to fight and flight is what is called the ‘tend and befriend’
response (Taylor et al., 2000), seen more in females but by no means exclusively
so (von Dawans et al., 2012). This is resorted to when it might be safer to reverse
traditional parent– child roles. Such children, sometimes termed ‘parentified’,
stay safe by becoming acutely aware of the state of mind of their parents, tr ying
to ensure that parents stay in a better mood, and they tend to be extremely sensi-
tive to any change of emotional temperature. Here we often see parent– child role
confusion (Macfie et al., 2015).
Adult Attachment Inter views show that parents who have children with
disorganised attachments have narratives that are ‘unresolved’. They describe
themselves and their childhoods in inconsistent and incoherent ways, and many
show ‘frightened or frightening’ behaviour towards their children. They often
cannot integrate and process painful and fearful affects. Not surprisingly many
such parents describe having childhoods in which they themselves suffered a
great deal of trauma. Such parents can unwittingly induce high levels of fear in
their own children, by being both inconsistent and unpredictable.
Disorganised (D) attachment generally comes with a secondar y classifica-
tion of disorganised insecure or disorganised secure (L yons- Ruth et  al., 2003).
Children with a D- secure label are more likely to show withdrawing behaviours
than D- insecure children who are more likely to be aggressive and hostile. Both
are acutely aware of their caregivers and struggle to stay safe in the presence of
adults who do not inspire trust. As previously stated, children classified as disor-
ganised are not necessarily suffering from the psychiatric diagnosis of attachment
disorder, although a disorganised classification tends to predict later psychopa-
thology. They are children who find it hard to find a strategy that consistently
keeps them safe. They can resort to hyper vigilance and controlling behaviours,
and at other times give up and have no strategy at all. A child’s need for a safe

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attachment figure can be in conflict with the pull to move away from a cruel or
abusive carer. The tragedy is that the figure upon whom they should be relying
on for comfort is the ver y person who is putting them in danger. More hopefully,
ver y early inter ventions such as parent– child psychotherapy have been shown
to move children out of disorganised attachment patterns (Stronach et al., 2013).
There is increasing evidence that early trauma and neglect have an impact that
can last through the lifespan, even more so when family trauma occurs along-
side community violence (Cecil et al., 2014). Adults traumatised as children have
more psychological and physical problems than others (MacMillan et al., 2014),
are more likely to use drugs and alcohol, to end up in prison or the psychiatric
system (Gilbert et  al., 2009), are less likely to manage stable relationships, to
do well educationally, or to hold down stable employment. Children who have
been abused or neglected in childhood are far more vulnerable to serious men-
tal health disorders as adults such as borderline personality disorder (Ball and
Links, 2009) and major depression, with child sexual abuse being a ver y high risk
factor (Bateman et al., 2013). Indeed sexual abuse has many long- lasting conse-
quences, including the likelihood of more sexual partners, contracting sexually
transmitted diseases, teenage pregnancy, as well as more risk of suicidality, men-
tal health problems and being in harmful relationships.
One of the biggest studies is an American one called the ACE (Adverse
Childhood Experiences) (Felitti and Anda, 2010). Examining a sample of over
tens of thousands, the ACE study showed powerful links between bad early expe-
riences and a range of poor health outcomes (Sinnott et  al., 2015). The higher
the numbers of adverse experiences, then the worse were the later physical and
psychological outcomes. Felitti (2002), stated that a male child with an ACE score
of 6 has a 4600 per cent increase in likelihood of later becoming an intravenous
drug user when compared with a male child with an ACE score of 0. This study
showed how childhood adversity reduces life expectancy, even increasing the
likelihood of early death from physical causes, such as heart disease and cancer,
as well as from violence (Felitti and Anda, 2010).
We have learnt that early stress particularly has a profoundly negative
effect on later psychological and health outcomes (Bazacliu et al., 2011). We also
know that whatever a child’s resilience factors, good parenting leading to secure
attachments will act as an inoculation against a biological predisposition to react
badly to stress, even when living in poverty (Conradt et al., 2013). Good experi-
ences and positive emotionality can decrease stress responses (Pressman et al.,
2012), as can inter ventions like mindfulness (Epel et al., 2009), even slowing the
ageing process.
Childhood maltreatment predicts high allostatic load (stress induced bio-
logical markers for illness) in adults 30  years later (Widom et  al., 2015). Early
stress and trauma is particularly linked with what are called metabolic syndrome
Long- term effects

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diseases, such as heart disease, strokes and diabetes, and indeed a British study
of over 7000 people followed up for 60 years found that irrespective of whether
later life experiences were good or not, it was the early childhood stressors that
predicted these diseases (Winning et al., 2015). A highly stressed life is also linked
with a central tell- tale sign of physical ill- health and risk of early death, shorter
telomeres (Epel et al., 2004). There appears to be a dose related response, so that
the more stress, the bigger reduction of telomere length and the more likelihood
of all kinds of diseases, from cancer to diabetes to heart disease (Price et  al.,
2012). Indeed a recent study even found that stress in intrauterine life gave rise
to shortened telomeres right up until adulthood (Entringer et  al., 2011). When
people are anxious, stressed or traumatised we see a speeding up of metabolic
processes.
It is important that parents, particularly mothers, are not ‘blamed’ for poor
mental health. Causes are always multi- factored and overdetermined. Living in
poverty in a run- down or violence- infused neighbourhood has a profound effect
on one’s ability to parent. One interesting study (Griskevicius et al., 2013) showed
that children born into worse economic circumstances are likely to have a differ-
ent psychological makeup through their lifespans.
Research based on Life Histor y Theor y, propounded by many evolutionar y
psychologists (Moule et al., 2013), is showing that if we are born into an environ-
ment where stress, anxiety, fear or trauma are likely, then we live a ‘faster life
course’, and for example, have children earlier (Belsky et al., 2010), take more
risks, have more signs of stress as measured by various biomarkers such as
inflammation and cellular damage, and even die younger and have worse health.
A faster life- course is an adaptive response, enhancing the chances of sur viving
in threatening environments, but at huge costs. Childhood abuse and neglect
have profound long- term effects on both physical and mental health. While it
does not help to blame parents, such research does point out the urgency of early
inter ventions and the huge health savings that could result from children having
safer, more secure and happier lives.
• Neglect and abuse should be differentiated.
• Trauma and neglect both have real and often long- lasting effects on a per-
son’s emotional, psychological and brain development and on their physical
well- being.
• Neglected children can be more passive, cut- off and dampened down. Their
issues can be missed by professionals but their prognosis is often poor.
• Abused children are often hyper vigilant, reactive and struggle with emo-
tional regulation.
Key points

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• The play of maltreated children reveals a belief that the world is dangerous,
frightening, and unpredictable, in which adults are not protective figures,
and life rarely work out well.
• Maltreated children can resort to controlling strategies to manage interac-
tions and have rarely learnt the give- and- take of reciprocal play or a belief
that interactive ruptures can be repaired.
• Disorganised attachment is a particularly worr ying outcome with poor
prognoses.
• Intruded upon and abused children often work hard to read other minds,
but from a fearful place, to avoid danger, rather than with genuine interest,
empathy, or sympathy for another person.
• Trauma and abuse is likely to take place in families where there are lower
levels of reflective functioning, and abused children in turn tend to show
less self- reflective capacities, making it harder to process their experiences.

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C h a p t e r   1 9
Resilience and good
feelings
Positive emotions and health 237
Optimism is natural in children 239
Resilience 240
Ambivalence and emotional complexity 243
Happiness: eudemonic and hedonistic 245
Resilience, interventions, and proximal and distal impacts 247
Key points 249

