James Robertson (psychoanalyst)

James Robertson (1911–1988) was a psychiatric social worker, psychoanalyst and filmmaker who based at the Tavistock Clinic and Institute, London from 1948 until 1976.

John Bowlby said of him, "(He) was a remarkable person who achieved great things. His sensitive observations and brilliant observations made history, and the courage with which he disseminated – often in the face of ignorant and prejudiced criticism – what were then very unpopular findings, was legendary. He will always be remembered as the man who revolutionised children's hospitals, though he accomplished much else besides. I am personally deeply grateful for all that he did".^[1]

James Robertson was born in Rutherglen, Scotland, and grew up in a working-class, close-knit loving family where children were cuddled, loved and protected.^[2] He intrinsically understood that children needed their mother and was sensitive to pain due to separation.^[2] He became a Quaker in his late teens, and in the Second World War he registered as a conscientious objector.^[3]

In 1939, Robertson met his future wife Joyce Robertson (nee User) in Birmingham, while he was studying the humanities at the Fircroft College of Adult Education and she was studying at the Hillcroft College for working women.^[4] The couple had both been working at the Bournville chocolate factory at the time they met.^[5] The couple had had two daughters, Katherine McGilly (born in 1944)^[6] and Jean Clelland (born in 1950).^[7][6] Later they had two grandchildren and three great grandchildren.^[7]

When World War II broke out, Robertson registered as a conscientious objector.^[2] At the start of the work he bagan working at a Pacifist Service Unit in East London, helping the victims of the bombing and helping to evacuate children who were at risk of bombing to other parts of the uk.^[2]

In January 1941 the couple began working with Anna Freud in the Hampstead Wartime Nurseries and remained there for the rest of the war. Joyce was a student caring for the infants who had lost family life due to the war, while James began by organising the firewatching at the nursery and as a general maintenance man.^[7] Freud had a particular reliance on the couple as they were English and from a working-class background, unlike many of the émigrés who arrived to work at nurseries. Freud used them to translate both cultural and linguistic differences that were unknown to Freud as an emigre herself.^[8] Robertson also acted in the role of a father figure to many of the children without fathers.^[8]

Both James and Joyce benefited from teaching by Anna Freud and Dorothy Burlingham in child psychiatry. They also learned more prosiac subjects like common childrens diseases, first aid and anatomy as well as subjects like the Montessori education method.^[9] Freud required that all her staff to maintain records of observations of childrens behaviour that were recorded on small cards that were then discussed during weekly meetings and then indexed.^[2] This led to Robertson receiving meticulous training in naturalistic observation.^[2] The collaboration with Freud in discussing the psychological development of children, led Robertson to consider taking further training.^[10] During the war he completed a diploma qualification in social science.^[11]

In 1945, the couples 13-month old baby, Katherine had to go into hospital for a week for treatment.^[7] The couple were appalled to discover that they couldn't visit their child. Indeed, this was considered normal practice.^[7] The reason given was the prevention of infection. This was illustrated in January 1940 when Ayr County Hospital decided to not to admit visitors to children that resulted in a editorial in The Lancet.^[12] This was widely practiced in UK hospitals. Robertson decided from that point onwards to only research mother/child seperation due to hospital admission.^[13]

At the end of the war when the wartime nursery was shutting down, Robertson had the task of either returning the children to their families, or seeking families who would adopt the child.^[14] Out of the 191 children remaining at the nursery at the end of the war, Robertson returned 101 children to their parents.^[14] After the war Robertson matriculated at the London School of Economics after the war to study psychiatry, graduating in 1947 as a psychiatric social worker.^[5][10] After his graduation he began training in psychoanalysis^[10] with the help of Freud.

In February 1948, Robertson was the first person to join John Bowlby's team at the Tavistock Clinic.^[15] Bowlby had received a small grant from the Sir Halley Stewart Trust in 1948 to start researching the effects of separation and deprivation of small children aged between 1 to 3 years^[16] that Bowlby called his sanatorium study.^[15] Robertson had been employed by Bowlby to make observations on separated young children^[3][5] and report the findings to Bowlby.^[15] Robertson had been trained in a strictly Freudian view of psychoanalysis that wasn't shared with Bowlby's.^[10] Bowlby at the time believed in what became known as the object relations theory of psychoanalysis that was developed in the early 1930's and 1940's by Melanie Klein and Donald Winnicott and formalised in 1952 by Scottish psychiatrist Ronald Fairbairn.^[17] Although for most practical purposes he was in agreement with Freud, when it came to discussing theory they had widely differening views.^[16] The German-American child psychologist Christoph Heinicke who specialised in mother/child seperation (and would later join Bowlby's team) also disagreed with Bowlby's theoretical conclusions but agreed with the empirical data, but again for practical purposes agreed with Bowlby on everything else.^[16] This perhaps reflects in Robertsons and Bowlby's relationship and how each viewed different theoretical aspects of mother/child seperation.^[16] Certainly they complemented each other work, Bowlby as theorist who would use Robertson material that he compiled from observation.^[18]

