PREVENTIVE PSYCHIATRY

PREVENTIVE PSYCHIATRY

FAMILY DOCTORS and pediatricians are often asked by prospective parents and actual parents: "How can we guarantee that our children will grow up free of emotional illness?" This is a logical question in an age when we can guarantee protection against polio and many other serious or unpleasant diseases. Unfortunately, we don't have vaccines to prevent development of abnormal personalities, neuroses, and psychoses. Some doctors even take a completely negative attitude; they feel that there is not enough knowledge to give any valid advice on prevention of mental disorder. However, most physicians, psychologists, and child educators believe that there are useful guidelines.

 We believe that a child has a better chance to develop the type of normal personality we have outlined previously if certain guidelines are followed. And we go along with the thinking of those psychiatrists who believe that if there are any hereditary or familial tendencies to emotional breakdowns, the individual with a sturdy personality can fight them off or, if afflicted, will have a better chance of recovery. We believe that of overriding importance are the basic attitudes of mother and father. When parents love and relaxed, there is usually a good future for a child.

Even babies sense love, poise, and acceptance in their parents, especially the mother. The mother's voice and touch are appreciated by the baby at an early age. If they are loving, warm, positive, the baby has a good start. When a mother is loving, eager to have her child grow into a happy, resourceful human being, and has realistic hopes for him, the child's upbringing and future are likely to be soundly based. Even though mistakes almost certainly will be made, they will be offset by a strong "bank balance" of loving, normal, good care. Because the first year of life, even the earliest days and weeks, are important, planning during pregnancy is important. It is often helpful for new parents to take a course in baby care. If a rooming-in arrangement -one in which the baby can be close to the mother (and shared by the father)-can be arranged in your particular hospital, we think it a good idea.

Sometimes, a little extra pressure on the obstetrician may make this possible. We think breast feeding brings mother and child into a close, warm emotional relationship. However, if it is not feasible, the mother should cuddle the child closely so that bottle feeding has much the same overall physical feel for the baby as breast nursing. If circumcision is desired, it should be arranged in the hospital before taking the baby home. Later in life, this minor operation may have major emotional importance. Prolonged separation from parents, especially from the mother, in the first year of life (and later, too) can be the basis for later psychological problems. Separations should be avoided if at all possible.

When unavoidable because of illness, divorce or death, a parent substitute should be introduced as soon as possible. The substitute should have the qualities of a good mother or father. Introduction of the baby to the new person should be made gradually because even a grandparent may rank as a total stranger to a child. After breast or bottle feeding has been settled upon, there should be a decision about demand versus scheduled feeding. We favor letting the baby's hunger set the schedule rather than having the clock prevail. However, that does not mean that the mother must be a slave to every first whimper from a baby. Infants are capable of tolerating some minor frustrations.