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In recent decades emotional concepts denoting positive states such as
resilience, well- being and happiness have been increasingly researched
and debated, and a new field of positive psychology has arisen (Seligman,
2012). This in part has been a reaction against a previous almost exclusive
emphasis on understanding and working with difficult experiences such
as stress, trauma or abuse in psychology and psychotherapy. The more
traditional focus on negative affective states has been seen as not providing
a sufficient understanding of how more positive mind- states develop. This
chapter will examine and unpick some of these issues.
It seems likely that in evolutionar y histor y humans thrived so successfully partly
by anticipating danger, an ability linked to our fear and stress systems. If we
do not predict danger we can be in trouble, worr ying can pre- empt problems,
and indeed people with insecure attachments are frequently the quickest to spot
real dangers (Ein- Dor, 2015). Our taste buds detect sweetness if we place just
one part of sugar into 200 parts of a food sample, but we are far better at spot-
ting bitterness, which we perceive in only 1 part per 2,000,000 (Harris and Ross,
1987), and perhaps humans are more adept at spotting danger than experiencing
pleasure. This of course can have a cost too, it being possible to anticipate too
much danger, as seen in some depressed or anxious people who always expect
the worst. Some such mood states or attachment styles can make relationships
difficult to sustain.
The biological and psychological systems for seeing a cup as half full
or half empty, for having positive and negative emotions, are quite dif ferent.
Positive and negative emotions tend to be processed in dif ferent brain areas
and some of us tend to default to the more negative areas more than others
(Moser et al., 2014). If one examines the brain activity of extrover ts and intro-
ver ts when showing them positive images such as playing laughing children,
and also some negative sadder or worr ying images, the result is fascinating.
Introver ts, who are often high in neuroticism barely respond to the positive
images, showing little change in brain activity, but their brains are ver y active
in response to the negative images. The converse is true for extrover ts, who
have little brain activity when shown negative images but lots when shown
more positive ones (Canli et al., 2001). We perceive and react to a version of
the world that we expect and understand.
All these systems exist for good evolutionar y reasons (Gilber t and Bailey,
2014). We have already seen how some children who have suf fered adverse
experiences can develop a highly ef ficient defensive system, concerned with
avoiding danger and seeking safety and security, which would aid them in a
dangerous environment. An opposite system is sometimes called the appeti-
tive or seeking system (Panksepp and Biven, 2012); seen in healthier forms
of extroversion, it leads to interest, pleasure, hope and is linked with moving
towards and not away from experiences. This system aims to increase good
feelings, not just avoid negative ones. A  slightly dif ferent system is the one
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(Gilber t, 2009). When in danger or under threat then the systems involv-
ing threat come to the fore and trump those involved in seeking and desire
(Panksepp, 2014) and our soothing af filiative systems (Goetz et  al., 2010).
Children who are traumatised and have had little positive experience need
help to process their dif ficult experiences, other wise these might remain to
haunt them. However managing their negative emotions is not enough; they
also need help to learn to enjoy the good things in life, to build up hope, to
have intimate relationships, to have pleasure and experience wellbeing.
Positive emotions and a sense of wellbeing are profoundly linked to better
health outcomes. This links back to earlier discussion of Life Histor y Theor y
(Belsky et  al., 2012). Those born into highly stressed worlds tend to have a
speeded up metabolism, faster heart rate and, more activated stress response
systems, and they tend to develop a fast as opposed to a slow life course strategy.
We see this in a range of other mammals as well as humans, and it is a strategy
that aids immediate sur vival but has long- term costs. We all have both strate-
gies in our evolutionar y back- pocket, as other wise any too trusting, at ease and
complacent ancestors might well have met a violent end before they had time
to reproduce. In some circumstances the best response is to be war y, vigilant
and untrusting, even if the cost of this is poor physical and emotional health.
From the perspectives of Life Histor y Theor y (Belsky et  al., 2012), a speeded
up metabolism, less trust, less relaxation, more suspicion and risk- taking might
be adaptive for abusive homes or violent neighbourhoods. Here there is little
emotional security or expectation that things will work out well. It is a strategy,
though, that increases the likelihood of physical and mental illness, of less stable
relationships and work lives and on average of dying younger (Felitti and Anda,
2010). Being able to feel at ease and regulate ones emotions depends on having
had sufficiently good experiences to trust the world, and feeling relaxed (high
vagal tone) (Moore and Macgillivray, 2004). In other words, good health and
emotional wellbeing come together with the kind of trust in life and relation-
ships that we see in secure attachment. The long term health and reproductive
advantages of good early experiences is sometimes called the silver spoon effect
(Rickard et al., 2014).
The more negative emotions we experience, the lower our immune
responses are likely to be and for example the more likelihood of succumbing
to infections such as the common cold. Interestingly positive emotional contact
and physical contact like hugging is a buffer against such infections (Cohen
et al., 2015). Stress and negative emotions can be damaging in themselves, and
there is a kind of ‘double whammy’ in that positive affect raises immunity, but
stress and anxiety lowers it. In a typical study two groups of university students
were given slight wounds by their experimenters. Those given wounds in the
holidays healed 40 per cent faster than those whose wounds were inflicted in
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stressful exam periods (Glaser et al., 1999). Similarly, patients experiencing more
marital hostility heal less well after major medical procedures (Kiecolt- Glaser
et al., 2005).
Attachment anxiety triggers worr ying autoimmune responses (Fagundes
et al., 2014), while good relationships and feeling at ease enhance immune func-
tions. Indeed even brief periods of relaxation can improve the healing of wounds
(Broadbent et al., 2012). Loneliness is extremely predictive of a range of issues
such as worse cardiovascular health, lower immune responses, more inflamma-
tion, and quicker cognitive decline (Hawkley and Capitanio, 2015). Good social
relationships, in contrast augment, longevity and health (Holt- Lunstad et  al.,
2010), as do being a member of groups (Jetten et  al., 2014) and activities like
volunteering (Warburton, 2015), maybe via increasing social integration. Good
relationships are good for us.
Yet it is in early childhood that the seeds of huge differences in health
outcomes and emotional wellbeing are sewn. Studies of Adverse Childhood
Experiences (ACE’s) are perhaps the most impressive evidence of the costs of
damaging childhoods (Danese and McEwen, 2012b). Those suffering trauma,
abuse and neglect often have chronically high stress levels, as well as poor physi-
cal and emotional health. Typically children from troubled backgrounds who
were in public care suffer worse health outcomes as adults (Viner and Taylor,
2005). Policy- makers often tr y to improve the health of children in public care
through improving access to good medical provision, while the impact of having
insufficient good experiences, and too many negative one is not taken as seri-
ously as it should be.
As well as good relationships, other activities can improve wellbeing and
health, such as mindfulness meditation, which also heightens immune systems
and positive affect (Schutte and Malouff, 2014). Mindfulness leads to higher left
prefrontal activation in meditators (Hölzel et  al., 2011a), and interestingly this
kind of brain asymmetr y is seen in more positive people, including ver y young
children. Toddlers were obser ved in play sessions and classified into two groups,
inhibited or uninhibited, depending on how explorator y, talkative or outgoing
they were, or how near to their attachment figures they stayed. The inhibited
children, while at rest, had greater right- sided prefrontal brain activation while
the more outgoing confident ones had greater left- sided prefrontal brain activ-
ity (Davidson, 2000). Cicchetti’s (2010) work on resilience found in EEG’s that
those children who were more resilient to maltreatment also had higher left
hemispheric activation, were more positive in outlook and had better capacities
for self- regulation.
A fascinating retrospective study suggested the large health benefits of
having a positive outlook. Over 300 nuns in Milwaukee (Danner et al., 2001) all
wrote diaries when they entered the Order in the 1930s, and these were exam-
ined in detail by researchers, for example in terms of how many positive and neg-
ative words were used. Although their lives once in the convent barely differed
in terms of routine, diet, climate, physical amenities, or activities, their relative
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earlier. One nun for example wrote ‘The past year has been a ver y happy one.
Now I look for ward with eager joy to receiving the Holy Habit of Our Lady …’
(p. 806), and we might note words like ‘happy’, ‘eager’, ‘look for ward’ and ‘joy’,
which did not appear in more negative diaries. Of the less positive nuns, two-
thirds had died before reaching 85 years old, whereas 90 per cent of the happy
ones were still going strong. It was having more positive feelings that predicted
longevity, not the amount of negative ones. The nun quoted above was still alive
at 98  years old, and on average the happier ones lived about nine years longer
than the more pessimistic ones. This study, using several scales and tested for
inter- rater reliability, found a statistically significant link between positive emo-
tion and a decrease in mortality rates.
A more modern research method isolated twitter feeds by geographical
location and examined the extent to which people in these different areas used
positive and negative language in tweets. It found that in areas where more nega-
tive preoccupations were most common, with more words like ‘hate’ and ‘anger’
as opposed to words like ‘wonderful’ or friends’, there were higher rates of mor-
tality from coronar y heart disease, and amazingly this was more predictive than
the range of usual demographic factors such as smoking or socioeconomic sta-
tus. (Eichstaedt et  al., 2015). Optimism generally is clearly linked to reduced
heart problems (Hernandez et al., 2015) and a range of health benefits. Feeling
good is good for us at so many levels.
Interestingly, when things have gone well for them emotionally, children’s levels
of optimism are naturally higher than adults. A  slightly overconfident view of
themselves seems to aid later competence, as Bjorklund (2007) has demonstrated.
In tests, adults, seven- year- olds and nurser y children were shown a series of 10
pictures and asked how many they expected to remember in the right order. The
adults and older children generally guessed they would remember about five to
seven, and tended to be right, whereas the little ones massively overestimated
(Yussen and Levy Jr, 1975). This is fairly typical. Children when young tend to
think they can climb higher mountains, balance more balls, score more goals
and generally perform excellently, and they are adept at ignoring evidence that
contradicts this. For example, in the early years at school most children think
they are one of the cleverest in the class (Stipek and Gralinski, 1996). Children
of various ages were asked to rate how well they understood the mechanics of
complicated devices such as toasters, and the kindergarten children gave them-
selves the highest ratings of all (Mills and Keil, 2005). Unlike older children, their
confident self- belief barely lowered after they heard an adult’s ‘proper’ explana-
tion, and again unlike older children, a quarter even increased their ratings after
hearing the actual explanations.
Bjorklund describes this as a form of ‘protective optimism’ and not just a
defensive denial of unwelcome realities. Young children when told stories about
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people with positive and negative personality traits are likely to believe that the
negative traits will change to more positive ones in time, and that things will work
out for the best. They do not generally have the opposite belief, that positive traits
turn negative (Lockhart et al., 2002). Bjorklund explains such optimism in terms
of its usefulness for children who need to tr y out new things with confidence and
to persist at tasks that feel too difficult. Of course, within ever y group there are
children who are more or less optimistic or pessimistic, partly because of expe-
riences, such as whether or not they have come from families which displayed
much negativity.
Many, if not most, adults are also prone to such self- deceptive beliefs, and
for example most are adamant that they are better than average drivers (Horswill
et al., 2004). Indeed the more optimistic we are the more we ignore facts which
threaten such beliefs, which means that depressed people often see things more
accurately (Garrett et al., 2014). There seems to be a trend towards overly positive
self- deception linked to increased narcissism in America (Twenge et al., 2012),
which might be worr ying in adults; but such tendencies in children seems to
have a positive and protective function. In another ‘picture remembering’ study,
the children who overestimated their skills in a first round, who we might have
assumed had an almost delusional level of self- belief, in fact tried out more strate-
gies second time around and improved the most. Their over- optimism encour-
aged them to keep tr ying (Taylor and Armor, 1996).
One might contrast such optimism with the children of depressed parents
who tend to be more passive (Murray et  al., 2015), or children who have been
traumatised, whose sense of confidence is badly affected. Obviously there are
dangers in overestimating one’s ability but optimism does give rise to a sense
of self- belief and self- efficacy. Child psychotherapists have learnt that children
need to have their positive affects states validated in order to grow and develop,
rather than just having help with negative emotions and defences (Alvarez, 1992).
Children who have less confidence can easily give up and become less effective.
Optimism in children generally is a good sign, and if a child’s scores on optimism
and pessimism are the same as those of an average adult this can be a sign of
depression (Seligman and Nathan, 1998). Optimism is a quality children begin
life with more of, at least when things are going well, and reality slowly creeps in
to revise expectations, but hopefully not too much or too soon. Optimism, even
laced with a degree of self- deception, can give rise to resilience, and although
Freud’s view that reality must eventually be faced has some truth, too much real-
ity too early might not always be in a child’s best interests.
Resilience is notoriously difficult to define. I am meaning it as either the ability
to stand firm and strong in the face of stressors (Ivtzan et al., 2015), and/ or to
be able to bounce back from significant adversity (Cicchetti, 2010). To remain
hopeful in the face of difficulty is not the same as not having distress or denying
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it. It is this ability to manage stress, not the amount of stress one experiences,
that predicts psychological and physical health outcomes, such as higher levels
of inflammation (Sin et al., 2015). Early resilience researchers were surprised to
learn that given terrible adversity like serious maltreatment, some children came
out much worse than others (Werner, 1994).
A major finding from such research is that, given the same psychological
stressor, those less badly affected find a way to believe that some good has come
out of their experiences, taking positive learning from it. Irrespective of levels of
anxiety, depression and unrest, it is levels of positive feeling that differentiates
resilient people. They have a more hopeful, ‘meaning- giving’ outlook, even if they
have no less distress than those who fared worse (Zautra, 2003, p.81), and more
hope. For example in a group of Chinese children left by their parents, those who
fared best could move outside their preoccupations with current difficulties and
conceptualise alternative futures (Bi and Oyserman, 2015).
Interestingly individuals who use humour tend to be more resilient
(Adelman, 2014), as seen both in war veterans (Hendin and Haas, 2004) and at
risk children (Werner and Smith, 1992). Humour seems to neutralise anxiety-
provoking situations by somehow reappraising and looking at them from
another perspective, and of course humour is ver y much a social, interpersonal
act. Laughter in itself has been show to increase immunity- boosting hormones.
Breastfeeding mothers shown a Charlie Chaplin film had higher levels of
immunity- enhancing hormones in their breast milk than mothers who watched
the weather report, thus helping their babies resist allergies (Kimata, 2007).
Similarly exposure to humour actively increases the amount of pain someone can
tolerate (Da Silva, 2012). Humour has many health benefits (Cann and Kuiper,
2014), including lowering cortisol levels, heightening immune systems and
improving cardiorespirator y functioning (Bennett and Lengacher, 2009).
Why some are more resilient and recover better than others from trauma
and bad experiences is a major research issue. Early resilience research looked
mainly at factors within individuals, such as the capacity for self- regulation, intel-
ligence or levels of autonomic reactivity. Researchers soon realised the need to
look wider, at factors in people’s life circumstances that led some to flounder and
others to thrive following adverse circumstances. We know that capacities in par-
ents, such as their own positive emotionality and ability to respond to cues, pre-
dicts positive affect in infants (Bridgett et al., 2013). In addition, as an ecological
approach teaches us, we need to link a range of explanator y factors, in individu-
als the family, but also wider cultural, socioeconomic and community influences
(Bronfenbrenner, 2004).
Recent epigenetic research also adds important new data, particularly the
continuing growing understanding of the genetic factors that make some chil-
dren ‘orchids’ as opposed to ‘dandelions’, and hence more susceptible to both
good and bad experiences (Kennedy, 2013). For example following maltreatment
those with one variant of the COMT gene are far less likely to become aggres-
sive as they grow up (Hygen et al., 2015). Similarly, different effects of maltreat-
ment have been seen in those possessing a variety of genes, the best known

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maybe being the dopamine receptor gene DRD4 (Bakermans- Kranenburg et al.,
2008), MAOA (Byrd and Manuck, 2014) serotonin receptor genes (Cicchetti and
Rogosch, 2014), and polymorphisms involved in the production of the impor-
tant brain ‘fertilizer’ BDNF (Brain Derived Neurotrophic Factor) (L. Chen
et al., 2015).
As stated, the presence of bad experiences is different from the absence
of good experiences, as seen in serious emotional neglect with its ver y poor
outcomes. Neglected children are more likely to show a lack of interest in life,
and little positive emotion, as Spitz’s (1945) early studies of barren institutional
care regimes showed. Most mammalian species lacking maternal care show less
interest in pleasurable experiences. Francis and colleagues (1999) studied rats
in bleak and deprived environments and, not surprisingly, on most measures
they did worse. They then enriched the animals’ environments by stroking and
handling them. The handled mother and pups in turn licked and groomed their
own pups, and this had a knock- on effect, the pups became more interested in
suckling, and eating more. As they got older the groomed pups had lower stress
responses and better immune systems and also eventually became better moth-
ers themselves. As in humans, Meaney suggests that there were two separate
mechanisms involved here. There was the mechanism for fear, which for exam-
ple is more active when there is maternal separation, but also a set of neural
circuits involved in social engagement that link with feelings of well- being and
heightened immune responses. The rats who did well not only had less bad care,
they also received more good care.
Similar processes are seen in humans, such as in research that showed
that, when cuddled, adopted but previously deprived Romanian orphans did not
release oxytocin in the same way as children brought up in their birth families
(Fries et al., 2005). Another study (Russek and Schwartz, 1997) tracked down in
middle age those who 35 years earlier had participated in a study in which they
had rated their parents’ care. Those who had rated their parents as uncaring
35 years before had five times higher rates of illness in middle age, as assessed
via careful medical examinations. What was striking was that better health arose
not from the presence of uncaring parents, but from the perceived presence of at
least one caring parent. It was their perceived good experiences that inoculated
against ill health.
Inconsistency and unpredictability in particular give rise to stress and anxi-
ety. Experiments have demonstrated the stress induced by what is called learned
helplessness (Peterson et al., 1993). For example dogs locked in a cage and given
repeated shocks do not tr y to leave when the cage doors are opened, unlike ordi-
nar y dogs (Maier and Seligman, 1976).
When subjects are given tasks to per form, but are intermittently inter-
rupted by ver y loud noises, humans do better when the noise comes at predict-
able inter vals, even if the noise is louder when it was predictable. Similarly,
subjects are less stressed and per form better when they are told that they can
press a button that will reduce the noise, even if they did not even use the but-
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it, reduces stress and gives rise to a sense of agency and master y, a crucial
factor in resilience in adulthood (Infurna and Rivers, 2015). Babies who are
responded to in an attuned and consistent way, and who feel they can influence
their interactive par tners, feel more confident and less stressed than babies
whose parents are unpredictable and abusive, or neglectful and unresponsive.
They recover better when things go wrong, as we saw in the research about
mismatches and repair (Beebe and Lachmann, 2013). Give any animal a major
stressor (the classic test was cruelly giving electric shocks to dogs), and those
with some control do not become hopeless and helpless, whereas those with-
out control become despairing, withdrawn, and fear ful, showing symptoms
rather like human clinical depression.
We see an exaggerated and more deeply engrained version of learned
helplessness in children brought up in abusive or neglectful situations. Once an
animal or human child has learnt that there is nothing they can do to change
their situation, then they no longer look for or see opportunities that are actu-
ally there. Children who have disorganised attachment patterns, for whom the
world is unpredictable, have little sense of control except that gained by vigi-
lantly watching the adults or becoming overly ‘controlling’. Most research on
resilience suggests better outcomes when people feel more positive, can take
an active stance, believe that they can influence events and feel confident that
the world is predictable, none of which is true of children who suffer extreme
neglect, unpredictable trauma, or both.
An active coping style in which we move towards experiences and do not
shirk them is what we see in secure attachment, and more confident children.
This links with the advantages of being able to face one’s fears rather than shirk
situations. Facing difficulty, an active coping style and an openness to experi-
ence, to meeting the world ‘head- on’ rather than shrinking from it, is what marks
out resilient individuals. They tend, like experienced meditators, to have more
left prefrontal hemisphere dominance, linked to embracing rather than shirk-
ing new experiences, whereas more depressed and introverted individuals show
less resilience under stress. Resilient people tend to look for ward to good things
and maintain an appetite for life. To deal successfully with stress we need well-
functioning seeking and affiliative systems, and high levels of stress and trauma
can turn these positive psychological and biological systems off.
While stress is bad for people, equally a stress- free life is also not what is
needed. Children who have come through mild stressors, such as moving
home, or a parent becoming ill, are better equipped to deal with stressors later
in life (Maddi, 2012) than those who had a stress- free early childhood. Indeed
those exposed to conflict at home tend to cope better with conflictual situations
as adults (Aloia and Solomon, 2014). Adolescent boys who had experienced
early dif ficulties such as ill or divorcing parents, had less reactive hear t rates
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and blood pressure when per forming challenging tasks than boys who had had
a relatively easier early life (Boyce and Chesterman, 1990). Too much and/ or
too over whelming early stress does not help later on, but interestingly nor does
too little, and some exposure to manageable early dif ficulty builds resilience.
Mild stress acts as a form of inoculation against later stressors (Hostinar et al.,
2014), something seen in most primates. Monkeys separated from their moth-
ers for an hour ever y week exhibited acute distress, desperate calling out and
high cor tisol levels, but they coped better later in life with novel situations than
those who had not ever been separated, showing less anxiety on all measure-
ments (Parker et al., 2007).
Thus some stress and challenge builds resilience. This is often talked about
in terms of post- traumatic growth, which has been described and researched
in detail (Calhoun et  al., 2014). Learning to face difficulties, and to process
and modulate one’s emotions enhances the capacity to cope with later difficul-
ties. This is not just about behavioural exposure, but also involves developing
capacities for emotional processing. What we see in those resilient in the face of
adverse experiences is that they do not deny difficulties nor retreat from them,
but are able to process and make sense of them. This is the capacity to meet
and move towards experiences, both good and bad, that both mindfulness and
psychoanalysis encourages. It entails the ability to sustain complex and mixed
feelings, to have both positive and negative affect, or in other words, to manage
ambivalence (Klein, 1946). People who describe themselves in mixed ways tend
to be more resilient (Niedenthal and Showers, 1991). Those who paint a rather
‘Pollyannaish’ too nice vision, who refuse to let any bad feelings in with the good
ones, turn out to be less resilient to stress. For example parents who score ‘dis-
missive’ on the Adult Attachment Inter view tend to describe their own childhood
experiences positively, irrespective of the reality, having no room in their minds
for the negative and also distancing themselves from their children’s difficult
emotional experiences.
As we have seen, being happy is not the same thing as not being unhappy,
and similarly the absence of happiness is different from the presence of unhappi-
ness. The number of positive emotions someone experiences does not necessar-
ily predict the number of negative emotions they have; ver y confident outgoing
people experience more positive feelings, but not necessarily less negative ones
(Zautra, 2003). A child needs positive experiences, but also the capacity to face
and manage negative ones without being over whelmed  – one might say to be
positive about negative emotions. This capacity to see two sides of the coin, to
manage mixed ambivalent feelings, is at the heart of much psychotherapeutic
theor y. Improvements in well- being tend to be seen more in people who can pro-
cess both positive and negative feelings, rather than avoiding either (Adler and
Hershfield, 2012). In one study substance using mothers who used more positive
than negative words were in fact the ones who were most insensitive to their
infants as well as most likely to relapse (Borelli et  al., 2012), which might be
explained in part by how they could not manage and bear any negative feelings
in their babies or themselves, and defended against difficult affects.

