why parents get the blame

Popular opinion about the right way to bring up children has, throughout history, varied between authoritarianism at one extreme and liberalism at the other. Child-rearing practices have typically been determined by expediency, experience or belief. Freud’s ideas about child-rearing caused a sea-change in thinking about the relationship between parents and children, because his ideas were based on an explicit theory involving the biological characteristics of human beings, rather than being derived from beliefs or pragmatic responses to circumstance.

Sigmund Freud

If I’ve understood Freudian psychodynamic theory correctly, it’s grounded in the Darwinian principles of inherited characteristics and natural selection. Freud proposed that the psychological forces that drive behaviour are passed on from generation to generation in the same way as physical characteristics are inherited. Over time, natural selection ensures that the physical characteristics and behavioural drives that maximise a species’ chances of survival are preserved. During a child’s development, all that’s required for these biologically provided physical and behavioural characteristics to ‘unfold’ naturally is a suitable environment. Physical development can be ‘disturbed’ by factors such as a poor diet or living conditions or by practices such as circumcision or foot-binding; behavioural development can be disturbed by parents or other adults being too controlling or imposing unnecessary social or religious taboos. In short, the model is one of each child having a species-specific genetic blueprint for development that, given appropriate conditions, will unfold naturally to produce a healthy adult human being. Two factors could disturb that unfolding process;

-a fault in the mechanism of inheritance (a chromosomal abnormality)
or
-external interference with the child’s natural course of development.

Two key points about the psychodynamic model

Firstly, the psychodynamic model assumes that potentially there is such a thing as a ‘normal’ human being – someone whose biologically provided development has been allowed to unfold naturally – even if in real life, the course of development is often disturbed, resulting in everybody having flaws of some kind.

The second point is that this theory puts parents squarely in the firing-line – developmental problems arise either because parents have passed on their faulty genes (even if they have no control over that) or because they are the most likely suspects when it comes to the child’s course of development being disrupted.

Psychodynamic theory had a huge impact on thinking about child development in the early part of the 20th century – it made people think about child development for a start. It also had beneficial outcomes for many children in terms of their health, education and psychological development. But there was a downside. Regardless of the personal views of psychodynamic theorists, psychodynamic theory is closely associated with eugenics. Although genocide, enforced sterilisation and limiting opportunities for certain sectors of the community have happened throughout history and would probably have happened in the early 20th century even if psychodynamics hadn’t been thought of, psychodynamic theory undoubtedly lent weight to these policies.

Logo from the Second International Eugenics Conference, 1921

Both Freud and Kanner were aware that knowledge about the biological process of inheritance was sketchy, and both expected subsequent research to shed light on their theories. Although some of Freud’s ideas have received support, there’s little evidence for the idea that social and sexual behaviour derives solely from unconscious drives. Although unconscious processes must affect social and sexual behaviour, the brain areas most involved during our interactions with others are higher-level rather than lower-level areas.

Despite 50 years of research into genetics and brain function bringing psychodynamic theory into question, the two explanations offered by psychodynamics for abnormal human behaviour have become deeply embedded in popular thinking in the developed world; either there’s a genetic/medical explanation or the parents must be responsible. Since WWII politicians and social scientists, not surprisingly, have been wary of genetic explanations for atypical or socially unacceptable behaviour, so causes are frequently framed only in environmental terms, often in terms of childhood experiences. In the absence of a medical diagnosis, the parent is often assumed to be responsible. But research suggests that the relationship between genes, environment and behaviour is much more complex than psychodynamic theory suggested.

Genes

The psychodynamic model saw genetic material as providing a blueprint – an engineering diagram – for development, based on Gregor Mendel’s ideas of independent segregation and assortment of genes. But later research has shown that DNA doesn’t work quite like that. DNA is a complex molecule, so when gametes (eggs or sperm) are formed, and when DNA from two parents combines during fertilisation, there’s plenty of scope for genetic variation. Indeed it’s the genetic variation in individuals that maximises a species’ chances of surviving environmental change. Because of the structure of the DNA molecule, some genetic variations are robust enough to be transmitted between generations and are inherited. Others might arise spontaneously. Some variations are common, others rare. As far as genetics is concerned, it’s meaningful to talk about ‘normal’ and ‘abnormal’ in descriptive terms (most people are like this but not like that) but not in normative terms (people should be like this but not like that).

