MATERNAL
DEPRIVATION
By Kurt Glasere M.D., and Leon Eisenberg, M.D.
Departments of Psychiatry and Pediatrics, University of Maryland School of Medicine, and the
Children’s Psychiatric Service, Johns Hopkins Hospital, Baltimore, Maryland
ADDRESS: (KG.) 4108 Barrington Road, Baltimore
7,
Maryland.SPECIAL
ARTICLE
626
O
\‘EII time imast tW(i decades, aconsider-able literature has acctmmmiulated on the
commseqimeimces of maternal deprivatioim, much
(if it in jourmials not easily accessible to the
1)edhiatricialm. It timerefore seemed desirable to review certain of its more significant
as-I)ectS, assess its validity, aimcl stress its
im-portammce for aim adequate understanding of time developmmmentah irocss . Time pediatrician
is oftemi time persomm wimose advice is sotmgimt in
timmmes of fanmily disruption, prolonged
hos-I)itahiz1ti0im, or child Pl1cemmmdmmt. His is the
resl)Olmsii)ihitV for (letermining hospital
visit-immg practices. It is ime who PlaYs aim
impor-taut role in thiC (irgallizatiomm of immstitutions
for time care of orpimammed, imaimclicapped, or
neglected children. For these and otimer
ieasons, it is essential that time pediatriciaim
lie as fammmihiar witim time immfant’s mmcccl for
“)Scim0lgic alm(l immteri)ersonah iimtake as ime is with time mmcccl for imu.mtritiommal intake.
Time Imimniami immfant, for a Period immuch
mimore iroiommgec1 than in aims’ other species, is
totally de1)eIidelmt on adult care for lmis
survival. Scientific immvestigation has
clan-fled niammv of time nutritional and timermal
requirenmemmts of the Imewi)orn ; application of
timis knowledge i)\’ pediatricians has resulted
imm a reniarkable lessening of neonatal
mor-1)idlitV ln(l immortality.
It has l)Cen less readily a)paremmt,
how-(y(i. that amoimg time fummclammmentah needs of time iimfant are requirememits for gentle
phys-ical com#{236}tact,501111(15 of pleasant and varying
t(iiieS of time hmumamm voice, aimtigravity play,
visual stiimiimli from the hmummiami envirommment
amid time imiore subtle interpersommal
communi-cations-imm sunm, all of those activities
or-dinarilv supplied by a loving mother. It
nmav at first be startling to consider these
as biologic necessities” but time evidence to
i)e presented suggests that they are hardly
less essential than adequate vitamin and
caloric intake for the infant’s survival and, mmiost assuredly so, for normal growth and
development.
Recognition of the “emotiommal” aspects of maternal care has beemi delayed for many
reasons, two of which deserve brief
mcii-tion. There is a reluctance on time part of
many physicians to accept the fact that
l)iologic processes can be sigmmificantly
al-tered by psychologic influences which teimd
to be regarded as nebulous amid “nonma-terial.” However, if we recall that
psycho-logic events are synchronous with electric
events in time imenvous systemmi,
psycho-physiologic interrelations become
inesca-pable rather than merely speculative.
An-other factor that has delayed recognition is
that maternal care is an almost universal
constant of family organization in all
cul-tures. By being taken for granted, its truly remarkable character is obscured. Only in the absence of adequate maternal care does
its fundamental importance become
appar-ent through the sequelae stemming from its lack: the syndrome of maternal depriva-tion.
Time concept of nmatenmmal deprivation, like
nmost medical concepts, has evolved over a
period of years. Its meanimmgs have beemm
cx-teimded and deepened. As a result, it is often
employed to describe situatiomms that may
differ in significant respects amid the
imphica-lions valid in one case may be misread into
another. It is therefore important to begin by clarifyimmg its usage amid time degree to
which the effects of deprivation ane
SPECIAL ARTICLE 627
Time effects of nmatermmal deprivation s’ere first recogmmized imm children removed from
(
or abammclommecl by) their niothers and placed imm institutioims for long perio(1s. Study oftimese cimildren revealed that time majority
failed to thrive amid exhibited retardation jim
social amid intellectual development, despite
mimaimmtemmance of )hysical hygiene and the
l)rovisiolm of nourishing foods. Something moore timamm imiechiammicahly acleqtmate care was
al)I)arently necessary for optimal growth
and devehopmeimt. Time immain emmvironmmmental
variable distimmguishing this group from
other cimilclremm vas time absence of the
inti-niate aimd hovimmg care ordimmanily supplied
within the normal fammiilv ummit, chiefly by time
mmmotimer. Heimce time pathologic features of
the institutionalized child were ascribed to
nmatermmah dieI)nivatiOmi.
W7itiioiit attempting aim exhaustive
cata-hogue of the niotimer’s role above and beyond
physical care, it camm be said timat: (1) sue
trammsmits to time child emotiommal warmthm
ammcl cultivates witimimm him respoimsiveimess
amid attacimmemmt to other hmunman beings, amid
(2) sime provides aim emmclless source, varying
with lien own adequacy, of stimulation for
immtehlectual growtim. This latter functiomm vihl,
of course, be enimanced to the degree timat
the
child is motivated by imis love for imer to master the iimtellectual accomphisimmentstimat slme finds pleasing and hence rewards
withm furtimer bestowal of affectiomm. Time
immsti-tutiommalized child, limited to a bare
mini-iimum of contacts witli adults-adults who
change iii inevitable shmifts-wihl have little
expenieiicc of intimate warmtim.
Concomi-tantly, he will have little stimiilatiomm
through PlaY amid direct teaching for time
acquisitiomm of knowledge; wimat lie does
learn, except iim so fan as it makes iminm less
of a “imuisance” on time ward, will not bring
time delighted response of proud parents.
Thus, what most investigators describe in
time psychiatric literature as maternal
dep-nivatiomm comprises a deficiency both in
enmotiommal imoimnisimmemmt and imm intellectual
stinmulation as well as time results of
interac-tiomm i)etweemm the two.
It is not, however, inevitable that both
aspects of care will be simmmltammeously
lack-immg. It is at least conceivable that a mother
who lacks genuine feeling for her cimild as
a ierson may 1)erceive imimmmas a potential
source of reflected glory for imerseif by virtue
of his intellectual attainments, which sue
may then assiduously cultivate. Timene will,
of course, in such a process lie emotional
immterchange but of a type so distorted as
to bear little resemblance to time mmormal pat-tern . This predicated relationship appears
clinically in the “emotional refrigeration”
described in time early experience of autistic
h2 The autistic cimild, who may be
able to repeat in phenomenal fasimion
mmur-sery rimynmes, catechisms, historic dates,
as-trommomic clmarts, etc., reveals a singular
detachrnemmt from human society. Other
peo-pie do imot seem to exist for Imim except to
the degree to wimicim timey immterfere with his
self-impelled activity; even timemm lie reacts
to time part of the Person (time hand, time foot, or the torso) that stands iii his road without
even so much as a glance at time persomm who
is no longer of concern once he stops his
active impingement on time cimild. Whether or mmot this syndrome is solely the result of
paremmtal attitudes or wimetimer it requires, as
seems likely, a constitutiommal factor as vehl,
the evidence is strongly suggestive that the
child’s early expeniemmce of cletacimed,
per-fectionistic, amid cold pareimtal care is aim
immm-portant factor in determinimmg the course of imis personality development. Time syndrome
of early infantile autism is timen time
proto-type of maternal emotional deprivation
without intellectual deprivation.