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One kind of feeling, whether positive or negative, cannot simply override
another. In one early study infants were deliberately mildly distressed with over-
whelming lighting and sound (Harman et al., 1997). Next came an attempt to dis-
tract them with interesting noises and colourful shapes, and the infants stopped
cr ying and were distracted. However, once the novelty was over the distress re-
occurred, rather like Freud’s description of the return of the repressed. It had not
been transformed into another emotion but had lain there dormant, re- emerging
when the distraction was over, but still needed processing in its own right. Just
managing either positive or negative feelings alone is not enough, and children
(and adults) are advantaged if they can manage both sets of feelings.
The current emphasis on wellbeing, positive affect states and happiness
can be used defensively too, as a way of avoiding facing difficulties. For good rea-
sons many have been sceptical of this approach and urged caution about an overly
positive version of positive psychology with ‘saccharine’ overtones (Burkeman,
2013). Others have critiqued overblown claims from small un- replicated stud-
ies (Coyne, 2013) which ironically are over- optimistic. Resilience and emotional
health are not just about being positive, but are marked by a capacity to bear and
manage difficulty too, to embrace what life throws up, both positive and negative.
This includes finding hope in difficulty, which is not at all the same as just being
positive and denying the negative.
I have described the slightly different versions of happiness and positive affect
involving different biological systems. In the seeking system, wanting and desire
are central, and the mesolimbic reward system and hormones like dopamine play
an important role. The other system is more involved in attachment, closeness
and social affiliation, and relates to the concepts of wellbeing and eudemonia,
which are firmly linked to good health outcomes (Ryff, 2014). One is more buzzy,
the other more calm and at ease. Both have a place in emotional wellbeing and
happiness. The lack of drive, desire and excitement is often a worr ying sign,
seen in depression alongside lower dopamine levels and a less active reward sys-
tem (Nestler and Carlezon, 2006). However we might be moving into an era in
which this reward circuitr y is all too easily activated, for example by consumer-
ism, advertising, gaming and a range of other potentially addictive activities that
hijack these systems (Kalivas and Volkow, 2014).
Thus these two systems denote different kinds of positive affect states
(Diener and Chan, 2011), relying on different bodily systems and interestingly
each seemingly having different effects on our health and well- being. One study
(Fredrickson et al., 2015) divided people up in terms of whether their happiness
was of a more hedonic buzzy, dopamine linked kind, such as from buying con-
sumer goods or having an exciting time, or of a more eudemonic kind, that is
happiness derived from engaging in meaningful activity based on personal values
such as a deep interest or cause, or from good relationships. The two kinds of
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happiness surprisingly had ver y different effects, right down to a genetic and cel-
lular level. Those whose sense of happiness and well- being was more eudemonic,
with a stronger sense of meaning and purpose, had lower levels of inflammation
and higher levels of immune response and antibodies than those whose version
of happiness was more hedonic and buzzy.
The Brafmans (2008) have helped make sense of these different motiva-
tional systems. They found that specific brain- based reward centres fired (such
as the posterior superior temporal sulcus), when scoring high in games where the
money won went to charity as opposed to their own pockets. However when the
same game was played but this time the financial rewards were kept by the play-
ers instead of going to charity, then the nucleus accumbens was firing up. This is
part of the brain is one which fires up in addiction, its activation can feel rather
like taking a small dose of cocaine, and it is linked to the release of dopamine.
This is a ver y different mind- set to calmer, more affiliative forms of wellbeing
such as that derived from caring for someone you love.
Kasser (2003) uses a similar distinction between ‘extrinsic’ values, mean-
ing being motivated particularly by how one is perceived by others, by mate-
rial goods, by being famous and the like. The opposite he calls intrinsic values,
meaning valuing a cluster of attributes like being community minded, living in
close families, being kind to others and living by deeply held beliefs. Exposure
to advertising can increase extrinsic values in children (Greenberg and Brand,
1993). Of course children and young people have become a huge new consumer
market with astronomical amounts of advertising revenue spent on them (Kim
et al., 2015), and increasingly aspirations are measured in terms of material suc-
cess and acquisitions. A  British study found that when 8- to 11- year- olds were
exposed to materialistic and extrinsic values, such as for material goods and
fame, these values were internalised, but these children with extrinsic motiva-
tions experienced less wellbeing, whereas intrinsic motivations came with more
wellbeing (Easterbrook et al., 2014).
Young people particularly at risk are those who have had more difficult
early lives. Parents who are less sensitive and warm tend to have adolescents
who are more insecure about their intrinsic worth. These same adolescents tend
to place a higher value on consumerism, high status and ambitions, as opposed
to the teenagers of more nurturing parents who place more value on relation-
ships, community life and self- acceptance (Kasser et  al., 1995). Similarly more
children with divorced and stressed parents value extrinsic, consumerist acqui-
sition more, irrespective of whether their families suffered financial hardship.
This is not surprising. When people feel bad, fear social exclusion or are nursing
emotional wounds they are more likely to compensate by purchasing high status
consumer goods (Sivanathan and Pettit, 2010). This is a ver y simple example of
ordinar y human defences against vulnerability. In children it seems it is the lack
of emotional resources, of love, caring support and stability which leads to more
individualistic beliefs and ‘compulsive consumption’ (Rindfleisch et al., 1997).
Those with more extrinsic values tend to have less psychological well- being,
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likely to report ailments such as stomach problems and headaches. Patricia and
Jacob Cohen (1996) looked at 700 young people in New York and clustered them
according to their values. Those clustered as materialistic were more admiring
of ‘having valuable possessions’, ‘being seen as attractive’ or ‘wearing expensive
clothes’. Another group of young people valued characteristics such as ‘being
a good person’ or ‘getting on with others’. Both groups were assessed for their
risk of psychiatric diagnoses such as ADHD, depression or anxiety and those
with more materialist beliefs had far higher levels of mental health problems.
As the Cohens showed, valuing being rich was alarmingly positively related to
almost ever y one of 20 diagnostic categories. Those who pursue intrinsic rather
than extrinsic motivations after college have better psychologically health, more
autonomy and better relatedness (Niemiec et al., 2009). Such research, has been
replicated in countries such as Singapore, Turkey, Germany, Romania, India,
China and Korea.
Thus there is a clear link between poor emotional experiences, extrinsic
values and a more buzzy, hedonistic outlook which lead to worse biomarkers for
health (Fredrickson et al., 2013), a finding which also makes sense in terms of
Life Histor y Theor y (Belsky et  al., 2012). There clearly are different and often
competing versions of what we mean by a Good Life (Music, 2014b), and a conflict
between the warm glow of being intrinsically fulfilled, such as by relationships
or ideals, or the buzz of personal reward, acquiring things and immediate excite-
ment. As the Brafman’s show (2008), pleasure seeking can often win out, even
though it does not generally bestow a sense of wellbeing. This is a particular chal-
lenge for parents, children and young people in a world in which consumerism is
so valued and advertising aimed at the young has grown massively. Despite often
tr ying to make ourselves feel better by buying new outfits or gadgets, research
suggests that money only really makes us happier when we spend it on other
people rather than ourselves! Interestingly international studies have found that
happiness levels across countries are firmly linked with how much people value
prosocial giving and helping others (Aknin et al., 2013).
Research emphasising the effects of good and bad early experiences has been
used to argue for early inter ventions that will enhance later life outcomes, in part
by building resilience. An enriched environment with plenty of stimulating, posi-
tive input seems to actually ‘grow’ the brain. Rats reared in isolation have thinner
cortical regions and less neuronal connections than their counterparts reared
in stimulating settings (Curtis and Nelson, 2003), In humans we see something
similar. Socioemotional deprivation has profound effects on the human brain
(Eluvathingal et al., 2006) while changing a neglected child’s environment, such
as in good foster care, has been shown to change brain structure and function,
such as increasing white matter (Bick et al., 2015). Enormous benefits have been
seen from early inter ventions such as The Family Nurse partnership model
Resilience, interventions, and proximal and distal impacts

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(Olds, 2012) and Headstart. In the Abecedarian Project in North Carolina high-
risk infants were given inter ventions in subjects such as language, reading and
maths, with a number of hopeful results. The inter vention group were more likely
to get through higher education, had higher IQ scores right into adulthood, had
children later and generally the effects lasted longer than in other programmes.
The children who gained the most were the ones who started off most at risk,
with less good quality input at home (Campbell et al., 2008).
Yet some see inter ventions aimed at parents as a way of not tackling big-
ger social issues such as rising inequality (Wilkinson and Pickett, 2009), poverty
(McMunn et al., 2001), the degradation of communities and macro- social issues
such as the hugely increased lack of social mobility, especially in America and the
UK (Chetty et al., 2014). A linked danger is that policies can be used to target par-
ents in poverty who end up being blamed for bad parenting and accused of hav-
ing pernicious effects on their children’s brains (Lowe et al., 2015). Indeed some
argue that the ver y concept of resilience is part of a neoliberal governmental
approach that places responsibility (blame) on individuals rather than on social
and political systems (Joseph, 2013). For these reasons wider socio- economic
analyses are needed, as is awareness of the powerful effects of factors such as
poverty and poor neighbourhoods on the capacity to parent.
While we need to heed the danger of blaming parents, and be aware of the
need for wider macro- social and community inter ventions, it is undeniable that
psychological inter ventions can be extremely helpful. We know that resilient per-
sonality traits, such as good emotional regulation and confidence, are more likely
to develop within a supportive, caring context. A huge raft of inter ventions have
been researched in recent years which have shown the benefits of early inter-
ventions (Fonagy et al., 2014). The factors that make a difference (Wampold and
Wampold, 2015) are closely linked to the kinds of parenting capacities that have
been emphasised throughout this book and it is clear that having good new expe-
riences can counter the negative ones and boost resilience. As Bronfenbrenner’s
(2004) ecological model shows, it is possible to have an impact at various levels,
from the individual, family, community and society as a whole.
What most studies show, whether of children of divorce, of mentally ill,
drug- using or alcoholic parents, is that some children are more resilient and less
badly affected than others, while some environments are more likely to breed
resilient individuals. The factors that seem to be protective are similar across
many studies, and are a mixture of individual attributes, such as genetic inherit-
ance and quality of care, and more distal factors, such as poverty (Kennedy et al.,
2009). When living in poverty or a stressful environment it is so much harder to
be a loving, attuned, reflective parent (Kiernan and Huerta, 2008), and this gives
rise to considerably poorer outcomes (Barlow et al., 2014).
When children suffer serious child maltreatment ver y few come through
unscathed. In one study not one of the 44 children identified as maltreated were
functioning competently in early schooling (Farber and Egeland, 1987). Another
found that only 13 per cent of maltreated children were doing reasonably well
in elementar y school but even these did not sustain their adaptive behaviours

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into adolescence (Herrenkohl et  al., 1997). The factors that enhance resilience
include quality of family relationships, community resources, age of onset of bad
experiences and some internal capacities (Marriott et al., 2014) as well as epige-
netic factors.
Proximal effects, such as the quality of family life, and distal factors such
as inequality, poverty and hardship, interact with each other. Maltreatment
occurs considerably more in poverty (Freisthler et al., 2006), with its associated
stressors. Families at the bottom of society’s pecking order are more likely to be
younger, single- parent families, have low educational attainment and poor work
prospects, all of which increase the likelihood of poor parental mental health, and
harsher as well as more neglectful parenting (Appleyard et  al., 2005). Parents
in poverty are less likely to respond to infant cues, have less stable caregiving
patterns and are more likely to convey a vision of the world as harsh, unstable
and frightening (Owens and Shaw, 2003). Yet these parents can on no account be
blamed, as they are often victims of their circumstances.
This chapter has shown how resilience and protective factors can develop
in children, shielding them when difficult experiences arise. The resilience
research discussed here asks what leads some children to come through such
adverse circumstances better than others. There clearly is a genetic input, with
‘orchids’ being much more vulnerable to bad experiences and benefitting more
from good ones. However, generally positive experiences predict positive out-
comes, and gives rise to what is called the ‘silver spoon’ effect (Hayward et al.,
2013). Resilience was once explained mostly in terms of factors internal to the
child, but with the advantage of children’s developmental histories, researchers
have shown that the quality of care has a decisive impact. Sensitive early caregiv-
ing is innoculator y and leads to feeling better which in turn leads to better health,
higher academic achievement, a more outgoing and confident personality and a
multitude of other positive traits.
• In recent years the importance of resilience, wellbeing and positive affect
states has been taken much more seriously by researchers.
• The psychobiological systems for processing negative and positive expe-
riences are different, and the dominance of one over another will affect
subjective wellbeing and emotional and physical health.
• Physical health and longevity is profoundly affected by adverse early expe-
riences and the ensuing levels of stress and unhappiness.
• In emotional health children develop a capacity to manage both good and
bad experiences.
• Good experiences are good for us, and having them can protect us when
bad ones come along, while facing and managing bad experiences can also
be good for us and foster resilience.
Key points

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• The factors influencing wellbeing range from more ‘distal’ social influences
such as poverty, inequality and the quality of neighbourhoods, as well as
personal factors such as neurological, biological and genetic influences,
and particularly emotional development in the family context.
• Some children, so- called ‘orchids’ are more affected by bad experiences as
well as good ones.
• There are different positive emotion systems, based on the seeking or affili-
ative systems, which can have different health effects.
• A disadvantaged environment trumps good personal attributes nearly
ever y time.
• On the plus side it is possible to make a difference on many levels of the
system, whether by working with families, schools, individuals, communi-
ties, or society as a whole. Resilience is bred from hope and positive action,
and there are grounds to have plenty of this.