Environment

Human beings are biochemical organisms so many environmental factors impact on our development. Some (epigenetic) factors can affect the expression of genes. Other factors, such as diet, toxins, allergens or infections can disrupt physiology and development. Other people’s behaviour affects children but parents aren’t the only people involved; other children, teachers, neighbours and wider community and societal issues can have a significant impact on a child’s development.

In short, what the last 50 years of research has shown is that inherited characteristics and parental behaviour are only two of many factors that interact in complex ways to influence a child’s development. But you wouldn’t know to that to look at current ideas regarding child health, education and social care. In fact, social policy relating to children often reflects the psychodynamic model rather than modern understandings about genetics and child development. I suggest this is largely because of the way we think.

The way we think; heuristics and biases

Human beings are capable of using logical, rational thought but as Herb Simon pointed out, we tend to do so only as a last resort. That’s because the ways of thinking that we’ve evolved as a default tend to be in the form of heuristics (rules of thumb) and biases (inbuilt tendencies) – rough and ready ways of responding to our environment. That’s because rough and ready ways of thinking that are due to the way our brains are wired up and that improve our chances of survival are more likely to get passed on to our offspring. These thinking strategies might maximise our chances of survival, but unfortunately they don’t lend themselves to figuring out solutions to complex problems or planning long-term strategies that will make everybody’s lives better.

For example, human beings have excellent pattern-matching skills. These enable us to recognise a tiger, a rattlesnake or our children, in an instant. They also result in pareidolia – seeing a pattern as significant when it isn’t. We’re good at spotting correlations; helpful when trying to figure out what causes what, but meaning we have a tendency to conflate correlation with causality. We like phenomena to have explanations; that improves our understanding of the world around us, but also results in us inventing concepts like ghosts or evil spirits. We’re also prone to looking for agents -assuming that if something happens someone must have made it happen – not that it could have happened by chance. Heuristics and biases have been investigated in some depth, notably by Daniel Kahnemann, Paul Slovic and Amos Tversky. You can find an extensive list of human biases here, though it’s likely that many of them are actually different facets of a few underlying cognitive phenomena.

Bettelheim’s philosophers

People have long been aware that we don’t get information directly from the world around us, but via the filter of our perceptions. Errors and biases in our perceptions result in theories like the sun moving round the earth or the earth being flat. It’s only when our observations don’t match up with how we think things work that we start using logical rational thought to figure out why. The problem of how to work round unreliable perceptions was what Bettelheim’s favourite philosophers were attempting to tackle. The reason they didn’t opt for the scientific method, which has developed as a way of counteracting unhelpful perceptive errors, was I suspect, because science also gets things wrong. A fundamental point to bear in mind is that science doesn’t deal in certainties, but in degrees of uncertainty. We have enough certainty about some phenomena to land probes on Mars, replace human organs and communicate instantly with someone on the other side of the world. We’re much less certain about the causes of other phenomena – human behaviour, for one. But science has a large toolbox of methods for systematically eliminating less likely explanations for phenomena and investigating explanations that are more likely, so even though our knowledge will always be subject to our perceptions and will always be limited, it is possible to have knowledge that’s reliable enough to be useful.

In my previous post, I highlighted two differences between Kanner and Bettelheim; their use of evidence and their level of relevant expertise. I suggest that these two factors are among the reasons why parents are often (wrongly) blamed for their children’s behaviour.

The use of evidence

Science evaluates evidence by comparing hypotheses about how things happen with observations of what happens. If a theory makes predictions and they turn out to be wrong, we modify the theory – evidence that conflicts with theory can be very informative. Other disciplines handle evidence differently. In disputes, for example, opposing parties marshal evidence that supports their argument, and in courts of law or formal debates an independent party evaluates the evidence from both sides and makes a decision about which is most likely to accurately map onto the real world. The difference between the use of evidence in science and in adversarial situations is that what’s most important to science is what’s actually happening in the real world, not who wins an argument about what’s happening. Obviously scientists do have arguments – and whoever wins influences which theories get investigated and which don’t, but that’s not what science is about.