Beginning in February 1948, Robertson began observing young children at Central Middlesex Hospital and made similar visits to local short and long-stay hospitals as well as residential nurseries.^[19][20] At the time, visiting of children in hospitals was still severely restricted. This was again illustrated by a 1949 letter to the The Spectator by H.G. Monroe Davies who published a survey of visiting times to London Hospitals for parents.^[21] Some allowed no visiting, some no visiting for under 3 year olds, others only 1 or 1.5 hours visiting a week, others - twice a week, but it all cases it was extremely restrictive. This caused great distress to the young patients, and it was well known in the community that a child could be 'changed' by a stay in hospital. However, little of this disquiet reached the hospitals, and later commentators would speak of 'an emotional resistance to the awareness of children's emotional needs and distress. The strength of this resistance is vividly illustrated by the work of James Robertson'.^[19]

When James Robertson first entered the children's ward to make observations, he was shocked by the unhappiness he saw among the youngest children, in particular those aged under 3 years old.^[15] The competent, efficient doctors and nurses gave good medical care but seemed unaware of the suffering around them.^[15] They saw that children initially protested at separation from the parents, but then settled, becoming quiet and compliant. However, Robertson saw this as a danger signal.^[15] After several years of observations in long and short stay wards, he formed a theory based on the typical sequence of responses of children aged beween 18-24months who had lost the care of their mother.^[15][22]

Robertson and Bowlby saw breaks in a child's attachment bonds as responses to 'phases of protest, despair and detachment'.^[a][24][25]

• In the protest phase, the child is visibly distressed, cries and calls for his mother ' – distress, angry crying, searching, trying to find the mother and get her back'.^[26] The child reunited at this stage will 'usually be quite difficult for a time. It's as though he is punishing the mother for going away. When he's got those feelings off his chest, he returns to normality'.^[27]

• If however 'the separation continued for longer...the child may go on to the stage known as "despair". He's very quiet, withdrawn, miserable and apathetic. He stops playing – seems to lose interest in everything'.^[28] The child gives up hope of his or her mother returning and may appear to be "settling down", to the satisfaction of unenlightened staff. In fact, 'when he gets home, he'll take much longer to get over the experience. He'll cling to his mother more', and before recovering will 'usually then have to go through the protest phase on the way'.^[28]

• In the denial/detachment phase, the child shows more interest in his surroundings and interacts with others, but seems hardly to know the mother when she visits or care when she leaves, which is why 'the third stage – "detachment" – is the most serious'.^[29] Apparently, the child seems not to need any mothering at all; but, 'in fact, he only seems to have recovered, and at the cost of killing his love for his mother'.^[28] When eventually reunited with the family, 'the child can seem quite changed and now appears superficial, emotionally distant'.^[28] His relationships with others are shallow and untrusting. 'This is the most difficult stage to undo'.^[30]

Robertson's research was met with hostility by the medical profession.^[31] Even his colleagues at the Tavistock Clinic – although accepting 'that anything that breaks up the child's life into fragments is harmful.^[31] Mothers know this' – did not feel the same sense of urgency.^[32]

James decided to make a film documentary of a young child's stay in hospital.^[31] Robertson sought to create a objective film that would enable the visual communication to take place in a way that the spoken word could not.^[33] Bowlby insisted that the film production was carefully planned so they couldn't be accused of any bias.^[31] A child was randomly selected for the experiment and a clock was always visible to show when the filming took place.^[31] With a grant of £150, he purchased a 16mm cine camera and 80 minutes of black-and-white film.^[34] In August 1952, he made the film, shot it silently then added commentary later.^[34] Robertson called it a "A Two-year-old Goes to Hospital"^[35] The film was reviewed after a showing by Austrialian psychologist William Andrew Dibden who defined a complete day-by-day breakdown of Laura's emotional state.^[36]