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C h a p t e r   2 0
Moral development,
antisocial and prosocial
behaviour
Primed for goodness 252
Attachment and empathy 253
How stress makes us less prosocial 255
Impulsiveness, self- control and aggression 256
Aggression: hot and cold blooded kinds 257
Emotions and reason 259
Genes 261
Evolved to both cooperate and compete 262
Them and us 263
Key points 264

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How children develop into prosocial and moral beings and why some
become antisocial, even aggressive, is a major question. This chapter draws
on relevant new research and recaps findings outlined earlier in the book
to trace such pathways, looking at early experience, attachment, empathy,
neurobiology, emotional regulation and aggression.
The urge to help others is present from a surprisingly young age. In one of many
ingenious and rigorous experiments (Warneken and Tomasello, 2009), an adult
walks across a room and pretends to drop an object. Toddlers of 14– 16- months-
old consistently go and pick up the object and pass it to the adult. In another vari-
ant, an adult places a pile of books into a cupboard, returns for more books but
has seemingly inadvertently closed the cupboard door, and on returning does not
have a hand free with which to open it. Once again these toddlers cannot help but
get up to open the cupboard. Such toddlers demonstrate a clear wish to help, and
for no obvious ulterior motive; indeed, when offered rewards for helping they just
don’t do it the next time (Warneken and Tomasello, 2008).
Such reaching out to others in need is seen in infants as young as 10 months
old (Kanakogi et  al., 2013). After watching one animated figure hurt another,
infants spontaneously reached out for the victim rather than the aggressor.
These are examples of what Batson (2011) calls ‘empathy- induced altruism’ in
which the act of helping is spontaneous, genuine and rewarding.
Until recently most psychologists believed that children were born egocen-
tric (Piaget, 1965), and did not develop moral capacities until late in childhood,
underestimating the extraordinar y capacities of infants. However we seem to be
born with inbuilt inclinations to be helpful, even moral, a counter weight to our
equally innate selfish potentials.
Babies between three and five months can tell the difference between nice
and nasty behaviour, as Hamlin and colleagues (2010) showed. Using video ani-
mations and puppets, they presented stories to babies. The protagonists were
goodies and baddies. In one stor y someone was tr ying hard to open a box but
annoyingly the partially opened lid automatically closed. Babies were then later
shown two alternative scenarios. In one a goody came along and helped the box
stay open, while in the other, when after a great struggle the puppet opened the
lid a nasty character arrived and slammed it firmly shut again. Babies as young
as five months old, when given the choice after the experiment, nearly always
chose the nice puppet over the nasty one. The same results have been replicated
in many studies, even with three- month- olds who reveal their preferences by how
long they look at each character, as they are still too young to reach or point.
Thus children and even babies can clearly distinguish between antisocial
and prosocial behaviours. This is about preferring good rather than nice behav-
iour. Eight- month- olds prefer puppets that are horrible to nasty characters over
the puppets that are nice to them. Babies like nice behaviour, but not if being nice
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is to a bad person (Hamlin et al., 2010). Such studies suggest an innate human
propensity for moral understanding.
Not all babies respond in the same way; some are more perplexed by unfair-
ness than others, seeming disconcerted by unexpected behaviour (Schmidt and
Sommer ville, 2011). These are babies who are more altruistic and generous
and, for example, willingly gave up their favourite toy if someone else asks for it.
A crucial question to examine is whether some babies are just born more altruis-
tic, whether parenting makes the difference, or both.
In one study children watched as a mother and baby climbed some steps. The
baby could not keep up, got upset and started to cr y. In one version the mother
returned for the baby, and in the other the baby was just left. Securely attached
children, who have had more attuned parenting, showed evident surprise when
the baby was left, but the insecure children had the opposite response, showing
surprise when the mother returned to her children (Johnson et al. 2007). Clearly
the expectation of helpful behaviour is built on previous experiences. Good expe-
riences are perhaps necessar y for our innate altruistic tendencies to come alive.
Mikulincer and Shaver (2010) have shown in a series of studies that one’s
attachment style is predictive of how prosocial, generous or altruistic one will
be. People with secure styles, for example, are more likely to donate to charity,
volunteer, spontaneously, help others in distress and give blood, and are gener-
ally more ‘other- focused’. People with primarily anxious ambivalent attachment
styles often offer help for ulterior motives, such as to gain approval and build
their self- worth. Those with avoidant styles tend to be simply less involved in any
form of altruism such as charity work. The attachment styles we form are predic-
tive of how we act morally.
This makes sense as we have seen how secure attachment relationships
are characterised by mutual enjoyment, sensitivity and reciprocity. Kochanska
and colleagues (2010), looking at over 3000 toddlers, found that those who had
more security- enhancing experiences were more likely to develop a conscience,
and were more responsive to others and more cooperative as they got older. The
impact of parental touch, bonding and responsivity on later prosocial behaviours
has been seen in a range of cultures, such as China (Nar vaez et al., 2013). Good
early relationships lead to children becoming more open, trusting, caring and
interested in others.
There is an obvious link between altruism, prosocial behaviour and being
empathic, seen even in pre- schoolers, where the most empathic are more proso-
cial and generous (Paulus and Moore, 2015). It is true that in some forms of
altruism empathy plays only a minimal role, such as in reciprocal altruism of
the ‘I’ll scratch your back if you scratch mine’ kind (Trivers, 2002). I might help
my neighbour not because I  really care for them, but because I  expect similar
favours to be returned when needed.
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However ‘empathy- induced altruism’, which Batson (2011) has spent the
major part of his professional life investigating, certainly depends on an ability to
understand another’s feelings, not be over whelmed by these feelings, and care
about the person’s plight. His meticulous research clearly evidenced the existence
of empathy- induced altruism, distinguishing it from altruism driven by a host of
different motivations, such as the wish to feel better or be seen as a good person.
Of course we gain definite rewards from altruistic acts: that warm glow
inside, that firing of the brain’s reward circuits that neuroscientists have
shown occurs when we give help (Moll et al., 2006). Nonetheless the wish to
help is real. In children as young as two their sympathetic arousal, measured
by signs such as pupil dilation, is altered both when they help someone in need
but also when they see another person of fer this help. Such tiny children genu-
inely want people to be helped, and do not just want to take credit for helping
(Hepach et al., 2012a).
Eisenberg (1996) asked school children to watch a video of children injured
in a violent accident. Some winced and were overwhelmed by what they saw
whereas others showed definite compassion. Given the opportunity to later offer
homework help to these child victims, the ones who offered help were those who
had previously shown compassion. They also showed heart rate deceleration, a
classic signature for compassion linked with good vagal tone (Porges, 2011). Those
who had been overwhelmed by the distressed children did not later offer help,
demonstrating the importance of being able to feel empathy and compassion and
how this is linked to being able to bear and process one’s own emotional states.
As seen, many toddlers can show empathy for another’s distress, altru-
istically helping others in need. By three years of age, many even make clear
decisions about whether an adult’s display of distress was appropriate or an over-
reaction (Hepach et  al., 2012b) and only help what seem like genuine causes,
showing sophisticated understandings of intentionality.
However, many neglected children who receive little empathic attention
are barely able to understand mental states in others, and indeed in themselves,
and so are less likely to be empathically helpful. Others who experience abu-
sive rather than neglectful parenting develop a skewed understanding of others.
They have often learnt that for self- protection they need to help the frightening
or unpredictable adults in their life, but this does not derive from compassion.
Thus, caring for others is profoundly linked to empathy and understand-
ing other minds, which in turn is linked to understanding one’s own mind.
Toddlers who passed the classic ‘mirror- recognition’ test, recognising that the
face with the blob of rouge on that they see in the mirror is theirs, were the ones
who in one Dutch study also responded empathically and helpfully to another
child’s sadness (Bischof- Köhler, 2012). Self- understanding grows simultane-
ously with increased understanding of other minds and feelings. People whose
empathic brain areas are working hardest seem to be more altruistic and helpful
(Tankersley et al., 2007).
Empathy as a moral force certainly has its limits, as many critics such as
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courts of law based less on personal empathy and more on fairness and what is
in the best interests of all. However, we also worr y if people make decisions too
unemotionally. If too driven by empathy we can help the cute child but not the
ugly one, respond to people in an accident in our road but not people in more
need on the other side of town; judges driven by empathy would give harsher
sentences to people who are ‘not like them’. Emotions can get in the way of what
many of us think is right, but few want moral decision- making based purely on
‘cold’ utilitarian reasoning.
In a famous experiment from the 1970s (Isen and Levin, 1972), a dime was some-
times left in a phone booth and sometimes not. Random people were obser ved
using these booths, and as they came out an actress pretended to drop a sheaf
of paper. Fascinatingly, the people who had unexpectedly found a dime were far
more likely to help the person who had dropped the papers A dime was an insig-
nificant amount even in 1972 but when the world feels like a more beneficent
place we tend to respond more kindly.
Both adults and children are generally more generous when they are in bet-
ter moods. Toddlers become more helpful after they have been shown pictures
of people who are doing nice things, such as dolls cuddling (Over and Carpenter,
2009). In another 1970s experiment children were induced into either happy or
sad moods, by getting them to reminisce about either upsetting or enjoyable
times (Rosenhan et  al., 1974). Those who were feeling happier were far more
generous in giving sweets away than those in sad moods.
Happy people tend to be more generous, but in turn being generous also
makes people feel happier (Anik et al., 2009). There is pleasure in giving things
away, and even toddlers have a higher level of happiness after giving treats to oth-
ers than when receiving them (Aknin et al., 2012). Feeling good and being altru-
istic seems to constitute some kind of virtuous circle, good acts fuelling good
feelings which fuel good acts.
However, the opposite, a vicious rather than virtuous circle, can be all too
common. Often those who have had the worst lives, such as many abused and
traumatised children, can be ungenerous and aggressive. Such people demon-
strate something true of us all. When we are highly stressed and anxious we
become less nice and less compassionate to ourselves and others. A lifetime of
chronically bad experiences can build deep beliefs about relationships, typically
that others are not to be trusted. Abusive experiences lead to bodies and ner vous
systems programmed in expectation of a scar y, unpleasant world, which in turn
has a dramatic effect on levels of empathy, helpfulness and aggression.
Children who suffer ongoing maltreatment grow up to have chronically
lower vagal tone (Miskovic et al., 2009), as well as having a much more highly acti-
vated sympathetic ner vous system; generally, they are easily aroused, often in a
dramatic way, and find it hard to calm down, concentrate or feel at ease. Similarly,
How stress makes us less prosocial

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infants whose parents have conflict- ridden relationships have lower vagal tone
and also are more unner ved by stressful situations (Moore, 2010). Both research-
ers and psychotherapists who work with the most violent criminals (e.g. Gilligan,
1997) have consistently found that they had histories of terrible childhood abuse,
and are often extremely sensitive to any hint of threat or humiliation.
Studies show that in nurser y secure children who hear another child in
distress are likely to offer support while abused children in fact can be quite
aggressive to them (Main and George, 1985). We have long known (Feshbach,
1989) that abused children tend to show less compassion, and are less likely able
to take the perspective of another person.
Having one’s feelings understood and empathised with in a way that makes
us feel safe leads to higher vagal tone, more emotional flexibility, a better func-
tioning oxytocin system and more openness. It also increases the likelihood of
wanting to help others in distress, and even babies have been found to want to
help more when they feel emotionally attuned to (Cirelli et al., 2014). Ultimately,
feeling safe, loved and cared for, and not feeling too threatened, opens up all
kinds of possibilities for rich interaction and both empathic and altruistic acts.
In a famous test devised by Mischel (2014) in the 1970s, children are placed
in front of an enticing marshmallow and told that if they can resist the tempta-
tion for 10 minutes, they can then have two goodies rather than just one. The
children tended to resort to agonising contortions to avoid taking a bite. These
children were followed up 40 years later, and the capacity for early self- regulation
predicted a swathe of adult outcomes such as the likelihood of holding down a
job, managing a stable relationship or negotiating good friendships. The Fast
Track program in the US (Jones et al., 2015) found that kindergartners with bet-
ter emotional regulation and social skills had better later life outcomes, including
a reduced likelihood of criminal activity at 25  years old, echoing another study
where over 1000 children were followed up until the age of 32 (Moffitt et  al.,
2011). Here, early self- control predicted physical health, substance dependence,
financial success and criminal offending, irrespective of IQ and social class. The
Fast Track program is hopeful in that those who received an inter vention fared
much better right into adulthood, and were less likely to indulge in offending
behaviours.
Sensitive parenting links with not only secure attachment but more self-
regulation, which in turn tends to come with more sympathy for others as well
as that tell- tale marker of good emotional health, higher vagal tone (Taylor et al.,
2015b). Indeed, the evidence is clear that compassion is linked to higher vagal
tone (Stellar et al., 2015), which in turn comes with feeling calm and better loved.
Eisenberg (2010) consistently found that those who best regulate their emotions
are also less likely to be over whelmed by other people’s feelings, and as a conse-
quence are more able to show empathy. This is more likely in secure attachment.
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Having a traumatic childhood, though, is highly predictive of being impul-
sive and dysregulated (Ersche et al., 2012). In families displaying high levels of
anger or aggression children not surprisingly struggle with emotional regula-
tion (Morris et al., 2007) and manifest externalising behaviours (El- Sheikh et al.,
2009). With less sensitive parenting and more corporal punishment children tend
to be more aggressive, have worse theor y of mind and are less able to regu-
late their emotions (Olson et  al., 2011). Many abused children cannot tolerate
waiting, are easily frustrated, and quickly feel provoked, seeing aggression and
threat where others do not.
I describe elsewhere how Life Histor y Theor y (Belsky et al., 2012) explains
how a speeded up metabolism, less trust, less relaxation and more suspicion and
risk- taking might be adaptive for those brought up in abusive homes or violent
neighbourhoods. There is a link between low socio- economic status, poverty,
chronic stress and neurocognitive outcomes right up into adulthood (Evans and
Schamberg, 2009), including on the growth of executive parts of the brain (Noble
et  al., 2005). Indeed, by as early as six months infants from socio- economically
deprived environments are less able to pay attention (Clearfield and Jedd, 2013).
One longitudinal study (Slutske et al., 2012) of over 1000 three years olds found
that the most restless, inattentive, oppositional and moody ones were over twice
as likely to be addicted to gambling when adults.
Kochanska has shown how effortful control, moral development and the
ability to feel guilt are closely linked. Children who can defer gratification are
also more likely to stick to rules set by parents and teachers. Although tempera-
ment also plays a role, effortful control depends on feeling sufficiently safe and at
ease, which for children means being protected by parents and being helped to
regulate their feelings. In empathy we learn to tone down more self- preoccupied
perspectives (Kirman and Teschl, 2010) in order to reach out to another’s state of
mind. Children and adults who have rarely been empathised with often struggle
to inhibit socially inappropriate responses, and are more likely to show anti- social
behaviours (Morgan and Lilienfeld, 2000).
Trust comes with greater ventromedial prefrontal brain volume it seems
(Haas et  al., 2015), something that is diminished after trauma and abuse
(McCror y et al., 2011a). Those with more impulsive character traits tend to lack
prefrontal ‘brakes’ on their impulsivity (McClure et al., 2004), and instead more
primitive subcortical brain areas are active. Thus several personality variables
are linked. Children who can self- regulate tend to also be more trusting prosocial
and moral, achieve better academically and have better relationships, as well as
having secure attachments and more sensitive parents (Carlo et al., 2012).
Impulsivity and an inability to tolerate frustration, often fuelled by early abuse
and trauma, can lead to aggression and violence. One kind of aggression is ver y
linked with impulsivity, a more ‘hot’ reactive kind, as opposed to a colder proactive
Aggression: the hot and cold blooded kinds