Many people developing social policy in relation to children are from disciplines that don’t handle evidence in the way science does, so legislation is often derived from policy-based evidence rather than evidence-based policy.

Levels of relevant expertise

Some years ago, I carried out a short research project on men’s and women’s perceptions of the clothing that women wore to work. I employed a technique called card sorts which had previously been used to find out how experts categorised their knowledge. What I found was that men tended to see women’s workwear in either/or terms (e.g. either the woman is married or she isn’t) significantly more frequently than women did. Some people thought this demonstrated that men think in black-and-white terms whereas women think in shades of grey, but other work with card sorts shows that experts in a particular knowledge domain tend to use more complex categorisation than novices. This suggests that women are likely to be experts on the non-verbal signals conveyed by other women’s clothing, but men aren’t. There are implications for theories about how women dress, but that’s another story. Most of my male research participants were professionals, so for the purposes of this post, what my study demonstrated is that you can be an expert in one domain, but a novice in another.

I don’t dispute that GPs, teachers and social workers have expertise; whether they have expertise that enables them figure out who or what is to blame for a child’s abnormal behaviour is another matter. It would be unrealistic to expect everybody to know about everything, but it doesn’t seem unreasonable to expect professionals working with children to have a basic grasp of relevant factors from other domains. For example, I’ve had to explain to a local authority attendance officer why doctors don’t prescribe antibiotics for viral infections. I’ve disagreed with a GP about the ‘gold-standard’ nature of randomised controlled trials and NICE guidelines. And I didn’t even try to explain one of my son’s teachers why spelling isn’t simply reading in reverse, that is, why he might be a good reader but be incapable of spelling words of more than three letters. I’m not alone; recent reports from the UK have drawn attention to the lack of training in child development received by GPs, teachers and social workers.

In the next post, I want to examine three areas where use of evidence and levels of expertise have had a significant impact on social policy development and on the experience of children showing atypical behaviours; attachment theory, fabricated and induced illness and cyclical models of socio-economic deprivation.

Further reading

Kennedy, I (2010). Getting it right for children and young people: Overcoming cultural barriers in the NHS so as to meet their needs. HMSO.

Munro, E (2011). The Munro Review of Child Protection. Final Report: A Child-Centred System. HMSO.

Rugg, G. & McGeorge, P. (2005). The sorting techniques: a tutorial paper on card sorts, picture sorts and item sorts. Expert Systems,22, 94-107.

Teather, S. (2011). Support and Aspiration: A new approach to special educational needs and disability – a consultation. HMSO.

Photograph of Freud by Max Halberstadt, 1921. Image from the Google-hosted LIFE Photo Archive where it is available under the filename e45a47b1b422cca3.

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social instinct

BlaiseLaPsy on Twitter, in response to what I said about the Freudian concept of social instinct, raised an important point about the work of John Bowlby and Harry Harlow that appeared to provide evidence for the existence of a social instinct. I have reservations about the conclusions drawn from Bowlby’s and Harlow’s findings, and about how the term ‘instinct’ is used. First, a brief round-up of Bowlby and Harlow’s research.

Bowlby, who graduated in medicine and qualified as a psychoanalyst in the UK in the 1930s, was interested in the development of children with behavioural problems and those who had been separated from their parents due to being orphaned or hospitalized. Influenced by René Spitz’s work on orphans, Bowlby became an authority on the effects of maternal deprivation and developed Attachment theory. He concluded that for normal social development, children need a secure relationship with a primary caregiver (usually the mother). Mary Ainsworth later found in her ‘strange situation’ experiments that children showed one of four patterns of attachment to their primary carer.