Time obverse situatiomm, gratification of time immfant’s emotional mmeecls without ptrailel
stimulation for immtehlectual growth, seems
hardly conceivable. Emmiotional immtenchmammge
occurs through actions and words that serve
as models for time infant’s developing
be-havior. In the early years of life whemm the
effects of deprivation are most apparent,
even the somewhat memitahly retarded
nmotimer is so immuchi more advanced than her infamit timat she can meet his rudimentary
628 GLASER - MATERNAL DEPRIVATION
his further growth, which is, however,
ordinarily stimulated by outside contacts.
One ftmrther altermmative may be con-sidered. Camm emotional
(
and intellectual) notirishmemmt be supplied without the intenserelationshmil) between nmothmer amid child that
is so consistemit a pattermm iii most cultures? Timere is at least a suggestion that this may lie possible. “Group motimening” in the
com-imitmnal collectives imm Israel appears to be
a(lequate for the development of
adoles-cemmts amid acltmlts who function effectively vitimimm time collective life of this specialized
ty)e of coimmmtmnity.
1mm sunimarv, matenimal dleI)nivatiomm is a
termmm eniploveci to describe the lack of
affectiommate immothmening care in time presence
(if “adequate” )imysicai care, usually, thougim
imot mmecessanihv, thmnough time prolonged
ab-semmce of time immotimer. Its effects iii time most
commmmmmommly emmcoummtered chimmical situations
are time result of time lack of both emotional
and iimteiiectual stimulation .
The
psychiatric
symmclrommmes resulting from pathologic
devia-tiomis in time ty)e of matenmmal relationship, so
comprehmemmsively described by Levy,6 will
iiot be discussed in the remaining sections
(if this article. Non shall we consider lack of
adequate pimysical cane, wimicim is termed
imeglect amid whose seqtmelae immclucle both
timose stemnnming from matenmmal deprivation
and timose attributable to mmimtritional and
other deficiemmcies.
EFFECTS OF DEPRIVATION
It is useful, for utmrpses of discussiomm, to
separate
tue
effects of (lepnivation into 3categories: phmvsieal, imitehlectual, amid
emo-tional. Time 1)ne(lOiiliIiaimt svnml)tOfl15 amid their
iiitemisitv cart h)e expected to vary with time
age at sel)anatiOlm, time child’s experience
Prior to separation (i.e., time inteimsity and L(lequacy of his earlier relationships), the
length of the separation, the relationship
to adults during the period of separation, the age at whicim substitution or
replace-mmiemmtoccurs, if it occurs at all, the adequacy (If time sul)stitutiomm, amid finally, factors as
vet ummkmmowmm, such as time iimtrinsic
endow-nient of
the
child.
In a sense,
the very
categories
we employ,
following customary usage, do violence tothe process we are studying. It would be wrong to divide “intellectual” and
“emo-tional” into separate compartmemmts if we
allow ourselves to forget that they are inti-matehy interrelated aspects of psychologic
function. Nor can we regard “physical” and
“emotional” as isolated aspects of the
or-ganism. The very thesis we are advancing stems from a realization that emotional
dys-function brought about through
environ-mental agencies is reflected in metabolic derangements and that physical disorders
will be accompanied by emotional changes. The sole justification for the arbitrary di-vision is the fact that dominant symptoms
immeach sphere are most easily disctmssed as
a unit, though each is accompanied by
cimanges elsewhere in the child.
PHYSICAL EFFECTS OF DEPRIVATION
The
physical
manifestations
of
depriva-lion, its most immediate results, are
cmi-cally the most apparent and most easily
demonstrable in the young infant.
Bakwin7
mentioned
listlessness,
lack
of
response to stimuli, hack of appetite, fail-nrc to gain weight, emaciation,pallor,
and proneness to febrile episodes as theprin-cipal
signs and symptoms found in children exposed to the emotionally sterileenviron-ment of institutions. He regarded a certain amount of maturity and conscious cerebral functioning as necessary in order to produce
this syndrome; thus it is not seen immyoung premature infants, in the newborn for the first 2 weeks and in the severely retarded
child. Sucim infants show satisfactory pimys-ical progress even in aim emotionally
de-pnived milieu. Bakwin exemplified his state-ments by the description of a 4-month-old boy who, after rapid cure of a diarrhea,
showed the above symptoms and failed to
gain weight until discharged home to his
nmother; although no change in his diet
oc-curred, he immediately started to eat, gained weight, amid showed vocal ammd
smil-ing responses which had beemm absemmt (luring
SPECIAL ARTICLE 629
h)ecIm Immd(lC re)eatedlly h)y l)ediatrieiamms
eim-gaged in hospital w#{176}
Statements in nmuch earlier publications
simow that experienced pimvsicians have long
I)een aware of the infant’s need for
mother-ing care; yet time piammning of hospitals amid
immstittmtiomms had develO1)ed in the direction of ftmntimer isolating time child in order to protect him from the timneat of cross
infec-tion.
As early as 1913, Talbot reported the
ammmusimmg ammecdote of 01(1 Anna” whom he
fou mi(l always wammclening around children’s
war(Is in D#{252}sseldorf carrying a baby on her
hip. He was told that whenever medical
care failed to make a nmalnourished child
thmnive it was handed over to old Anna “who
mmever failed”!
Bremmmmemannbo observed that “nurses’
1)ets (attractive babies) developed better timan others and instituted time rule that
in-famits should be “picked up, carried around,
amrluse(l and ‘motimereci’ several times a
day.”
Time experiences at time Children’s Medical Service at Behlevue Hospital,7 even before
time era (if antibiotics, did not show an
in-crease of immfections as a result of increased
imammchiing (if cimildremm by time house staff and
mmmore hii)enal visiting by time mothers. A simmmilar observatiomm was made recently at
time Govermiment Hospital iii Tel Hashomer,
1‘here mothers were encouraged to
51)emidl as much time as they could with their children Ofl the ward. Timis experiment is particularly interesting because most
chil-clremm admitted to time wards were children of
imew imimmigrants whose knowledge of
immodermm concepts of hygiene and nutrition was practically nil. Nevertheless, the
accept-0 Ceber ami(1 i)ean recently reporte(l from
Ugammda’ tliit ab(iut half of time clmildren adniitteci
for time treatmnent of kwashiorkor were clmildren who
were reS)omidimig to acute maternal deprivation by failure of appetite. In the commimmiunity sttmdied, “the food is of smiclm a kind timat ommly a good appetite will provide (time child) with enough protein, and if (his) Imlpetit’ is impaired, kwashiorkor is all the
mmmorelikely.” Feeding problems in children abrtmptly
weaned or removed from their mother’s bed often
resulted iii time development of this dread disease.
aimce of sucim a new policy by doctors and
nurses has made the expenimemmt a success and the presence of the mothers has been
found to be a definite asset to the care of the children in the ward and mmot a hum-(malice, t5 might imave i)eemm exl)ected.*
Spitz’2’ i:i, compared the course of
cliii-dremm residing in a nursery of an institutiomm for delinquent mothers, wimere each mother
attended to her child and had few (itimer respommsibilities, witlm a foummmdling imomne
where children were cared for by nurses.