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form (Dodge et al., 1997). Reactive aggression is often seen in those with poor
social skills, who misread social cues, for example seeing anger and aggression
where others would not.
We have already seen how children with secure attachments tend to be less
impulsive. Arsenio and Gold (2006) found that maltreated children with insecure
attachments often suffer from a profound lack of empathy and mentalizing capac-
ity. Such children come to believe that life is not fair or just, let  alone safe and
consistent.
Interestingly, children with reactive aggressive styles often have clear
moral beliefs, reacting strongly to what they perceive as unfairness or injustice.
This is different from more proactive aggression where the victimisers see the
benefits of aggression in order to get what they want. Reactive children often mis-
perceive the motivations of others and can ver y easily feel that they are ‘victims’.
Their physiological arousal, such as heart rate, shallow breathing and sweating,
tends to be greater too (Hubbard et al., 2010), with higher subcortical (e.g. amyg-
dala) reactivity (Qiao et al., 2012).
The worse the early experiences, such as physical aggression from par-
ents, the more likelihood of impulsive aggressive behaviour (Lansford et  al.,
2012). There are other factors, of course, including temperament. For exam-
ple, there is a slightly increased likelihood of externalising behaviour with
some genes such as GABRA2 (Dick et  al., 2009) or low MAOA (Byrd and
Manuck, 2014), but the main ‘pathogen’ is nearly always the maltreatment in
the home.
Other children and adults have a propensity for colder more proactive
forms of aggression. Such ‘cold’ aggressors are more likely to have better verbal
and cognitive skills, better abilities to read social cues, more friends, and indeed
are often leaders of their groups. They tend to use aggression in deliberate tar-
geted ways in order to achieve definite goals for themselves. They might read
minds and intentions ver y well but have little fellow- feeling. They often feel posi-
tive about their violence, as it ser ves clear purposes, and are sometimes called
‘happy victimisers’ (Smith et al., 2010).
Unlike reactive children who might cr y out against unfairness, these cold-
headed aggressors generally lack much moral sense, caring little about those
they harm and lacking remorse (Arsenio and Lemerise, 2010). As Arsenio sug-
gests (2006), many who come from backgrounds lacking love, support and empa-
thy come to believe that relationships are all about power, control, domination
and getting what one wants.
Some children who are much further along this cold- hearted spectrum are
labelled callous- unemotional (Viding et al., 2008), lacking moral sense, empa-
thy and remorse, and displaying severe anti- social tendencies. The worst offences
tend to be committed by them. Often such children show signs of such behav-
iours from an early age, and researchers have found a lot of continuity into adult
life (Frick and White, 2008). Many adult psychopaths were children reported to
have been anti- social, started fires, tortured pets and shown other instances of
cruelty. The presence of callous- unemotional traits in children, alongside conduct

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disorders, hugely increases the likelihood of serious offending, violent crime and
shorter periods between re- offending (Brandt et al., 1997).
Of course, we are all capable of being callous and self- interestedly aggres-
sive. Such traits come to the fore with danger, threat, violence, competition or
sur vive- or- die environments. The traits associated with psychopaths, of being
cold- blooded, reptilian and ruthless, are those we share with other mammals. In
psychopaths and callous- unemotional children we see cold, emotionless aggres-
sion similar to predators as they stalk their prey.
Unlike impulsively aggressive children, those with callous- unemotional
traits barely react to negative emotional words, or to distressing pictures (Kimonis
et  al., 2006). Interestingly, they also tend to look at other people’s eye regions
less (Dadds et al., 2006). Callous- unemotional children have minimal amygdala
response in the face of fear, compared to most of us (Jones et al., 2009), are barely
affected by another’s pain (Lockwood et al., 2013), and struggle to recognise sad-
ness, but not other emotions such as happiness, disgust or anger.
In such cold presentations there is less connection between prefrontal
brain areas and the amygdala, and linked to this, a poor ability to pick up fear
signals (Kiehl, 2006). More fearless children are more at risk of criminal and psy-
chopathic behaviour as they get older. Indeed, low autonomic arousal and lack
of fear in infancy is predictive of later behavioural problems (Baker et al., 2013).
Many abused children I  work with show high levels of fearlessness alongside
impulsive traits, sometimes stealing or hurting others on a whim.
Genetic research notwithstanding, there certainly are links between early
trauma and both psychopathy and callous- unemotional traits. Poor early attach-
ment has been linked to callous- unemotional traits (Pasalich et al., 2012), and, for
example, adopted children who have empathic adoptive parents can lose such
traits (Waller et al., 2015). Trauma and neglect in fact affect similar brain regions
in which we see differences in psychopaths, such as the amygdala, hippocampus
and ventromedial prefrontal cortex. Maltreatment and the lack of early maternal
care have been clearly linked to callous- unemotional traits and aggressiveness
(Kimonis et  al., 2012). Tellingly, longitudinal samples from Romanian orphan-
ages have found high levels of callous- unemotional traits in children adopted into
even ver y caring and loving families (Kumsta et al., 2012), but that the adopted
children have far less of these traits than those remaining in the orphanages
(Humphreys et  al., 2015). Good care reduces the risks of callous- unemotional
traits, and we know that sensitive parenting lessens externalising behaviours
in children with callous- unemotional presentations (Kochanska et  al., 2013).
Trauma and poor attachments are not the whole stor y but they certainly play an
important part.
Kohlberg (1976), one of the earliest moral psychologists, used a range of hypo-
thetical moral dilemmas to work out children’s stage of moral development.
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Probably most famous is the case of Heinz, whose wife was desperately ill. She
needed expensive medicine, and the pharmacist was charging an unaffordable
high price and making a massive profit on this. Heinz had unsuccessfully tried
ever y way he could to raise money to pay for the treatment. Eventually out of
desperation he robbed the drug store to help his dying wife.
Psychologists were interested in the thought processes behind children’s
moral views. For example, younger children might say that Heinz should not
steal the drug because he would be put into prison, which would mean he was
bad; for them if Heinz was punished then he must be bad. As children mature
they might say that Heinz should not steal because the law prohibits it and one
should abide by laws. Children who can reason like this already have an idea of
a ‘we’, maybe a society, who share norms. Slightly more mature forms of reason-
ing enable thinking about issues such as human rights, maybe that Heinz has
the ‘right’ to medicine at a reasonable price. Later on, still more sophisticated
reasoning might occur such as whether it is more important to save a life than
to respect the chemist’s property rights. Psychologists suggested that ideally
people become properly moral when they can move towards such sophisticated
moral debate.
Haidt (2012) is one of many modern psychologists who have argued that
Kohlberg and his followers missed something important, and that our moral
choices are led much more by emotions and gut instinct than reason. In a typi-
cal Haidt scenario, we learn of a brother and sister, Mark and Julie, travelling
abroad on vacation. They are alone in a seaside cabin and decide it might be inter-
esting to tr y having sex together. Mark uses a condom and Julie is on the pill.
They enjoy making love but decide never to do it again and to keep this a secret.
Haidt asks us whether what they did was wrong? Most people intuitively say yes.
However when asked why, they can be hard pushed to give logical reasons for
their view. The usual ones, such as the risk of birth defects, do not apply due to
careful contraception use. Often people resort to ‘it’s illegal’, or ‘it’s disgusting’.
Our antipathy to the act is a powerfully emotional one.
Dutton (2012) describes a classic thought experiment. After hitting an
iceberg, a boat disintegrates. The 30 sur vivors cram into a lifeboat which can
only stay afloat with seven people aboard. The captain must decide whether to
throw 23 people off. Using reason alone one could state that if they were not
thrown over they would die anyway. When asked whether we would throw 23
people over board, most of us struggle and take about nine minutes to decide.
For un- empathic psychopaths though it is a ‘no brainer’, ‘obviously’ they should
be thrown off, and the psychopaths’ decisions are made in about nine seconds,
not the nine angst- ridden minutes most of us take.
To function as a moral person we need to use both emotion and reason. We
can rely too much on emotionality, such as favouring someone we like, maybe
speeding them to the front of a housing queue (c.f. Prinz, 2011). This is partly why
we also rely on ‘impartial’ judgements such as from courts of law or government-
appointed bodies. We want juries to debate carefully and rationally but with their
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at times such instinctual responses can be trusted, but at other times it can pay
to rationally re- appraise our initial strong reactions (Feinberg, Willer, Antonenko,
et al., 2012). However, many maltreated children can do neither well, and either
over- react emotionally, as in reactive aggression, or under- react emotionally, as in
the colder proactive forms. Ideally, the rational and emotional parts of our brains
work in tandem.
The relationship between our different brain areas and our moral function-
ing has been interestingly captured by Nar vaez (2009) in her theor y of Triune
Ethics, which uses many similar ideas to those argued for in this book. She
argues that our approach to morality and prosociality will be formed in large
part by early experiences. Some people will function from more defensive,
stress- induced systems, leading to a lack of empathy, some from a more ‘cold-
blooded’ state of mind and others from a more compassionate, empathic and
prosocial position, each utilising different psychobiological and biological sys-
tems. She suggests that the evolutionarily more recent prefrontal brain regions
are implicated in what she calls an Ethic of Imagination, being able, for example,
to envision a range of possibilities and to debate issues in the sense that Kohlberg
suggested. These capacities, though, can be harnessed, she states, by either a
more rational if heartless way of relating or a more compassionate one, depend-
ing on one’s formative experiences.
There are epigenetic predictors of how open we are to the plight of others, linked
for example to how much oxytocin we release. Higher levels of oxytocin are asso-
ciated with more trust, generosity and kindness (Zak, 2012). We have already
seen how early stressful life experiences lead to fewer oxytocin receptors and
lower oxytocin levels (Heim et al., 2008; Opacka- Juffr y and Mohiyeddini, 2011)
and that higher oxytocin levels increase the ability to understand the thoughts
and feelings of others (Domes et al., 2007).
However, genes can also play a role. As mentioned in Chapter 8, there are
two versions, A or G, of the oxytocin receptor gene, OOXTR, inherited from each
parent, and any of us might be AA, GG or AG. Those with two Gs seem to be the
most prosocial, so much so that when obser vers watched less than half a minute
of 23 romantic couples in conversation, they consistently tended to say that the
listeners with two Gs were kinder and more empathic (Kogan et al., 2011).
Another study found that on perceiving a threat, those with two Gs
remained charitable and helpful while those with other combinations became
less prosocial (Poulin et al., 2012). Pre- schoolers with one variant (the RS3 vari-
ant of the arginine vasopressin receptor 1A gene) were consistently less altruistic
(Avinun et al., 2011).
However, we know that experience will moderate such predispositions.
For example, securely (but not insecurely) attached children have been found
to be more generous when they have one of two versions of a dopamine
Genes