Harlow qualified at the same time as Bowlby but had a very different academic background. He was an American psychologist; his PhD supervisor was Lewis Terman, who developed the Stanford-Binet IQ test. Prompted by Bowlby’s work, Harlow studied maternal deprivation in rhesus monkeys and macaques. His most famous experiment showed that rhesus monkey infants raised with substitute ‘mothers’ consisting of a wire frame covered/not covered with a terry cloth, preferred the cloth ‘mother’ and clung to it when frightened, even if it was only the wire mother that provided milk. The baby macaques were raised for varying lengths of time in isolation; Harlow looked at the effect on their development, which was invariably abnormal.

What the work by Spitz, Bowlby, Ainsworth and Harlow appears to show is that human and/or primate infants have a social instinct and that instinct triggers a typical pattern of social development. If an infant’s relationship with their primary carer is disrupted by lengthy separation, abnormal social development results. My main problem with these conclusions is the concept of ‘instinct’. Instinct is one of those constructs like ‘love’ or ‘education’ that everybody thinks they understand until they try to find out how it works, or until they discover that their concept of it is different to someone else’s.

We all know what we mean by ‘instinct’ – an automatic, unconscious behaviour. We know what Bowlby, Harlow and others mean by ‘social instinct’ – it’s an automatic, unconscious, typical pattern of social behaviour that appears to develop in the same way in everyone unless something stops it. But Bowlby, Harlow and their contemporaries faced three problems when it came to instinct.

First, as Blaise points out, conceptual models are influenced by cultural worldviews. At the time Spitz, Bowlby, Ainsworth, Harlow and Kanner were researching, human social behaviour was generally assumed to be governed by instincts. Darwin’s work on natural selection implied that many characteristics peculiar to a given species – physical features, physiology and behaviour patterns – were inherited. All male blackbirds have similar songs. Bowerbirds build and decorate complex bowers to attract mates. Ants live in complex colonies, dogs run in packs, cats tend to be solitary. Because human beings tend to behave socially in similar ways across cultures, there was no reason to suppose human social behaviour wasn’t as instinctive as that of blackbirds, bowerbirds, ants, cats or dogs. The main alternative to the psychodynamic framework at the time was Watson and Skinner’s behaviourism, which proposed that complex behaviours such as social interaction were learned. But behaviourism was widely treated with suspicion because it was seen as reductionist. (How can you reduce something as nuanced and complex as social interaction to something as basic as a rat’s tendency to run through tunnels or a pigeon’s tendency to peck?)

Secondly, no one working in child development prior to the 1960s knew much about how the brain worked. They were all guessing. Their guesses were often extremely well informed, but they were guesses nonetheless. Spitz, Bowlby, Ainsworth, Harlow and Kanner all came down on the ‘instinct’ side; Watson and Skinner on the ‘learned’ side, but none of them knew about the biochemical mechanism of learning in the brain.

Thirdly, none of the child development researchers needed to figure out how social instinct worked because the idea of ‘instinct’ itself explained their findings. It was a ‘black box’ concept. They didn’t know what was inside it and didn’t need to know; what they were interested in was what happened when the social instinct was disrupted.

People who did need to figure out how instinct worked and what was inside the black box, were ethologists studying the development of animal behaviour. In the 1950s, researchers such as Lorenz and Tinbergen began to look more closely at the difference between instinctive and learned behaviour. Most people are familiar with the famous pictures of Lorenz being followed by a column of baby geese. Because goslings and ducklings follow their mother from the moment they hatch, it was assumed that this was an instinctive behaviour. What Lorenz discovered was that the tendency to follow something was instinctive, but that what the goslings followed was learned – they followed the first moving object they saw after hatching. It might be their mother, a chicken foster-mother, the farm dog, a pair of boots (didn’t matter who was wearing them) or Konrad Lorenz.

There was a debate about instinct amongst ethologists in the 1960s because it had become clear that different researchers were using the term in different ways and so definitions got tightened up. Unfortunately, apart from Bowlby, many practitioners working in medicine or psychiatry wouldn’t have read the ethology literature – they weren’t (and often still aren’t) interested in the behaviour of goslings or wild macaques even if they had time to keep up to date with it. That’s a pity, or a tragedy depending on how you look at it, as far as instinct is concerned because what has emerged from animal behaviour research is a picture of instinct as an umbrella term that can be applied to a range of different concepts. Essentially, instinct refers to behaviours that are genetically determined, biologically controlled, automatic and unconscious. But it isn’t quite as simple as that.