Whereas there was no mortality iii time
mmun-sery, its rate was high in the foummdhing
home. The nutritional and hygienic stand-ards of both institutions were reported to be
equally high. The children in the foundling home presented a picture of depression:
disinterest in environment, weeping and screaming when approached, lack of appe-tite, loss of weight, and insomnia. They were susceptible to colds and eczema. The
syn-drome became most pronounced 3 to 4
months after separation from time motimen. If institutionalization continued beyond this
period, the children showed frozen rigidity,
wide-open
expressionless eyes, and frequent “autoerotic” activities. This symmdrommie could be reversed when a motherly person entered the child’s life. Spitz believes timat during timesecond half of the first year time cimild is most susceptible to damage, this beimmg the time when he acquires and progressively takes over “the executive, defensive, and
pereep-live functions” which until then had been entirely delegated to the mother.f
The deprivation syndrome with detni-mental physical effects can develop not only when the mother is absent but also in lien presence, and it can be preveimted imm lien absence if an adequate substitute takes imer place in all phases of infant care. Rejection
0 Time beneficial effects of immure liberal visiting
hours have recently hieen advocated by otimers.707
t Spitz’s work has recently beemm criticized on statistical grotmncls.7’ There is considerable doubt about his contention that there is a one to one relationship between given situations and particular
symptoms. However, his general observations
63() CLASER - MATERNAL DEPRIVATION
of time infammt his’ a mmmothl(’r vhmo continues to
take care of thi(’ pimysical Deeds of her
off-srnmg cami I)nd1ce time same syniptoms.
EngeP1 describes an immfaumt with a surgically
produced gastric fistula because of
esopha-geal atnesia, with nesuitimmg rejection omm the
I)art of time mmmotimen who was afraid of the mnammagement of time child. Upon admission
to time hospital in aim apathetic and marantic
conditiomi time child, despite hmighm caloric
immtake by ttmi)e feedimmgs, simowed at first no
improvemimemit of nmanasmmmus on apathy. He
\vas ummresl)oiisive to his emmvinommment until
he formed a close relatiommship to omme of the
imunses and omme of time doctors who, in order
to study gastric secretion, had to spend
con-si(lerabie time with him. \Vithin a short
timime he started to smile in response to the
approach of 1 of time 2 persons and began to
gaimm in weigimt, amid this continued even on
a immuch reduced caloric immtake.
As noted by Spitz,15 eczema seenms to
occur witim great frequency among children
(lepnived of time love of timeir mothers. It has
i)eemm kmmowmm for some time that the skin
may readily express cimamiges in psycimologic
tensiomm. Neuroclenmatitis, which is widely
accepted as a sonmatic expression of
emo-tiommal stress in time adult and in older
cliii-cinen, shows fluctuations in its course
paral-helimmg those of time emmmotiommah life of time
pa-tient.’’ Eczema iii time immfammt follows a
similar P1tten1m.
\Voodimeacl,18 in a study of 26 cases,
pin-pointed psvchologic problems of parents
wimichm ummden certain circumstances affect a
chiid vith commstitumtiommal predisposition to
allergy alm(l cause thme ups ammd clowmms in the
course of time ilhimess. Time case of a
5-mommth-old cimilci with immfaimtile eczemmma
demon-strated timis point. His condition was
aggra-vated wimemm his immature and dependent
nmother’s security was threatened by father’s
leavimmg for the Navy ammd whemi
grand-nmothen, Whm() l5SiSte(l time immotimen iii time care
of the l)aby, stiffened an accidemit.
\Viihiams’’ studlie(1 53 eczematous
chil-cinen ammcl foumicl maternal rejection a
pre-dominant feature in almost all. Treatment in
33 was directed toward time goal of
improv-ing time mother-child relationship; in 20
c(imitnol cases therapy \‘as (lirectedi toward
eimimmatiomm of the ailergemm and topical
ap-Phicatiomm was used. The results imm the psy-chothenapeutically treated group were
con-sidenably superior to those in time control
group.
Rosenthal,2#{176} in a study of 25 children with eczema, found many more rejecting mothers
than imma group of nmothers of non-eczema-tons children of the same age. These mothers
usually had adopted an attitude of “let
thenm cry it out” ammd did a minimmmum amount
of cuddling and caressing.
Physical damage such as described above
can lead through manasmus ammd
suscepti-bihity to infections to high mortality nates in
institutions where children are kept under
deprived conditions. Bakwin and others2’ reported on the high montality rates (up to
100 per cent in children below 2 years of
age) in this country in the first two decades
of this century and the rapid decline after the policy was adopted of placing children
in the cane of foster parents as soon as feasi-ble. Altimough progress in our knowledge of infant nutnitiomm and the advent of antibiotics have greatly influenced infant mortality
dur-immg the last years, these factors alone cannot
be held responsible for such dramatic changes reported by earlier writers.
Nutni-tion and hygienic conditions may be
ad-versely influenced when a child is
trans-ferned from a good institution to private
cane.
Therefore it seems likely that the recogni-tion of the importance of emotional factors,
intuitive though it may imave been, and a
gradual change in the policy of institutions
as a result of this recognition, have
influ-enced the reduction of mortality. Such
changes as the supply of toys, the provision
of play areas, the permission of intenaction
between children, the liberalization of
visit-ing regulations and the change of emphasis
from mere physical care supplied by the
numnsing personnel to a more relaxed attempt
of giving the cimild loving attention, the
participation of volunteers in the care of the
patients, all have contributed in varying degrees to meeting the emotional needs of
SPECIAL ARTICLE 631
it is of interest in this conmiectiomi to miote
that Seitz,!2 w’hmo raised mmmatchmed groups of
rats imm large and small litters, found that
those raised iii small litters (and thus
pre-sumably given more maternal care) attained
higher weights amid exhibited lommg-term
be-imavioral effects of this early experience. The
weight gain was not attributable to mere
availability of nipples on the mother rat
because food was supplied artificially.
In stmmmmmanizing the pimysical effects of
enmotiommal dIeI)rivatioim upoli infants we can
state: They occur in early infancy; they can
occur imm the presence or absence of the
biologic motimer when time child does not get
the proper emotional care, and they can
often be relieved rapidly if a loving person
to supply his emotional needs is introduced
immto time child’s life.
INTELLECTUAL EFFECTS
Children reared in institutions with a
minimmmum of opportunity for contact with
adults, whether by virtue of a how personnel
ratio on as a consequence of specific design to minimize cross infection, reveal consistent
(Ieficits omm tests of intelligence. Studying
dc-pnived cimilclnemm in Germany, France, an(1
Aimmenica respectively, Durfee and Wolf,23
Roudimmesco amid Appell24 and Spitz and
\Volf’5 reached striking agreement in
find-ing marked lag iii developmental quotients
(D.Q.), with a definite trend toward greater impairment the longer the period of institu-tiommahization. From a rigorous viewpoint,
time comparability and adequacy of the
con-troi series in these studies is open to ques-tion; “natural” field experiments rarely
afford time precision of design possible in
plammmmecl studies. One is, however, impressed
by time commsistemmcy of time findings between
these ammd other reports summarized by
wy Goldfarb,26 wimose investigations
have been the most carefully controlled,
foummid a 28-point difference in intelligence
quotients (I.Q.) in contrasting 3-year-old
foster-imome reared with institutionally reared children (Stanford Binet
(
L), Cattell,
I\iernihl Palmer). Even more impressive is
imis finding that, at time age of 10 to 14 (7 to
1 1 years after menioval frommm imistitutionah
cane), there was a statistically sigimificaimt
I.Q.
difference
of 23 points
(95
vs.