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receptor gene (Bakermans- Kranenburg and van Ijzendoorn, 2011). Another
study found that Americans with either two Gs or an AG combination were
more likely to seek social suppor t when in trouble, but the genetic influence
was less present for Koreans with the same gene combinations, for whom such
suppor t seeking was less culturally common (Kim et al., 2010). Another study
looked at mothering and found that it was the combination of both the form of
oxytocin gene a new mother had and the kind of parenting the mother herself
received which predicted the quality of mothering (Mileva- Seitz et  al., 2013).
Once again, gene- environment interaction research is revealing how dif ferent
experiences trigger how our genes are expressed. Genes, although influential,
only explain so much.
Recent research has shown that in what Bowlby called our EEA, or environ-
ment of evolutionar y adaptedness, which was mainly in hunter- gatherer groups,
humans lived in small, cohesive, altruistic and highly moral bands. Boehm (2012)
studied ethnographic reports of just about ever y hunter- gatherer group known,
particularly those living in conditions nearest to the time before the first known
settled communities. He found that whatever the climate or continent, the same
egalitarian pattern emerged. Altruism, generosity and group cooperation were
highly valued and selfishness and laziness were punished. All such hunter-
gatherer groups exercised powerful social control via clear moral rules to tr y to
ensure a cooperative and egalitarian lifestyle.
Aggression, warfare and murder were also part of this heritage, of course,
seen most obviously in some bellicose cultures. Similarly, selfishness and
greed was endemic; but in the hunter- gatherer societies studied such tenden-
cies became relatively suppressed and controlled, while altruistic and coopera-
tive personality traits were more valued. Evolutionar y anthropologists such as
Boehm and Wilson (2012) agree that there is a clear rule: selfish individuals out-
compete altruistic individuals, but altruistic groups out- compete groups made up
of selfish individuals. We might think of the analogy of sports. A band of superb
individualists is unlikely to succeed in team competitions.
Hrdy (2009) also stresses the importance of being a cooperative breeding
species which rears its young in groups, unlike nearly all primates. She argues
that this led to the development of our extraordinar y capacities for empathy,
understanding other minds, mutual trust and prosocial tendencies. Cooperative
breeding species, including wolves, meerkats and a variety of birds and a few
primates, tend to be more prosocial.
This is of course not to suggest that altruistic and egalitarian traits are
any more or less natural than selfish, aggressive or competitive ones, but they
are central to our evolutionar y inheritance. Hunter- gatherer life was basically
egalitarian and cooperative. It is harder to be ver y selfish when one’s actions are
likely to be noticed by ever yone else. It is possible that the advantages of being
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altruistic, generous or moral might be diminishing in modern market economies
favouring more self- interested individualistic traits.
Typical of the kind of evolutionarily evolved traits that facilitate socially
cohesive living is embarrassment which, Keltner (2009) suggests, is an evolved
mechanism that helps ensure social order. In embarrassment we turn our heads
away, rather than look someone in the eye, and take a ‘one- down’ position. The
infancy researcher Reddy (2008) has even shown traits like coyness in four-
month- old babies. Most of us look embarrassed if we make a social gaffe, trans-
gress someone’s boundaries or break a rule.
Some show less embarrassment than others, including, as Keltner found,
children diagnosed with conduct disorders or ADHD, and boys who fight,
bully or steal. Maltreatment, abuse and neglect can lead to this, of course.
When Keltner gave a group of boys a test which they were bound to fail, it was
the well- adjusted boys who showed embarrassment; they cared what others
thought of them and wanted to do well. However, the less emotionally regu-
lated boys tended to show anger instead, for example threatening to stomp
out. Embarrassment might be a sign of our commitment to the social and
moral order. Those lacking commitment to group norms would have strug-
gled more in our hunter- gatherer past.
Gossip seems to be another evolutionarily evolved trait that can, perhaps
surprisingly, be a force for social good. When people know they might be the
subject of gossip they act more fairly, and the biggest change is seen in the least
altruistic (Feinberg, Willer, Stellar, et  al., 2012). Even young children do it. In
one experiment (Vaish et al., 2011) three- year- olds watched a puppet draw a pic-
ture. When this puppet left the room another character destroyed their creations.
The three- year- olds protested when the damage was being done, and also ‘tat-
tled’ on the culprit when the harmed puppet returned. Indeed, young children
have also been found in experiments to actively use moralistic and normative
language to prod peers who are not conforming to group norms (Schmidt and
Tomasello, 2012).
Gossip and embarrassment are examples of mechanisms that aid group
cohesion and conformity to group norms, and discourage selfishness and
immoral behaviours, all hugely important in hunter- gatherer life.
Much research shows that babies have what are called in- group preferences.
Eleven-month- olds prefer individuals who share their own taste in food and even
expect them to be nicer than those with different tastes. Nowak and Highfield
(2011) argue convincingly that loyalty to in- groups made evolutionar y sense
given that strong, tight- knit and cooperative groups were so important to sur vival.
Indeed, a different part of our brains lights up when we look at a famil-
iar kind of face as opposed to one with less well- known features (Dawson et al.,
2002). Sixteen- month- olds, when presented with food that they were uncertain
Them and us

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about, chose the same food that people they knew preferred (Hamlin and Wynn,
2012). More worr yingly, nine months olds preferred people who treat people in
their group well and treat people who are ‘not like them’ badly (Hamlin et  al.,
2013), and three- month- olds prefer people of their own race (Kelly et al., 2007).
Prejudice starts early.
It seems that, troublingly, it is harder to even sympathise with people we
see as dissimilar. We even use different parts of our brains if we tr y to empathise
with those who see the world differently (Mitchell et al., 2006). We are also more
generous to members of our own group when they violate social rules than to
those from out- groups, recruiting more mentalizing and empathic brain circuitr y
(Baumgartner et al., 2012). Higher levels of oxytocin normally come with more
trust, generosity and empathy, but this is for our own group members, and can
in fact make one less generous to outsiders (Everett et  al., 2015)! Even young
children, while often protesting about unfairness that they hear about, are more
lenient to members of their own group and suggest harsher punishments to out-
group members (Jordan et  al., 2014). As we saw earlier, humans have a natu-
ral tendency to divide the world into ‘them and us’, even when the belonging is
based on the most spurious of grounds. The chances of reaching out to those in
other cultures and groups are even more compromised by the fact that belonging
and group loyalty increases self- esteem (Hewstone et al., 2002). Prejudice about
ethnicity, class or nationality are extreme examples of this double- edged predis-
position. Being a group species with close social bonds gives rise to some of the
ver y best and ver y worst of human traits.
• A propensity to be kind, empathic and generous is present from infancy
onwards.
• The kind of experiences we have, especially early ones, influence the extent
to which we become empathic, altruistic and moral, and how much we are
able to participate in social groups and interpersonal relationships.
• The development of empathy and of understanding other minds is a cru-
cial achievement, without which altruism and good- hearted generosity do
not occur.
• Issues of morality and altruism cannot be understood properly without tak-
ing seriously the pivotal role of emotion and emotional development.
• Trauma, abuse and stress can lead to the atrophy of many prosocial traits,
leading to impulsivity, lack of fear and an inability to abide by social norms.
• When we feel good about ourselves, we are more likely to be generous and
less selfish.
• We feel better when we help others. In fact, helping others not only makes
us feel good, it makes us healthier.
• Aggression can be of a hot, reactive or a cold, proactive kind.
Key points

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• Our prosocial propensities became more central to human life through the
consequences of living in closely bonded groups in our hunter- gatherer
evolutionar y past.
• We have an in- group preference which can lead us to be less empathic and
moral to outsiders.

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267
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C h a p t e r   2 1
Conclusions: earlier
experience and
its longer- term
consequences
Psychological effects of early experiences 269
Adverse experiences and the body 271
What change is possible? 272
Conclusions 275

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This book has aimed to describe something fundamental about how the
human infant, with all its unrealised potentials and possible futures, devel-
ops into a particular kind of person. Research findings have been at the
heart of this endeavour, and they have cast an increasingly bright light
on the subject in recent years. Any life lived means not having lived other
potential lives, and it is the coincidence of being born into a particular fam-
ily, in a particular culture, historical period, and social group, with the expe-
rience of unique life events, in combination with genetic inheritance, that
provide the ingredients that form a person.
One vital question we must ask is how much continuity is inevitable from early
life, and how much change is possible as time goes on. We have seen that chil-
dren are affected by earlier experiences, but also that they can build new experi-
ences alongside past learning, can develop new expectations and new internal
working models of relationships. This final chapter goes back over some of these
issues and questions.
Fundamental to this book is an understanding of how our emotional
worlds, brains (Krugers and Joëls, 2014) and ver y beings form by adapting to
our environments, most importantly, to our early attachment figures. Central to
secure attachment is much that this book has emphasised, emotional sensitivity,
attunement (Stern, 1985), mind- mindedness (Meins et al., 2013) and mentaliza-
tion (Fonagy et al., 2004), or in other words being held in mind, thought about,
cared for and understood. We have seen how the nature of these early relation-
ships impacts on our psychological expectations of life and relationships, and the
ways in which our brains and bodies develop.
Attachment security as measured in the Strange Situation Test has not
always been the best predictor of later life outcomes, but the massive longitu-
dinal studies of attachment by the Grossmanns (2005) in Germany and Sroufe
(2005) in Minnesota have found clear evidence of the ver y long- term effects of
early experience. We can see how this might happen. For example children who
have been maltreated at home are unlikely to give or accept care even from an
early age. Early nonconscious relationship patterns are carried for ward to future
situations. The maltreated children might not be maltreated in their next context,
for example in nurser y, but they can end up somehow being less liked and more
shunned than other children. Such children can find sitting still and concentrat-
ing harder, they might get into more fights in school, be unhappier, and such
patterns can show continuity all the way to adulthood unless there are helpful
inter ventions or changes of circumstances.
If a child loses a benevolent breadwinning father or gains a violent one,
then their context changes and they adapt to it, and if a parent becomes less or
more sensitive a child’s attachment style can change (Belsky and Fearon, 2002).
What early attachment security seems to offer is a kind of buffer against later
socioemotional blows. In other words, a secure child at 15 months might have a
head start on an insecure one, but they are maybe more likely to remain secure
and confident two, or four, or 10 years later also because they have remained in

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a home where sensitive thoughtful parenting was present. To state the obvious,
the best position of all to be in is to have good early experiences followed by good
later experiences, allied of course with the right temperament.
The premise behind the idea that early attachment has an ongoing impact
is that one develops, in response to experiences, internal mental models of
relationships that are then used in later relationships. Maltreated children will
often ascribe aggressive intentions to actions that other children perceive more
benignly. Such nonconscious internal models, based on procedural memories,
can be challenged by new kinds of experiences, or be affirmed by continuity of
experiences, and internal models always reflect a combination of current and
earlier experiences.
Sroufe found that the more factors and moments in a person’s life that are
examined, then the more sense one can make of how people end up as they do.
There is definite continuity between early attachment and later life (Fraley and
Roisman, 2015), but this is mediated by many factors, including epigenetic ones
(Raby et al., 2013). A raft of later influences can change a trajector y in one direc-
tion or another, such as if we offer support to a child’s parents (Raby, Steele, et al.,
2015) or they have an emotionally attuned teacher. Partly for this reason I have
described development in terms of an ecological perspective (Bronfenbrenner,
2004), which takes account of individual, family, neighbourhood and societal fac-
tors, and the ways these all influence each other, allowing us to think of there
being a ‘cascade’ of effects throughout life, and that there are a variety of levels of
influence and potential points of inter vention over a life course.
We have learnt a huge amount in recent years about how both good and bad
early experiences can have a lifelong impact on psychological states. On a posi-
tive note, large studies have shown that sensitive good early caregiving predicts
a range of outcomes 30 years later, such as educational status, social competence
and romantic relationships (Raby, Roisman, et  al., 2015). The best predictor of
wellbeing in adulthood seems to be good early relationships in childhood and
adolescence, as also seen in a 32- year study (Olsson et al., 2013). Much research
suggests that early experiences are influential irrespective of later experiences,
as if such early caregiving and contexts programs the ‘life- course’ (Fraley and
Roisman, 2015).
Unfortunately the most profound marks are left by negative experiences,
and indeed it is psychological more than physical or sexual abuse that often leaves
the deepest scars and has worst long- term outcomes, including serious later psy-
chiatric disorders (Spinazzola et al., 2014). One large Irish study found that those
sexually abused in childhood had, by age 50, done much worse in the job mar-
ket, for example (Barrett et  al., 2014). Another British study found that those
who suffered several adverse childhood experiences such as neglect or trauma
were far more likely to be suffering with a range of issues, from alcoholism, poor
Psychological effects of early experiences

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relationships, eating disorders teenage pregnancy, drug use and violence (Bellis
et al., 2014).
Adverse experiences will give rise to a range of disturbances in adulthood,
from ADHD (Fuller- Thomson et al., 2014), sleep disorders (Baiden et al., 2015),
psychosis (Muenzenmaier et al., 2015), alcoholism (Strine et al., 2012), obesity
(Suglia et al., 2012) and criminality (Baglivio and Epps, 2015), to name but a few.
These adverse experiences need not even consist of maltreatment to the child
directly, and could be just being exposed to worr ying behaviours, such as inti-
mate partner violence (Holmes, 2013). Having several adverse experiences can
make adults not only more prone to disorders such as depression but also less
amenable to treatment (Nanni et al., 2014).
We have seen how adverse early experiences such as abuse af fect both
the structure and functioning of the brain (Teicher and Samson, 2016). The
most common ef fects are seen on the hippocampus in adulthood, prefrontal
cor tex activity, smaller corpus callosum and more limbic activity, especially
the amygdala (McCror y et al., 2011b). Indeed insecure attachment is associ-
ated with higher amygdala volumes (Moutsiana et al., 2015), while less over t
adverse experiences such as maternal depression have also been shown to
have an ef fect on some specific brain areas (Gilliam et al., 2014), as of course
has institutional and other forms of neglect (Strathearn, 2011). We have also
seen how inheriting cer tain gene variants can either increase or decrease the
risk of serious ef fects of maltreatment (Nemerof f and Binder, 2014), if never
obviate it. Experiences such as maltreatment have an ef fect right down to the
genetic level, turning up or down the expression of a range of genes (Mehta
et al., 2013).
Of course this is not just about parenting, and we see a ‘double disadvan-
tage’ when children suffer maltreatment and are also living in deprived neigh-
bourhoods where community violence is prevalent (Cecil et  al., 2014), even if
secure attachment can inoculate against such risks (London et al., 2015). Social
background hugely influences cognitive development and educational attain-
ment, which in turn influences job and other prospects (Bukodi et  al., 2013),
and clear links have been found between brain development, educational attain-
ment and family income (Noble et al., 2015). Childhood poverty and the associ-
ated stress levels have a big effect on capacities for emotional regulation, the
development of inhibitor y brain networks (Kim et al., 2013) and the likelihood of
increased risk- taking (Griskevicius et al., 2011). Serious financial strain of course
puts huge pressures on any adult’s parenting capacity (Hetling et al., 2014). The
socio- economic context a mother finds herself in will influence how she parents
her children (Meunier et al., 2013). Once again, such research suggests we need
to inter vene not only with parents, but also at the level of community, socio-
economic inequality and a range of other levels.
Basically, the more adverse childhood experiences (ACE’s) a child expe-
riences then the worse the outcome, as corroborated in a major American
study of over 17,000 people. An ACE might be, for example, emotional neglect,
sexual abuse, alcoholism in the home or a parent in prison. The more ACE’s