The patient was Laura, aged 2, in hospital for 8 days for repair of a umbilical hernia via surgery.^[31] She is initially filmed at her home, then filmed in the morning and afternoon at regular intervals from when she was admitted to her departure.^[37] The hospital treatment was considered examplary without any operational complications.^[37] Robertson and Bowlby were planning to abandon the documentary since Laura did not cry very much.^[31][38] In the film, the mother is seen leaving the child, assured by the nurse that she would settle down when she leaves. When the mother does leave, Laura reacts violently and her mood changes for the worst. By the end of the stay it appears that Laura is withdrawn and depressed, shaken in her trust.^[38] When her husband and Bowlby showed her the film, it was Joyce who made the critical breakthrough in realising why Laura was not crying,^[7] being a desperate attempt by the tiny girl to control her feelings.^[39]

The film now regarded as a classic. It has been designated "of national and historic importance" and a copy is being preserved in the National Archives.

In recent years there have been great changes in children's wards, partly brought about by this film. But many young children still go to hospital without the mother and, despite the play ladies and volunteers, the depth of their distress and the risks to later mental health remain an insufficiently recognised problem.

This film study of typical emotional deterioration in an unaccompanied young patient, and of the subtle ways in which she shows or conceals deep feelings of distress, remains as vivid and relevant as when it was made.

Reviews

Contemporary reviews commented on the film’s restrained and objective style, noting that although the child appeared composed for her age, the extent of her distress was evident. Writing in Nursing Times, reviewers observed that the film challenged assumptions about children’s adjustment to hospitalisation.^[40] Nursing Outlook similarly questioned the belief that a “good” child is necessarily well-adjusted. The The BMJ described the film as a detailed depiction of the observable manifestations of emotional processes in infants separated from their families.^[41] Anna Freud, writing in the The International Journal of Psychoanalysis, referred to it as a connected and credible account of stress and separation anxiety.^[37] Other commentators described the film as conveying an implicit call for reform.

The Robertsons went on to make 'a series of harrowing films that revealed the true nature and extent of distress shown by separated young children'.^[42] in hospital.

They also explored the reverse situation, when a mother was hospitalised and the children thereby separated from her – themselves 'fostering children while their mothers were in hospital' and so demonstrating that 'planning for the situation and arranging proper care can make a difference'.^[43] The Robertsons found of the fostered children that, 'in varying degree, reflecting their different levels of object constancy and ego maturity, all made a relationship to the substitute mother...The relationship with the foster-mother gave comfort and an emotional anchor which prevented them from deteriorating and held them safely until they were reunited with the mother'.^[44]

Robertson contributed evidence from his research to the Platt Report 1959 regarding the welfare of children in hospitals.^[3] Decades later, 'now that we understand the process, hospitals are making it much easier for parents to visit more or live in the hospital with younger children so that the two later stages are reached much less often';^[30] but it required shock tactics from Robertson to achieve that end.

'In 1971, Robertson, in coordination with his wife Joyce, began to publish influential articles...us[ing] the term bonding for parent-to-infant attachment'. For the Robertsons, '"bonding" refers to the feelings parents have for their children and "attachment" to the feelings children have for their parents...they run in parallel'.^[45] They distinguished the two on the grounds that 'Bonding is a mature form of loving. But the attachment of child to parent is an immature form of loving – unstable in the early months and years'.^[46] They considered that 'bonding progresses down the generations to promote the well-being of each new batch of babies...where the parents are not bonded to the children, the children are put at risk'.^[46]

• Robertson, James (1970). Young children in hospital (2nd edition (with postcript) ed.). London: Tavistock Publications.
• Robertson, James; Robertson, Joyce (1989). Separation and the very young (1st ed.). London: Free Association Books. ISBN 9781853430978.

In 2003, Robertson and his wife Joyce were awarded the Bowlby-Ainsworth Award for Documenting And Improving The Lives Of Young Children In Difficult Circumstances.^[47]

• Attachment theory
• Platt Report 1959 British government report that made wide ranging recommendations based upon the principle that children needed their parents.

• Lindsay, Bruce (March 2003). "'A 2-Year-Old Goes to Hospital': A 50th Anniversary Reappraisal of the Impact of James Robertson's Film". Journal of Child Health Care. 7 (1): 17–26. doi:10.1177/1367493503007001672.

• Robertson Films, a site giving details of Robertson's work, which also makes the films available.