72)be-tween 2 groups of children whose
emmviron-ment had differed in only this one major respect: time first hmad been neared iii foster homes from simortly after bintlm, whereas time
second remained in aim institutiomm for the
first three years of life and then were placed in comparable foster lmommmes.27
But time qumestiomm mmmay be asked: Are time
differences in
D.Q.
amid l.Q.
scores
inclica-tive of Iermammemmt degradation of
immtellec-tual ability on do timey mmmenely reflect time
reversible resumits of lack of training?
In-tehligemmce tests measure I)nesent
1)erfOnm-ance on the basis of whelm timey pumrpont to
predict future functioning ability; that is, they are attempts to measure the possibility
of new learning. If we conclude that, as a result of deprivation, time cimild is mentally
retarded and not merely edumcatiommaily ne-tanded, we are statimmg that lmis ability to meet and master new situations has beemm irreparably damaged. (Time possibility of
“innate” retardation in this group of diii-dren has been excluded by comparing them
with control groups wimo, stemming fromn
similar family backgrounds, achieved scones
iii the normal range after imome on foster
home nearing.)
The need for caution iii drawing
con-clusions as to imitehlectual ability from
avail-able “intelligence tests” is immdicatecl by time
University of Chicago studies)’8 Tests such
as the Binet, standardized on urban middle
class children, penalize rural and lower-class
children because the tests are loaded witim
culturally derived items less common to the
experience of the latter groups. “Cumltuire free” tests which attempt to minimize, though they can mmever eimimmate, stmcim
load-ing,
result in a narrowing of the I.Q. spread between children of differemmt socialclass-29 Time most widely used tests of
632 C IASER - M ATERNAL DEPRIVATION
tails to (iistimmguisil clearly betweemm
igno-rance 1ui(l immcal)acity, two factors differing
markedly in their implications for time
“in-tehhigence” we are attempting to assess.
However, time possibility of simple lack of
fammmilianity vitim test pr01)iems as aim
cx-Plammttiomm for the poorer scores of imistitu-tiommahizeci chmilclnemm would appear to have
i)eemi excluded in time Goldlfanb study
al-ready cited. Sommme 10 years after the
insti-tuitioiial exl)enielice, years dunimmg wimich a
cuiti mnal exl)eniemice cOmmil)aral)he to that
pro-Vidle(1 time comitnol group was provided these
children, a statistically sigmmificammt deficit in
nmeasunecl I.Q. was still present.
Wimether time intellectumal loss of the
dc-1)rived chlldl can be repaired by cultural
ennicimmemmt at a later period is very much
imm question. Skeels and Dye3#{176}felt they had
demonstrated a mim(ist nemmmarkabie
immmprove-merit iii the I.Q. of retar(iedl cimildlren who were given more imomnehike cane. Aim attempt
to (luplicate thmese results in a secondl expeni-mmmemmt”was ummsuccessful; consequently some
have questioned time validity of the original
study.32 This issume, imowever, is still very
mumcim iii controversy.33’ 3#{149}mIt may be that
there is a critical Period! for the growing
cimildi dumning wimich appropriate
eimvinOnmen-tal reimmfoncemmmeimt must be provided if
dIe-vehopmnent is to l)noceel imormahly. If this
stimuhatiomm is mm(it provided, 1)ermn1mment
(leficit may be time result. Time analogy to
embryologic development suggests itself:
if time embryonic “ongammizen” is not available
tt time proper stage, differentiation in the
PP#{128}’clinectiomm fails to occur and cannot be induced at a later period.
Timere vouid tppear to be little doubt
that envirommmmmemmtal O))ontummity plays a
tre-mnendoums role iii cleternmimmuimg the realization of possibilities latent iii time child. Skodak,35
for example, foummmcl that time I.Q. of foster
cimilcinen bone less relationship to the I.Q. (if time biologic motimer than it did to the
occupatiomm of time foster father (taken as a
crude index of time cumltumnal level of the
home).
The concept that development of
be-imavior is continuoumsly amid fundamentally
(Iepemmdemmt umpoim envinonmmmemmtal
reimmfonce-ment is clearly supported by data available
from animal and human studies. The ability to organize and interpret the very sensory
impressions upon which higher functions
are based depeimds upon the opportunity for
use. Careful clinical investigatiomm of blind
adults who by operative intervention were
enabled to see for the first time revealed the
painful and labonioums process by which the
ability to make visual discriminations is
achieved.3 Simmmilanly, chimpanzees neared
in time clank fronm birth required a long pe-nod of leanning after exposure to light
be-fore they could make use of vision.37’ 38 At
first, the sight of the banana which would
be avidly
eaten if it were touched or smelled produmced no response. If the period ofin-duced blindness was sufficiently long, net-inal degeneration could be observed by ophthalmoscopic examination. In the rabbit,
a sufficiently long period of total darkness
from birth resulted in the disappearance from the retina of a crucial nucleoprotein.39 The implication is that the sensory receptor
itself, at least in certain species, is
depend-ent upon stimumlation for the maintenance of
the capacity to function. Experiments, again
in the chimpanzee, revealed that an animal
neared with arm cuffs that prevent tactile stimulation was unable to integrate the sen-sation of touch when the cuffs were first removed and may show permanent impair-ment of tactile discnimination.’o
When we turn to the study of more com-plex behavior, the evidence is
overwhelm-ingly indicative of the crucial role of
experi-ence in the elaboration of adaptive behavior pattern. Even so-called instinctive behavioi
can be shown to depend on prior experience. The rat, reared in isolation and prevented from licking or touching itself, will fail to
exhibit the so-called maternal instinct which had been supposed to be an innately or-ganized pattern released by hormonal
changes.4’ Rats, reared in artificially isolated
cages with little opportunity for normal
cx-penience, exhibited a permanent deficit in
problem solving ability.42 Differential
SPECIAL ARTICLE 6:3:3
nat, this loss is produced by isolation in
voutim but not by a comparable period in
adulthood after a “normal youth.”4
Thomp-5Oii and Henommmm, i5 demonstrated in the dog
that nestnictiomm dumning the first 8 to 10
mouths of life produced immability to solve
commmpiex tasks, an inability that persisted
after later exposure to mmormnal laboratory
life. Time amiimals renmainecl overactive amid
“puppy-like,” suggesting “emmmotional”
im-painment as well. Thus, time experimental
eviclemmce (lenivedi from ammimal studies, much
mimore extemmsive tlmami space permits us to
review,’ seenms to warrammt the expectation
already derived from time clinical data that
dlepnivatiomm in chuldhoocl will have serious
cleietenioums effects upoim the imuman
organ-ismmm.