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the higher the likelihood of a range of mental health issues, but also physical
symptoms such as hear t disease, strokes and even cancer, and indeed of early
death. For example, compared with persons with an ACE score of 0, those with
an ACE score of 4 or more were twice as likely to be smokers, 12 times more
likely to have attempted suicide and seven times more likely to be alcoholic,
while someone with an ACE score of 6 or more has a 4600% higher chance of
being an intravenous drug user than someone with an ACE score of 0 (Felitti
and Anda, 2010).
A huge swathe of studies have shown that early maltreatment has ver y serious
ef fects on the physical body right into adulthood, on the likelihood of contract-
ing serious disease, and of early death from a range of causes (Dube et  al.,
2003). Typical is how childhood physical abuse is predictive of coronar y hear t
disease and type 2 diabetes in adulthood (Midei et al., 2012). Hear t disease and
diabetes come under the heading of metabolic syndrome diseases alongside
strokes, and are clearly linked to ACE’s (Gilber t et al., 2015). Links were found
between adverse experiences and many outcomes such as weight, cholesterol
levels, blood pressure and fasting glucose levels during one seven- year study
(Thomas and Johnson, 2008). The researchers found a strong link between
childhood abuse and other symptoms such as smoking, poor physical activity,
alcohol use and depression in mid- life. Similarly there is a hugely increased
risk of hear t attacks in women who suf fered sexual abuse as children (Rich-
Edwards et al., 2012).
Many studies have found links between a range of biomarkers for ill- health,
such as chronic inflammation and ACE’s (Levine et al., 2015). As we know from
Life Histor y Theor y (Hochberg and Belsky, 2013), more stress and anxiety
and worse early experiences gives rise to speeded up metabolic systems, and
increased risk of all kinds of disease. For example if you are bullied as a child
there is more likelihood of higher levels of inflammation well into adulthood
(Copeland et  al., 2014), while social isolation in childhood is also linked with
higher levels of inflammation as well as mental and physical problems in adult-
hood (Lacey et al., 2014). One of the best predictors of illness and early death is
shorter telomeres, the caps at the end of each strand of DNA that protect our
chromosomes. With bad experiences they shorten and fray. Shorter telomere
length is associated with a range of life stressors (Epel et al., 2004), particularly
adverse experiences such as family violence (Drur y et  al., 2014). Much other
evidence demonstrates how telomeres are profoundly affected by adverse expe-
riences (S. H. Chen et al., 2014).
All in all, stressed, traumatic and unhappy childhoods have a hugely nega-
tive effect on later health outcomes. The physiological processes that lead to
such poor outcomes nearly always start as sensible adaptive responses to difficult
circumstances, such as a vigilant, tense bodily response to violence, alongside
Adverse experiences and the body

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shallow breathing, heightened blood pressure, high cortisol levels, lowered
immune functioning and much more.
Yet change is possible, and inter ventions can really affect children’s futures.
A graphic example of how later experiences can alter trajectories is seen in chil-
dren who have been traumatised or abused but receive the radical inter vention
of adoption. Research using stor y- stem procedures (Hodges et al., 2003a) shows
that children subjected to trauma often have minds full of disastrous scenarios,
and have little faith that adults can be trusted or that life could include order,
routine, or safe boundaries. Their stories at the point of adoption are often full of
blood, death and violence, of adults acting like immature children, and people liv-
ing in an unsafe world. Once adopted into safe homes changes are seen as early
as three months later. These children develop new narratives with less disastrous
scenarios, and their stories begin to show more order and narrative structure,
and to describe a world where children can rely on adults to look after them. Yet
their old stories remain, and continue to be relied upon, even though new ver-
sions are growing alongside the old. In this study the children who did best were
adopted by parents who scored secure- autonomous on the Adult Attachment
Inter view, or in other words, parents who had good capacities for processing
emotions, for reflective self- functioning or mentalizing, which has been another
theme threaded throughout this book.
Equally hopeful are the changes seen in children’s attachment status
after they are fostered early in their lives. Dozier (2015) has done extensive
research with fostered children who often come from ver y traumatising and
abusive backgrounds. She strikingly found that infants fostered in their first
year of life tend to re- organise their attachment patterns in line with their new
carers. When placed with carers classified as ‘secure- autonomous’ those who
had been subject to abuse nonetheless formed secure attachments, and their
biological systems such as cor tisol levels change positively. A  British study
also saw attachments in maltreated children move from insecure to secure
through foster care input (Joseph et al., 2014). Being placed with carers who
are sensitive to their psychological states can be life- changing. In the Hodges
sample not only did the children’s representational worlds become more
benign and hopeful, but the placements were less likely to break down or have
serious dif ficulty.
Being adopted or fostered into a caring home after abusive early experi-
ences is a more dramatic inter vention than most children experience. We know
that there are a range of influences and factors which might tip a child from one
potential trajector y onto another. Such life changes might include, for example,
a mother becoming depressed, a financial crisis, a supportive (or violent) step-
father arriving, or a child entering a ver y good or bad school or a ver y different
neighbourhood. Other important inputs include what professionals do, such as
What change is possible?

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teachers, social workers or therapists, or major community or social inter ven-
tions. Many readers of this book will be undertaking activities with children and
families that most definitely change their trajector y.
There is increasing evidence that early inter ventions can have an effect
on children’s psychological and social wellbeing that lasts right into adulthood.
Some of the most impressive results were seen in the carefully randomised
Abecedarian project which targeted early childcare inter ventions for low income
high risk families (Campbell et al., 2014). Compared to the control group, those
helped early in life were some 30 years later much more likely to be in work, to
have children later, to be in stable relationships, and less likely to need public
assistance. The Fast Track program (Carré et al., 2014), which aimed to reduce
externalising behaviour problems via cognitive and socio- emotional input, was
linked to reduced aggression and lower testosterone reactivity some 10  years
later. These are but a few examples of a range of inter ventions geared towards
families and young children that paid huge dividends. One long- term follow up
found that disadvantaged children randomised to an inter vention were earning
25 per cent more than controls 20  years later (Gertler et  al., 2014), and many
other programs such as Headstart (Walters, 2014) and Family Foundations
(Solmeyer et al., 2014) have shown clear gains.
Successful community inter ventions include multi- systemic inter ventions
with youth at serious risk of criminality who have been shown to have been
helped on to better trajectories some 25 years later, keeping not only the identi-
fied youth but also their siblings on the straight and narrow (Wagner et al., 2014).
Research in this book has emphasised how central parental emotional
sensitivity, and in particular mind- mindedness and mentalization, are in ensur-
ing secure attachment in children. Several therapies have tried to target just
this area, often with success, and children’s attachments improve when parents
get help in being sensitive to their child, such as via dyadic mother– child work
using video- inter ventions (Juffer et  al., 2008), or parent– infant psychotherapy
(Salomonsson 2014). This can be especially crucial with mothers whose infants
are at risk, either because of their socioeconomic position or because of infant
temperament. In one attachment based study 78 per cent of the control group
who did not receive help had children classified as insecure after a year, as
opposed to only 38 per cent of the group who received help (Powell et al., 2013).
When mothers are helped to become more responsive and thoughtful, and to
read their children’s emotional signals, then a real difference can be made to
these children’s attachment patterns.
Similarly Murray’s inter ventions, with postnatal depression have shown
success. Without such help children become more passive, with less sense of
agency, are more likely by age eight to be showing conduct disorders; and by 15,
daughters of depressed mothers in Murray’s sample were showing above aver-
age frequencies of depression (Murray et al., 2014).
There is also now an impressive array of research concerning the impact
of various kinds of parenting inter ventions such as Webster- Stratton (Webster-
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a gloomy pessimism that sometimes descends when thinking about the effects
of bad early experiences. Even in the most serious cases, such as children and
young people at risk of incarceration, hopeful changes are seen that move young
people onto better trajectories (Woolfenden et  al., 2003), many such inter ven-
tions being geared towards family and school settings (MacArthur et al., 2012).
In the world of child mental health we have seen increased evidence of
how inter ventions can make a difference. I will not go into too much detail here
about which methods work with which problems, as this has been reported in
depth by experts such as Kazdin and Weisz (2009) and Fonagy and colleagues
(2014). For example we know that serious conduct disorders and oppositional
behaviour can be treated successfully with forms of parent training, that adoles-
cent depression can be effectively treated with interpersonal psychotherapy, that
cognitive- behavioural therapy (CBT) can be effective for a range of issues such
as anxiety disorders and obsessive- compulsive symptoms (Fuggle et  al., 2012;
Wolpert et al., 2006), and that psychoanalytic and systemic therapy are successful
with depression (Trowell et al., 2007; Midgley et al., 2013).
Such findings give considerable hope, although a degree of caution should
be used when arguing that one form of treatment is necessarily more effective
than another. Other factors inevitably inter vene and skew results. There are
many forms of therapy used that have not as yet got an evidence base, and other
approaches such as mindfulness have been hugely researched with adults but
not so much as yet with children, even if the signs are hopeful (Weare, 2013).
Furthermore some therapies, such as CBT, might be particularly amenable to
accepted research formats such as randomised control trials (RCTs), and
CBT practitioners have been good at gaining research funding. Other treat-
ments, such as psychoanalytic and systemic approaches, have not yet been as
widely researched via RCTs, but still have a growing evidence base (Abbass,
2015; Kennedy, 2004). Not having an evidence base gleaned from a RCT does not
mean that a treatment does not work.
Worr yingly, there have been considerable difficulties in translating good
treatment outcomes in experimental clinical trials to similarly good outcomes
in the ordinar y clinical settings that most clients attend. This might partly be
because the zeal and belief of the originators of research trials cannot so easily
be transferred to such ever yday settings. Linked to this is the fact that consistent
belief in a treatment definitely affects outcomes (Beutler, 2009). Furthermore in
clinics children are increasingly diagnosed according to psychiatric classification
systems such as DSM or ICD and assigned to treatments that in fact might not
fit them. This is seen particularly in maltreated children who often are misdiag-
nosed as ADHD or on the autistic spectrum (DeJong, 2010; Music, 2011), where
lack of empathy or hyper- reactivity is so often in fact due to traumatic experi-
ences. Also, most research trials compare treatments for children who present
with a single disorder (such as anxiety or depression), while practitioners in the
field rarely meet children with a single treatable disorder. Indeed many children
referred for help have a range of issues, what is called comorbidity, such that
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Maybe more importantly, there is also increasing evidence that factors
other than the form of treatment make a difference (Wampold and Wampold,
2015). Evidence shows that often the quality of what is called the therapeutic
alliance between a client and a therapist has a greater effect than the form of
treatment offered (Green et al., 2013). In other words, children or young people
suffering from the same disorder but being offered different forms of treatment
are more likely to get better if the therapeutic alliance between therapist and
client is good, irrespective of the treatment modality. Furthermore, it has been
shown that outcomes are not particularly affected by whether clients like the
therapist, but are measurably linked to the degree of skill of the therapist (Scott,
2008). In fact it seems that there are some common factors that make a good
therapist (Lambert, 2005; Wampold and Wampold, 2015), which include being
able to make a good alliance, being consistent, and having hopes and expecta-
tions of improvement, as well as good skills. Relationship factors such as the kind
of therapist and the kind of patient often have a bigger effect on the outcome of
treatment although of course a good therapist nonetheless still needs to use an
effective treatment (Laska et al., 2014).
This should all make sense in terms of the main themes of this book. The
psychological attitude and skills of parents and how they interact with children,
makes a big difference, just as do the attitudes and capacities of professionals
such as therapists, teachers, or social workers.
As stated, inter ventions can take place at different levels and have different
effects depending on a multitude of factors such as where one inter venes (e.g.,
child, family, school system), its timing, individual factors in a child, the skill of
the therapist, the quality of the inter vention, and many others. For example the
child of a depressed mother might get better as a result of a mother’s support
group or parenting programme, or therapeutic work which could be with the
mother, the couple, the whole family or the child, or as a result of a community
inter vention. Not only can psychotherapy help a mother’s depression, but more
importantly, children of the mothers who are treated for depression improve
more than children of non- treated mothers (Wickramaratne et  al., 2011); thus,
ameliorating a mother’s depression aids her children, even when the children
themselves are not treated directly. Children’s lives can also be changed dra-
matically via changes in contextual factors such as poverty or socioeconomic
status and social care programmes. Thankfully there are many inter ventions and
many levels of inter vention that can alter worr ying trajectories and give us hope
that better lives are possible, as long as there is commitment to this goal and
investment in it.
We have learnt a huge amount about child development research in recent years.
Although I have tried to avoid personal judgements and views, it is hard to deny
that far too many children suffer through having less than optimal emotional
Conclusions