Time complexity of time imumTnan
develop-mnemmtal is so much greater than that
of time nearest primate timat one wouild
an-ticipate that eveim at later stages of growth
time effects of lack of stimulation would be
chiscermmihile. That this is imicleed the case is
demonstrated by the ingemmioums experiments
of Bextomm, Heron and Scott.47 Adumlt
vohmn-teens were deprived of visual, auditory, and
manual tactile stimulation for periods of up
to 3 days. During time period of enforced
stimumlus deprivation, hallucinatory
expeni-ences occtmrred in the experimental subjects
and a mneasurai)ie decrease in problem
solv-immg ability was mmotecl. Thus, even time human
adult requires continuous reinforcement by
emmvironmental stimumhi for the maintenance of normal functiomm.
There is aim adlditiomiai important
com-Pomment of time imiteihectual deficiency seen iii deprived cimildiren vhmicim has mmot thus far
beemi commsiclerecl, time factor of motivatiomm.
Time fneqtmemmtlv reported dhfferences in I.Q.
scores betweemm ethmmic and religious groups
reflect, ammmong otimen thimigs, the difference
iii time cultunal emphasis upon intellectumal leanmiing. Time cimildi, for vhmom himiguistic and
commceptuah accomphishmemmts are made a
mmmatter of Oi)ViOtms family pride and the
bestowal of special rewards, is stimumlated to
ursume these imitenests fumrthen. Time child \\rhosd. gaimis are mmeitimer specially noted nor
even observed by timose about imimmi,has ommhv
his own drive for mastery to spur imim on.
Since the deprived child temmds to be
emo-tionahly disturbed, this drive, requiring a
concept of one’s own self as a person, will fail to be sustained and time chmilcl will lapse
into a dull depressed inertia. He vihl fail to
profit even from that to vimich hme is exposed.
The ensuing scholastic failumne ne-enforces
the defeat and apathy, amid a
seif-perpetnat-ing cycle is created.
Timums, the evidence, chimmicai amid
expeni-mental, indicates clearly thmat time develop-ment of complex adaptive pattenns of
be-havior (intelligence) is continuously
depend-ent on interaction with time physical an(I social environment. Lack of cultural stimum-iation resumlts in a lowering of the functional
ability of the deprived ongammism. This
ap-pears to accoumnt for thme intellectual deficit
dIis)layedI by institutiommahizeci children. If
the period1 of institutiommahization is lommg
enough and occurs early enough in life, time deficit would appear to be permanent,
though, of course, sumbsequemmt cumltumral cmi-nichment would prevent further clegradatiomm
and enhance the development of remaining
abilities. Simmce time family unit (chiefly via
the mother) is time main transmitter (if
ctml-tunal influmences to the yoummmg child up to time
period of elementary sociaiization,’ intellec-tual impairment may I)e regarded as one of time consequences of maternal deprivation.
INFLUENCE OF DEPRIVATION UPON
EMOTIONAL DEVELOPMENT
Emmiotiommal dlepnivation cami occur iii time
verY yoummg in time presemmce of goodl physical
cane; imi fact, it would seemn frommm time stumclies
of Durfee and \Volf, published imm 1933,
almmmost as if good sterile physical care may
imave a positive relationship to poor, equally
sterile emotional cane. In a study of 4 types of infants’ care in institutions by a) trained mmumrses, b) trained nurses and mothers, c)
mothers alone, d) mothers who took care of
other children in addition to their own, they
foumnd that the best resumits were obtained
nuder the care of trained mmumrses amid
6:34 ChASER - MATERNAL DEPRIVATION
that uimmder time cane of trained mmunses alomme
(a) time chmildnemm were provided with a
phy-sicailv cleamm amid sterile environment but
also aim itmmy’ sterile emotional milieum. 0mm
the other imammcl, wimemm few motimers took care
of many children, time physical imygiene stiffened considlerai)hy amid time emotional
needs of time cimilclneim (otimen thamm maybe
their own chmihd) were proh)abiy also imot met.
l)amimage nesumltimmg frommm )hiysiCah care
was probably also greater when mnothers
took cane only of timeir owmm cimildiren, as
coimipared to time combination of both nurses
amid mothers which evidlemmtiy provided the
best nmihieu.
Social workers have frequently observed
time iiap)Y and wholesome milieu in some foster hi(immies where economic and hygienic
commclitiomms are anything but good bumt where
time mother has real hove for children and is
capable of giving affection to the children,
even at the expense of hmousevonk.
A similar observation was made by
Lewis4” vimo, imm stumdviimg children referred
fronm time Court, foundi a surprising number
of Ii(irlmmal children stemming from homes
which were dirty afldl vhmere the mother was
mmeglectfuml immmaterial timings or dumhl
intellec-tumailv. A considerable percentage of
cliii-dreim separated from timeir mothers before
the age of 5 were found to be disturbed.
The type ammd extemmt of effects upon the emmiotiommal development of the child depend on a number of factors, sumch as a) the age
at wimicim separation occurs, b) the duration,
c) thme quality of substitute mothering or the
partial presemmee of the motimen during
sep-anatiomm (totality of sepanatiomm), and d) the
Pre- and post-separation expeniemmce of the cimild.
Boviby,25 considenimmg mainly
charactero-logic devehopmemmt, concentrated his studies
oil chiil(lnelm above 1 year amid stated that a
certaimm maturation is imecessary before such
dammiage clue to separation can occur.
Spitz1” #{176}‘5’ hmowever, found evidence of
marked disturbance iii the youmnger child
(
first amid secommd year of life). These changes are characterized by lmis ignoring timeen-virommnmeumt and resisting time approach of
persons by weeping and screaming; the
child progressively withdraws from contact with his environment and finally falls into a
frozen rigidity with wide-open
expression-less eyes and immobile facies. He engages in
“autoerotic” activities. The concurring phys-ical and intellectual changes-anorexia, loss of weight, marasmus, susceptibility to
infec-tions and eczematous lesions as well as
men-tal amid physical retardatiomm in development
-have already been mentioned.
These “emotional changes” imm the infamit
are closely linked to the intellectual and
physical changes and can hardly be studied
separately. That the damage is “emotional” and not only the consequence of physical
breakdown and suffering has been
demon-strated by Engel’s case where recovery from
the marantic condition of the child did not oceumr until the emotional factors had been improved by the child forming an
attach-ment to a member of the hospital staff. Disturbances in the emotional develop-ment of children probably occur dumning
in-fancy as well as
at a
later age, but the typeof damage and its intensity varies. In
in-fancy physiologic derangement is
predomi-nant, perhaps only because we are at
pres-ent not in a position adequately to measure emotional factors as such in infants, al-though Spitz coined the phrase “anachitic depression” for the observed symptom
corn-plex, emphasizing the emotional etiology of the symptoms which are somatic in cx-pression. The reason for the different nature
of the reactions to maternal separation may have its cause in the various maturation rates of cerebral functions. Whereas during the first year the executive and perceptive
functions (the “ego”) develop and the child
takes these functions gradually over from
his mother, the conscience (“superego”), based on the child’s desire fon approval by
those whom he loves, develops during time following years. It is not surprising that different functions are disturbed if trauma occurs at different periods of deveiopment, much as intrauterine fetal damage will
SPECIAL ARTICLE 635
Emotiommal deprivation may also occur in
a home wimene time mother, aithoumgh
phys-icahly l)resemlt, is substitumted hYs t sequence of ever changummg maids, mmumnsemaids, and
governesses. Such a child may have
diffi-cumity in forming a permanemmt attachmment to omme of time maids, partly because of the
relative shmortmiess of contact and partly
be-cause of the frequmemmtly encoummteredl
“cx-l)eniemiced, professional, im’npersoimai, effi-cient” attitumcle of time nursemaid vimo is
commcenmmecl omily with the cleanliness of
clothes and body amid the good behavior of
time children, but is neither capable nor
wihhimmg to offer love to the child. In the case
of thme vorking mother of the lower
eco-nomnie classes, substitution anrangememmts are fnequentiv more permanent with neighbors
amid time mother very often gives her whole
attentiomm to time cimild after returning home
vhmemm time family is reunited.
Goiclfanb’2’ used the Rorsehach Test to
study a group of children who imad been
neanedl imm institutions and compared the
re-suIts with those obtained from a study of a
group of chihdnemm neared in foster homes and
ammotimer gnoump of scimizopimnenic children. He
found that the children reared in institutions
are deficient in ratiommal control and in
ab-stract timinkimig. They lack a drive for
intel-lectumal and social attainment. They are
emotionally imnmatumre and of a lower
intelli-gence. Some of the personality trends
stnommgiv resemble those in the schizophrenic
group. In another study, thme same author
conmpaned time success of foster placement
1mmchildren who had spent their first 3 years
of life iii an institution as contrasted with a
grOul) who imad beeim reared in foster homes.
He found that, in a group of 40 children with continuous foster home experience,
only 1 had to be replaced because his
beimavior could not be tolerated by the
fos-ten parents. In time group of 40 children,
I)lacedl in institutions as infants, replace-ment because of unacceptable behavior was
necessary in 12 cases and 7 had to he
re-placed at least twice.
Lowney,54 in a study of 28 children who
spemmt their first 3 years in institutions, found
the followimmg characteristics : aso cial
be-havior; hostile aggression; lack of pattern for giving and receiving affectiomi; inability
to understand and accept iimitatiomms; inse-curity in adapting to environment. In a few
children who had their first institutional cx-penience after the age of 2 timese personality
trends apparently did not develop.
Time superego
(
conscience) begins to dc-vehol) at the end of time first year andthmere-after, amid its disturbammces were sttmciiecl and
described by Bowlhy.25 He stated that time
child’s “following response” starts during
the first 6 months and is strong for 2 to S
years; his relationship to others develops
out of this pattern. If separation occurs
be-fore the development of time following
ne-sl)onse, time child fails to develop physically amid intellectually; if separation occurs
chin-ing this later critical period, the child will
be apt to develop: a) a psychopathic person-ahity (inability to achieve continuous,
co-operative nelationsimip to other persons), or
b) excessive and anxious dependency.
Bowiby was particumlanly concerned with the group of children who had been
sep-anated during the critical period of 6 to
12 months to approximately 5 eans and
thus never had a chance to develop an
en-during positive relationsimip to a loved
per-son.25’ Once this period has passed, it
appears that the child is imot capable of ac-quiring the ability to form continuous, co-operative relationships. This age period is crucial because the children are old enough
to form a relationship to a motherly person and to discriminate between persons bumt too
young to maintain time capacity to love jim
time absemice of loving persons; the organisnm is very immature and time capacity to form love relationships is in a coumnse of rapid
development.
A child who is separated before the
“cniti-cal period” (first 6 months), before lme huts
learned the following response, becomes
isolated and withdrawn. A cimild who has had the opportunity to develop meaningful relationships and is separated after the
636 GLASER - MATERNAL DEPRIVATION
for longer periods and will acquire
sub-stitute ones along the learned paths.
Wimat influiemmce does this “lack of ability to develop a love relationship,” this
“affec-tionless” character, as Bowiby termed it,
have umpomi time child’s futumne life? The
de-velopmemmt of the cimild’s sumperego, his con-science, dlepemmdls umpon his imitation of, and
idemmtificatioim witim, loved parents : lie desires
approval; lie wishes to please; and, in order
to do so, lie hmas to comply and respect the
wishes, rules, clemammcls, and feelings of the
loved pensomm. In the absemmce of parents this learning experience vill miot occur; it is one of the important roots of an individual’s
ability to differentiate betweemm “right or
wnommg.” 1mmtime absence of “conscience,” the
factors which will nmake the individual fit immto social rules amid prevent imim from
committing amitisocial acts are fear on lack of
opportummitv. It may be clime to these two factors that miot mmmore childiren undergoing
exl)eriemmces of separation develop into ammtisocial admits. Amiotimen reason, not
sep-arabic lMmt immtenacting, is the fact that
dleI)nivatiomm is ranel’ total since pre- andl
l)05t-5el)trtttimm experiences, age at time of sepanatiomm, partial sumbstitumtiomm, and age at
time of restitution are different in each ease
and contribute to the variety of results
rather than present a stereotyped picture.
Bowiby5 studied 44 juvenile thieves as
they were brought to the child guidance
clinic ammcl compared them with a matched
control group brought to the clinic for
other reasomms. Among time group of thieves lie found 14 youths with “affectionless”
characters (chilcineim who imaci mmot learned
,immd were immcapahle of emmtening loving mean-immgful nelationsimips witim others), all of
wimomTn had been separated from their
mothers at aim early age. No affectionless
characters were found in time control group
mmor in other observations of nondelinquent
childremm.
Bowhby’s conclusions, however, are not
borne out by Lewis’ study.49 She did not
find the “affectionless character” solely
among eimiidren separated from their
mothers and she therefore (loubted the
spe-cificity of the syndrome. Moreover,
Gold-farb,27 rather than finding “affectionless” be-havior, reported similarly deprived children
who craved and demanded affection from others. Bowhby5m implied that the difference
may be semantic. It should be stressed that
all investigators are agreed that maternal deprivation has devastating effects upon
emotional maturation, though they differ in their description of the resultant behavior patterns. These differences need not be
eon-strued as invalidating the general thesis if
we consider that: a) data about the precise character of the early cane in institutions are usually obtained retrospectively and fail to
distinguish quantitative differences in the
type of care supplied, and b) the subsequent
experience of the children in foster homes
of varying degrees of adequacy must bear
upon their ultimate character development. It does, however, suggest the need for
cau-lion
before accepting categorical statements about cause and effeet.If we summarize the reported emotional
changes produced by deprivation of mother love, we can roughly divide the child’s life into 3 periods : the first year of life, when we see a picture of general depression with great retardation in physical growth; the
period up to about 5 years when the con-science is being formed and the child learns the pathways of forming permanent
attach-ments to the mother or other persons and when failure to learn this may result in the psychopathic character lacking in superego
and thus maladjusted to the rules of society; and finally, separation at a later date which
may not have these deep and fundamental
influences on the development of body and
mind as the child tends to be capable of seeking and finding other relationships which will gratify his needs.
PREVENTIVE MEASURES
Preventive measures should be directed first of all toward an attempt to prevent separation by maintaining the home,
see-ondly to prevent the results of unavoidable
separation by well-planned foster home
institum-SPECIAL ARTICLE
637
tiomis mnakimmg thmenm more hommic-hike for those clii iclnemi for whiommm institutiommalization seems
to be time most practical way of manage-memmt.