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experiences. It is also hard not to worr y about the worsening mental health
issues in countries such as the UK and America in recent years.
It would be naïve to think that this can be understood solely from a psy-
chological perspective. Evidence from numerous sources has been mounting
that mental health outcomes differ widely across the Western world, and indeed
across the whole world, and in great measure these differences reflect the way
societies are organised. A consistent theme is that the wider the income gaps in
a society, the worse the mental health for those at both the top and particularly
at the bottom of the ladder. Epidemiological studies of large international sam-
ples (Wilkinson and Pickett, 2009; Barlow et al., 2014) have found that the more
unequal and individualistic cultures are, on average people’s physical and men-
tal health outcomes are worse, and the overall prognosis deteriorates. It seems
that the higher the inequality levels in a society then the lower the are general
levels of trust (Uslaner, 2008), and the weaker is community life (Putnam, 2000).
Indeed with greater disparity, wealthier people seem to become less caring of the
needier (Nishi et al., 2015; Piff et al., 2010). Social support systems do not work
so well in such cultures, and for that reason communities can become more vio-
lent, families are less likely to stay together, and outcomes across the board can
worsen. Many have argued that an increasingly consumerist culture is fuelling
these changes (Gerhardt, 2010; Music, 2014b), and we have also seen that people
who are more materialistic have worse mental health (Kasser, 2003).
Thus it would be naïve to think that only psychological help is going to
improve children’s mental health. International epidemiological evidence sug-
gests that the cause largely lies with larger, wider factors. Tackling psychologi-
cal problems directly is important, but so is tackling social problems and both
are needed. One study looked at maternal depression and economic deprivation,
and their combined and separate effects on children’s outcomes (Kiernan and
Huerta, 2008). It found that when both were present then children’s cognitive
and emotional development suffered, but it was not just either poverty or par-
enting that had the effect. While poverty had a big impact, parenting factors in
their own right also made a big difference to the children’s lives. Again, one can
inter vene at several levels in the system.
One of the exciting things about current research findings is that we can
make links between individual children’s experiences and more macro whole
population findings. On a micro- level we know a lot about how children experi-
ence the world. We have seen the kinds of defences children build in response
to stressful and painful situations, such as turning in on themselves and self-
soothing in the absence of adult care. We can now understand how unsafe some
children’s worlds can feel, via research with their stor y- stems as well as directly
from therapeutic work. We know for example from fMRI scans how fear affects
the brain, giving rise to a more active amygdala, and how stressed children have
higher baseline cortisol levels. We similarly have learnt a lot about how different
family atmospheres and parenting styles affect children, as well as the effects
of different kinds of neighbourhoods, different cultural beliefs, and the various
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We are also better at interpreting our findings. It has been all too easy
to confuse factors that indicate risk, such as what used to be termed ‘broken
homes’, and the factors that really cause the risk, which might be more to do with
the discord in the home, or community violence or poverty rather than the mere
fact of parents splitting up. We have learnt to take into account both immediate
influences that can affect children, such as parental depression, and also what are
called more distal causes, such as poverty and inequality, which make parenting
much harder and increase the likelihood of parental mental illness. Awareness
of social and cultural factors can also help to take the ‘blame’ out of the research,
particularly the blame of mothers. Parents affect their children, but often for
reasons well beyond their control, such as violent neighbourhoods or abusive
partners. Similarly the direction of influence between parents and children is
also by no means only one way, and children affect parents too. The relationship
between immediate and more distal effects still needs to be understood much
more. There is also still a lot to discover about the relationship between genes
and environment and epigenetic effects.
Interestingly the best predictor of childhood resilience in Werner and
Smith’s (1992) classic study was how ‘loveable’ a child was at two years old. This
striking statement is typical of those that need a great deal of unpacking. ‘Love-
ability’ may be something to do with a temperament a child was born with, or
alternatively how much a child has been loved and enjoyed until then, or how
mind- minded the parents were, which in turn will be influenced by more distal
social factors. This finding does though take us back to the fact that all such
research, whether micro or macro, concerns children’s experiences and feelings,
such as of being loved and cared for.
No human being can be reduced to the sum of the influences on them,
even if such a comprehensive analysis was feasible. While this book has aimed
to understand general principles, and wider external factors, ultimately it is
tr ying to describe real lived lives, and people who think, feel, respond, adapt
and experience the world in multiple ways. Each child’s developmental trajec-
tor y can only be made sense of via understanding not just behaviours, but
also the biological, psychological, and emotional states of a person, and how
a whole being interacts with and responds to their environment. On an indi-
vidual level this means being aware of each person as an active agent. The indi-
vidual enters any new moment constrained by their current external situation
and also by their histor y and prior expectations, their own set of emotional and
biological capacities. Yet the next moment is always open to possibility, and
although people have patterns in place, such patterns can be either confirmed
or challenged by new experiences, new contexts and new oppor tunities. Viktor
Frankl was famously quoted as saying ‘Between stimulus and response there
is a space. In that space is our power to choose our response. In our response
lies our growth and our freedom’, and in children’s lives it is adult choices that
can lead to a child’s freedom and growth.
The last few decades have been an extraordinarily exciting time for under-
standing how children develop. The next few decades promise to be equally

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revolutionar y, and many clinicians and researchers await new findings with
eager anticipation. What we can be absolutely sure of, and what the research
has clearly shown, is that while temperament and genes play a role, the kind of
parenting one receives and the kind of influences one has as a child has a huge
effect, even if some children are more influence- able than others. This research
can be a springboard for arguing that the kind of society we produce, and the
kind of support and help we put in place for children and families, will make a big
difference to future generations.

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Glossary
Adult Attachment Interview (AAI): A measure of an adult’s attach-
ment style using analysis of their narratives about their
childhood
Af fectional bonds: An emotional bond that forms over time, such as
between a mother or other caregiver and a child
Af ferent: Describes ner ves that go towards, e.g. fibres that commu-
nicate from gut to brain rather than vice- versa
Allele: A variant of a form of gene, often humans having two variants
of a particular gene
Alloparent: A caregiver who is not the biological parent (allo mean-
ing alternative)
Ambivalent attachment: A form of attachment associated with
more clingy behaviours, generally linked to more inconsistent
parenting styles
Amygdala: Almond shaped brain areas in left and right hemispheres
central to emotionality and emotional memor y
Androgen: Male sex hormones
Attachment disorder: see Reactive Attachment Disorder
Attunement: being in tune with another’s emotional state
Avoidant attachment: An attachment style in which a child seems to
be little bothered if their caregiver is nearby or not, linked with
more ‘dismissive’ parenting styles
Borderline Personality Disorder: A psychiatric diagnosis describ-
ing people with unstable relationship patterns, lack of a well-
defined sense of self, and regular or constant changes in mood
Brain stem: Evolutionarily ancient part of the brain shared with all
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Callous- unemotional: Children who lack empathy and remorse and can appear
emotionally cold and act in a psychopathic way
Cerebellum: Plays a vital part in motor control and decision- making, sometimes
known as the ‘little brain’
Conditioning: In conditioning one learns to associate one stimulus (e.g. a bell
ringing) with another (e.g. salivating because food is coming)
Containment: a term from Bion describing how emotional experiences, such
as in an infant, are processed and made understandable by a mother or
therapist
Contingency: The expectation that one event or act is likely to cause or give rise
to another predictable one
Corpus callosum: A bundle of ner ve cells that link the left and right cerebral
hemispheres
Cortisol: The best known stress hormone, produced by the adrenal gland
Deactivating: An attachment strategy based on not seeking out attachment fig-
ures, closing off emotional needs, and dampening emotional feeling and
expression
Declarative memory: sometimes known as explicit memor y, a form of long- term
memor y of facts, such as dates
Default Mode Network (DMN): A set of brain regions that fire up only when
the brain is not involved in any intentional tasks, i.e. it turns off when the
Executive Attentional Network turns on
Defence: A way of protecting the self from the effects of experiences that other-
wise might produce huge anxiety or feel unbearable
Deferred imitation: The ability to imitate an action having witnessed it some
time previously
Developmental trauma: Early life cumulative trauma that has a long- term effect
on the personality, seen as a potential alternative diagnosis for maltreated
children and adults.
Disorganised Attachment: An attachment style in children who have had
frightening experiences with their primar y carers and either have
given up on developing a coherent strategy to respond, or who become
hyper vigilant
Dispositional Representations: A neural pathway that attributes meaning to a
situation based on past and current experiences, similar to internal work-
ing models or RIGS
Dissociation: A split in the mind so that some aspects of experience are ‘cut- off’
from; often seen in trauma
Dopamine: A neurotransmitter that is particularly involved in the reward sys-
tem and in positive affect
Duchenne smile: A smile of genuine happiness that uses both eye and mouth
muscles
EEA: The human environment of evolutionary adaptedness in which much
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Egocentric: A cultural belief that individualism and autonomy should be highly
valued. Also refers to Piaget’s theor y of a ver y early stage of thinking when
children cannot see another’s perspective.
Entrainment: The process whereby an infant synchronises their movements
and rhythms with a parent
Epigenetics: The study of how genetic traits are turned on and off by particular
experiences
Episodic memory: Stored personal experiences, often tied to specific people
or places
Epistemic trust: The trust which allows social and emotional learning, as seen
in secure attachment
Exectutive Attentional Network (EAN): Brain network involved in actively pay-
ing attention
Executive functioning: This describes a range of capacities such as being able
to analyse situations, plan activities, and maintain focus to get a task done
Experience dependent: Developments and changes, such as in the brain, that
depend on having particular experiences
Experience expectant: Experiences that a human might be born expecting, such
as some care from an adult or being spoken to
Explicit memory: Memories of facts, such as dates (see also declarative memory)
Externalising: Behaviours such as dramatic acting out, behaviour problems,
violence and conduct issues, seen more in boys than girls as a result of
adverse experiences, and contrasted with internalising disorders
Flashbulb memories: A memor y that is stored after an emotionally arousing
event (e.g. what one was doing when hearing of a famous person’s death)
Genome: The genetic material of an organism e.g. the genes that make up a
human being
Genotype: An individual’s collection of genes and how they are expressed
Glia: Brain cells that have been discovered to be much more important than
previously thought, and are more numerous than neurons
Habituation: How a new, exciting or worr ying stimulus is got used to
Hippocampus: Brain region central to memor y
HPA axis: Regulates the body’s stress system via the hypothalamus, pituitar y
and adrenal glands
Hyperactivated: In attachment theor y, showing ver y vigilant, unsettled and
jumpy behaviours and states of mind
Hypothalamus: Brain area responsible for the production of many hormones in
the body
Infant- directed speech (IDS): see Motherese
Infantile amnesia: Denoting that humans retain no or few declarative memories
from the period of infancy
Internalising: A response to adverse circumstances via presentations which are
turned inwards, such as in depression, self- harm or eating disorders. Seen
more in girls than boys, and generally contrasted with externalising disorders

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Internal working model: A mental model, based on previous experiences, which
allows someone to predict what is likely to happen in relationships
Interoception: The sense of one’s own bodily sensations and states
Intersubjective/ Intersubjectivity: The sharing of subjective states between two
or more people
Joint attention: Sharing one’s experience of an event or object with another per-
son through gestures or pointing
Limbic system: A set of brain networks best known as being central to
emotional life.
Marking: An exaggerated demonstration of attunement with another’s state of
mind or feelings
Medial orbitofrontal cortex: Brain area in the frontal lobes central to
decision- making
Mentalization: The ability to reflect on one’s own and another’s experience
Methylation (and demethylation): A process whereby the expression of genes
is regulated
Mindfulness: An ability to be aware of one’s mental processes, often cultivated
via meditative exercises
Mind- Mindedness: A mother’s capacity to be in touch with her infant’s psycho-
logical and mental states, and to refer to these
Mirroring: Reflecting back to someone their mental or emotional state
Mirror neurons: Neurons found in humans and other animals which fire both
when an animal acts and also when it obser ves that action in another
Motherese: A way of talking most adults across the world adopt with babies,
often called parentese, or Infant Directed Speech (IDS)
Myelination: An white insulating sheath around ner ve cells that allows much
faster communication
Neuroception: The ner vous system’s picking up signals from the external envi-
ronment, such as if a situation is safe or not.
Neuron: A basic cell in the brain which sends messages to other neurons via
axons and dendritic connections
Neurotransmitter: A chemical that transmits messages between ner ve cells
Neurotypical: Presenting as typical rather than atypical, often used to contrast
with autistic spectrum
Oxytocin: A hormone centrally involved in good feelings between people, seen
particularly in pair- bonding species
Parasympathetic nervous system: Involved in slowing down heart rate and reduc-
ing blood pressure, particularly in response to trauma
Peer review: Scholarship that is accepted for publication after being anony-
mously reviewed by professionals in the field
Phenotype: The obser ved characteristics of an organism, how they turn out, as
opposed to their genotype
Pheromones: A scent chemical used for communication, with a role in attracting
those of the opposite sex

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Post- traumatic growth: When people becoming stronger and develop in the
aftermath of trauma, sometimes called transformational growth
Priming: A disposition to act in a certain way due to prior exposure to specific
stimuli
Procedural memory: The most basic form of memor y, learning ‘how to’ do
something, like riding a bike
Projection: Seeing in another person what really belongs to oneself (e.g attribut-
ing anger to one’s partner when one is really angr y oneself)
Prolactin: A hormone which stimulates milk production after birth, and is also
involved in protective feelings of children
Proto- conversations: The earliest, preverbal, forms of communication between
an infant and its carer
Proto- declarative pointing: Pointing which aims to draw someone’s attention to
an object, particularly to share interest in it
Proto- imperative pointing: Pointing at something because one wants it
PTSD (Post Traumatic Stress Disorder): Psychiatric diagnosis for people who,
following traumatic experiences, suffer a range of symptoms such as night-
mares, flashbacks, high anxiety and other emotional distress
Qualitative research: Research based on non- numerical data, often relying on
interpreting the ideas or thoughts of those being researched
Quantitative research: Research based on statistical or numerical forms, often
presented through graphs and using maths
Reactive Attachment Disorder (RAD): A psychiatric classification denoting the
effects of severe early neglect leading to a compromised capacity to form
attachment bonds with caregivers
Reflective self- functioning: The capacity to reflect on one’s own thoughts and feelings
Resilience: The ability to be little affected by adverse circumstances, or to come
through them relatively unscathed
RIGS: Representations of interactions that are generalised into expectations of
how relationships are likely to go
Scaf folding: Bruner’s idea of facilitating learning by building carefully on earlier
learning, and revisiting previous learning to consolidate
Secondary intersubjectivity: A stage, at about nine months, when an infant can
share perception of another object, as seen in social referencing, joint atten-
tion and protodeclarative pointing
Second- skin defence: A psychoanalytic term denoting an infant defending against
anxiety by ‘holding themselves together’, such as via muscular movement
or clutching an object
Serotonin: A neurotransmitter particularly involved in positive feelings
Social capital: A metaphor taken from economics denoting how someone
accrues social capacities and advantages which aid functioning in a range
of contexts
Social referencing: The use of non- verbal cues to check another person’s
approval or not

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Sociocentric: A culture which values having strong prosocial values and putting
the needs of one’s social group before the individual
Strange Situation Test: An attachment procedure testing the reaction of an
infant of about a year to separations from a caregiver
Stress: A physiological and psychological response to changing circumstances,
one often associated with anxiety and the release of the stress hormone,
cortisol
Symbolism: Representing something else by means of a symbol
Sympathetic nervous system: Responsible for arousal responses to danger, as
seen in increased heart rate, blood pressure and shallow breathing
Telomeres: Caps at the end of each strand of DNA that protects our chromo-
somes. Short telomeres are a sign of ill- health
Temperament: A disposition to react in a certain way, at least partly inherited
Testosterone: A hormone, seen more in men, that is linked to sexual desire
and also levels of aggression, as well as regulating other bodily functions
Thalamus: Central to sensor y perception and relaying information to brain
areas such as the cerebral cortex
Theory of Mind: The ability to understand and make inferences about someone
else’s mind, mental #state, and feelings, normally fully developed by about
four years old
Transgender: Those whose gender is the opposite of their assigned sex, or
those who do not fit the binar y male/ female categorisation
Transsexuals: Those who are changing or have changed from their assigned
gender, sometimes via surgical procedures
Vagal tone: An index of the health of the autonomic ner vous system, linked to
the vagus ner ve and measured by heart rate variability.
Vasopressin: A hormone that has a variety of functions, but has a role in loving
feelings, and increases following sex
Wet nurse: A woman paid to breastfeed another mother’s child
Zone of proximal development: A concept of Vygotsky describing how a child
able to manage one level of learning alone can be facilitated to the next level

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