Statemnemmts such as, “Any home is better
timan an institution,” “A 1)ad home is better
timamm a good immstitutiomm,” or “The mmatunal
I)aremits are 1)referable to any foster parents” should be viewed critically. The adherence
to these l)nimmciPles imas in time past led to
sonic tmnfortumiate consequmemmees. Should we
mi(it ask ourselves: How bach can a mmatumnal
imomime i)e t(i be still better thamm a foster home
on an institution? What cami we do to make
immstittmtiomms more “home-like” from time point of view of time emotiommal development of the child, and is the hope of doing away with
immstitutiomms in the future a realistic one?
With regard to the maintenance of the
home iii cases whmere the mother is unable to
cane for time family, the care of childiren iii
the fammiihiar setting of timeir imome by a
imomimemnaker may be preferable to the
re-mmmoval of time childremm to foster homes or
institumtions.”
Imm a study of chmildren evacuated by age
groups from big cities in France during the
war years, it was found that they remained
emmmotiommahlv fragile even iii the years to
foi-1(i\V. Stmtter3’ recommnendledl that, if
evacua-tiomm should agaimm become necessary, it should be I)lanmmedl by family units; that is,
mmmother with all lmer children or at least
sibhimigs together, and not children grouped
according to their ages and separated from
mimothmer and sibhimmgs.
Some lessomms camm be learned from the
expeniemmces iii rearimig cimildlren in collective
settlements imm Israel (60 and personal
ob-servations of one of the authors (K.G.) dun-immg his stay in Israel 1950-1954). These chil-clreim are reared from earliest infancy in chiil(lreims houses gnoumped according to age.
Depemidiumg on the wealth and age of the
settlement and the background of its
mem-liens, time women attending to the children
vary frommm fully trained nurses to mothers
withm no training other than their own
cx-1)eriemices. iost of them, however, have one thing in common: They are not working as
i)ti(l eimmplovecs limit rather as nmelmmh)ers of one big family taking cane of “their”
chil-dren. Thus, with the exeeptiomm of those “well trained, efficient” nurses who feel that
by
showing
their motherly feelings theylose in professional standing, time care of time cimild is much more one resembling a large foster family thmn an immstitution. Time panemmts
take their children to their own room or small house after working imouns amid over
week-ends, and umsumahly a corner or small
separate room is provided for the chmilclremm. Thus the family ties are preserved amid have
even been strengthened clumning the last
years as experiemmee in this young experiment
of living has accumulated.
With this background, the children at the
age of 5 to 7 years still show some
charac-tenistics resembling those of the institution-ahized child, and in the group up to 2 years
the development migimt be somewhat slower than expected. However, as they grow older and experience the imitensive livimmg together with their peers and their strong attachment to group leaders and their better
under-standing of the activities of their parents and their relation to them, they seem to
completely recover and develop into well-adjusted adolescents and adults, even under the most adverse conditions of time \Var of
Independence. (Capian : “I have mmever seen
a Kibbutz war neurotic.) It mnumst he
pointed out that this applies to social set-tings such as the collective settlement and the army. Possible adjustmnent of these
adults in the individumahistie world oumtsicle the protective shell of a settlement on the army still remains to he studied. It seems that there is a tendency for such adults to
yearn to return to the settlement on to seek
the company of other members of such
settlements on time outside.
Maintenance of the family unit may mmot be possible or practical in some cases and should not be pursued “at all cost.” Time home situation with a neglectful, rejecting,
638
GLASER - MATERNAL DEPRIVATIONsliovs (‘IimOtiOiIdl (listunl)ances imi his
umn-healthy hmommme situatiomm, particularly’ if the
background of time children amid the
emo-tional, intellectual, amid eharacterologic
quality of the foster parents can be taken immto considenatiomm in time selection of the
foster home. However, there are ammd
prob-ably always will i)e situations which are
bet-ten treated by choice in an institutional
settimmg rather thiamm in Private homes, no
mmmatten how fittimmg and well equippedi these homes niay be amid eveim if psychiatric care
ammcl counsel are available for child and
foster paremits at the time of placement in a foster home.
Time motimen may Imave to be taken out of time family circle because of temporary ill-mmess. If timene are no close relatives an
in-stittmtiomm, 1)erha1)s only for day cane, might
be preferable to the confusing situation
arising from new attachments made to foster
Panemmts while time real parents are living and ciI)le to ne-establish time home. The less
immtemmse ties fonmmmecl iii iumstitutiomms while the
relationship to time Imaremmts is continued by
nmemory amid frequent visits might have a
mmmore stal)ilizing iimfluence than either foster
hi(imile i)i1cemmiemmt or contimmuatiomm at all cost
imm time immadlequate hmommmeof time child.
The severely disturbed, aggressive,
de-structive child frequently cannot be
toler-atedl even iii time best of foster homes andl
mnav do 1)etter iii time 5I)eciil institution in time settimmg (if a smmmall group tinder the care
of a smmmpathmetic, wanmmm, timcl well-trained
persomm. There lie camm learn to form
attach-memmts to an adult while still commtinuing in
time inure neutral atnmosphmere of the group.
A successful experiment of this nature was
descnil)ed by Aichhorn6l with children who,
after havimmg been placed in the institution
l)ecause of their delinquent behavior, were
too disturbed even to be kept in the ordinary
groups, butt adjusted well under the above
situatiomm of a special smmmall group.
1mmFrammce, Cotmve et al.62 studied the emo-tional behavior of children ummider 6 years
institutiommalized in tuberculosis sanatoria
amid found timat the yoummger the child the
more lie suffered from separation. They
suggested time ad(lition of )sychohogists an(l
social vorkens to the staff of timese immstitum-tions who could direct their efforts toward
creating a favorable emotional climate for
the children.
A recent report of preliminary results from an institumtion in Switzerlammd indicates that with special attention to time emotional
needs of infants and young children the lag
iii development frequently notedi in institu-tional settings need mmot necessarily occur.63
With these realizations in mind, our at-tempts toward prevention of time
depriva-tion syndrome should be directed toward endeavoring to attain a good, healthy rela-tionsimip between the child and his mother or adequate mother substitute. This may be accomplished either in the child’s home, in
a foster home, or in an institution, depend-ing on the needs of the case amid the avail-able resources of the community.
TREATMENT
The effectiveness of treatment will
ob-viously depend upon the age of the child,
the clinical syndrome he presents, the se-verity, type, and duration of the depriva-lion he has undergone, as well as upon the
adequacy of the therapeutic measures avail-able. In this, as in most illnesses, the earlier and more adequately treatmeit is instituted,
the more satisfactory the results.
Mention has already been made of the
reversibility of the marantic state in institu-tionalized infants given “replacement
ther-apy” be restoration of the mother, by
spe-ciahly designated institutional personnel, or by foster parents.’4’ 21 This is most
eonvinc-ingly demonstrated by the report of Lourie
of a group of 12 children with “psychoso-matic disorders”-cycic vomiting,
rumina-tion, and nonspecific ar6’ These chil-dren were studied and managed
psychiat-nicahly after the best available inpatient
medical management had failed to interrupt their downhill course which threatened to
SPECIAL ARTICLE 639
etc.) wlmicii lie seenmed mim(ISt al)le to accept.
(1mm 1 refractor case, it was discovered that time immfant responded positively only to
an-other cimilcl and hater to time adult earing
for that cimild.) \Vithm patience and persistent efforts, each immfant was voim over to a
posi-tive nelationsimip with a substitute mother
and as this took place, his symptoms
re-mimittecl. Ummfortunately, the aumthmor attempted
imo commtrol series; imis eommclumsions as to the
efficacy of “replacememmt therapy” are based
iIl)Oti climmical jumdgmmment which, however, is
impressive iii view of the hmigh fatality rate
wimicim may be associated with these
dis-orders and time progressive deterioration of
time clinical course prior to
psyehotherapeu-tic intervemmtiomm.
Time clevelopmemmtal lag immchildren
institu-tiommalized for brief periods within the first
few years-as, for immstance, during wartime
evacuatioim from target areas-are
appar-entlv readily reversible upon return to
nor-mmmal fammmily life.65 Whether or not the
intel-lectuai lag mmoted after prolonged
depriva-tiomm camm be remedied remains a disputed
issue. Goldfanb’s studiesc6 indicate that it
cannot, but further investigation of this issue
will be imecessary before a definite answer
cami i)e given. The frequemmt glowing reports
of rise in I.Q. in institutionalized defective cimildremm after one or another new agent
(ghumtamic acid, for instance) is
introduced-reports which are then contradicted by
sub-sequiemmt studies-suiggest that the
enthusi-asm amid immcreased interest surrounding their
admmministnation has a stimulating and
bene-ficiah effect umpomm children previously reie-gateci to back wards. But, again, the
ques-ti(iii arises: Are the reported gains real or appanemmt? Is a change in I.Q. or a change in motivation being measured? In any event,
umnreleimting efforts to provide optimally
stimulatimmg environments for deprived
cliii-dremi are empimaticahiy justified clinically. At
time very least remaining potential will be realized; moreover, it is by no means cer-tam that the apparent deterioration is
irre-versibie.
Results are far less satisfactory in the
treatment of antisocial character trends as
the late aftenmmmatim of prolomiged
dIeI)riva-tion. On timenonctical groulli(Is, it is
comi-siclered likely timat time very mmatune of time
child’s disorder-imis disability in forming interpersonal attachments-makes hminm
tin-responsive to convemmtional psyeimotimera)e( m-tic efforts. Yet even imere nmehionative mmotes
are apparent. Aicimhonn,Gm cirawimmg from cx-tensive experience in dealing witim adoles-cent psychopathic disorders, mnammy of which
he mmoted “come from loveless imonmes,” was
able to report successful rehabilitation of a number of cases. His clinical sttmciies, as imm
so many instances, do not preseimt a
com-parison of the outcome of treated and
un-treated cases and canmmot therefore be considered convincimmg; nevertheless, he does outline a course of tneatmemmt imm a
specialized residential setting vhmich may offer some hope for a better outcome thaim the generally pessimistic contemporary atti-tumde predicts. To timis may be added, ali)eit
very hesitatingly, time surprising expeniemmce
of one of ums (L.E.) with a severely deprived youngster steahimmg almost daily for 18
months in an adloptive home. Fohlowimmg
outpatient therapy for botim child and
aclop-tive father, a remarkable immmpnovemmmemit in
behavior occurred, witim mmo episodes of
antisocial acting oumt iii over 9 montims. Timis
anecdote is imot cited as proof, but rathmen to
immdicate that, whether spommtammeoushy or as result of therapy, remission can oceumr iii this
syndrome.
In striking contraventiomm of most
in-formed opinion in Western countries, is time exuberant (and amusingly written) book by
Makarenko.67 Reporting his expeniemice with delinquent youths who were a major social
problem in the aftermath of the Ruissiamm Civil War when they roved town and
coun-tryside as bands of brigands, he described
an amazingly high degree of success in re-storing these youngsters, bereft of paremits and wandering the streets stealing and
scav-enging
for survival, to productivenmemmmber-ship
imm society. So successful were these “collectives,” according to a subsequent report,68 that they became functioning640 GLASER - MATERNAL DEPRIVATION
uimd nianni(’d. As t c(Immse(Iuiemmce, thmeir
strue-tore dhmamige(1 so completely that miew
settle-mmmeimts had to be orgammizeci to accommodate
additional “patients.”
Sumcim nel)orts, vitiiouit access to detailed
(lata, cami h)e accel)te(l ommly with
resenva-tiomm. Nevertimeless, thme’ poimmt iii a direction
which seems imiclicated l)y time lack of
suic-cess iii foster hi(ime placement of deprived chmildren. Time telmum(ius amid fragile natuire of
time relationships established by such
voummigstens may make time closeness of a
home setting inmpossible for them to
toler-ate. A properly organized residential center
-withm its eml)hasis OIl grouii living without too much immsistence omm personal closeness
till time chmilci seeks it omit-would appear to
(lifer the oI)tilmmai emmvironment for their
pro-gressive sociahizatiomm . Unfortunately,
spe-ciahiZe(I imistitutions of this type are
rarely-if at all-available in immost communities.
w5’ after studying the subsequent acljuistmnemmt of 28 children who had been immstitumtionahizecl for timeir first 3 years,
eon-chudedi that immediate foster placement is
contraindicated. He recommended that
suich children first be placed iii small groups
with )rOfessionahly skilled, affectionate
adults iii (irdien to dissipate their initial
ag-gressive ammdl mmegativistic response. Once so
sociaiize(l, timey may be more easily toler-ateci in a foster home which is usuiahly
tin-I)reI)tredl to cope witim time unrewarding task of withmstammchimmg hmostile outbursts over a long
l)eniodl. Even thmemm, foster parents will re-(itmire proiommged andi careful social casework and time childnemm psychiatric supervision.
The treatmnent of choice for the deprived
imifammt audi youumg child (within, say, the
first 24 to 30 months of life) is clearly
“re-Pltcem1ment therapy”; timat is, the provision of affectiomiate matermmal care, either through foster placement on via isyehiatrie
treat-mmmemmtof larents, if they are available but
emotionally inadequate. With the somewhat
(il(her chilcl, the deeisiomm for foster
place-ment will depend upon his clinical behavior;
somime are able to respond to immediate
piacenment, others may nequmire an immter-mediate period of small group life in a
cottage settimmg i)efore moving on to a foster
hommie. \Vith time l)tmh)crtLl aix! adolescent
child, foster home placement is not likely to he successful becaumse of the antisocial be-havion displayed and the inability to
toler-ate personal closeness. Residential treat-ment appears to offer the most promising
mode of approach; time specific mmattmre of the
treatment program is under active immvesti-gation at a number of centers. It remains to
be seen just how effectively the late
after-maths of pnolonged deprivation can be
treated.
SUMMARY
The effects upon the child of separation from his mother (deprivation syndrome)
have been critically reviewed. Effects of physical neglect or emotional rejection by
the child’s mother have not been included in this paper.
The results of maternal deprivation in the
physical, intellectual and emotional areas
have been described. They have been shown to vary in type, intensity and reversibility depending upon the age at which separation
occurs, duiration of separation and pre- and post-separation experiences of the child.
Preventive and therapeumtic measures have been briefly discussed.
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Onthopsychiat., 19:416, 1949. 4. Eisenberg, L. : The autistic child inadoles-cenee. Am.
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