Levels of instinctive behaviour

Starting at the lowest level, human physiology is genetically determined, biologically controlled, automatic and unconscious; circulation, respiration, digestion, growth and sexual development occur without any awareness or intervention on our part although we are aware of what happens as a result of them. We know a lot about how these autonomic functions work and that they are very similar in everybody. But we wouldn’t usually call autonomic functions ‘instinctive’ because instinct is about how organisms behave rather than how they function.

The most simple form of instinctive behaviour is the reflex – a simple, automatic motor response to specific stimulus. Reflexes – such as the rooting, palmar grasp, startle, swimming and stepping reflexes – are present from birth. Some have obvious survival value; others, like the stepping reflex, form the foundation for behaviours that emerge later – in this case, walking. We know a lot about how reflexes work and that they are very similar in everybody. Most people would classify reflexes as instinctive, I think.

More complex species-specific behaviours, like birds learning songs or building nests, often vary between individuals. Songbirds develop their own unique songs, bowerbirds make their bowers out of whatever materials are available. Although all human beings, regardless of culture, show similarities in social behaviour, the evidence to support the existence of a social instinct is pretty flimsy. We’d expect organisms with similar autonomic functions and similar reflexes to behave in similar ways, but that’s about as far as the evidence takes us. How people interact and communicate with each other and how frequently they do so varies much more than their autonomic functions or reflexes. Some people choose to live in tightly-knit highly interdependent groups, others to live in isolation. Some are highly gregarious, others prefer the company of cats, dogs, horses, the landscape or machines.

I’m a fan of Monkey Life, the TV documentary series about Monkey World, the primate sanctuary in Dorset, UK. A few years ago, Monkey World took in 88 capuchin monkeys from a lab in Chile. Some of them had been born in captivity, others had been captured from the wild. During their rehabilitation, Alison Cronin the sanctuary director commented that the wild-born capuchins instinctively knew how to eat their natural food but the cage-born capuchins didn’t – they had to learn to do that. Alison’s comment introduces a slightly different use of the word ‘instinct’, meaning a behaviour that happens automatically and unconsciously, but isn’t genetically determined and biologically controlled. The documentary also showed that chimps and orang-utans born in captivity tend to be poor mothers. You could argue, as the psychodynamic theorists would have done, that the capuchins’ feeding instinct and the chimps’ and orang-utans’ maternal instincts had been disrupted by their captivity and so hadn’t been allowed to develop normally. That’s one theory. What’s also possible is that the cage-born primates, or those captured in infancy, simply hadn’t had the opportunity to learn how to forage, peel fruit or rear babies.

Human social behaviour varies widely. That variation could be because the normal social instinct is disrupted by events in childhood. But because we don’t know exactly what ‘normal’ human behaviour looks like, and we have no idea how the social instinct works (in contrast to what we know about autonomic functions and reflexes), a more likely explanation is that some aspects of human social interaction are instinctive and others aren’t. Social behaviour is hugely complex, so the question is which bits of social behaviour are instinctive and which aren’t?

As I pointed out in the post about the social instinct and Kanner’s syndrome, the areas of the brain dealing with social behaviour handle complex information from many areas of the brain. From an information-processing perspective, social behaviour, far from being instinctive, results from an interaction between the way the body works, environmental factors such as nutrition, and experience. Most researchers in all areas of child development are aware of the importance of interaction between factors in development, but by necessity, they are usually focusing on one factor only, and tend to overlook anything outside their field of expertise.

Social or sensory deprivation?

A final observation about Harlow’s work. There’s no question that Harlow’s baby primates were socially deprived. But they also suffered sensory deprivation as well, and I don’t know if Harlow controlled for that. Given his conclusions I don’t get the impression he did. Some of the infant macaques, for example, were kept in total darkness for months. Light is essential for entraining circadian rhythms, so absence of light alone would have seriously messed up their physiological functions. Coincidentally, I was listening to Crossing Continents yesterday on BBC Radio 4. A former inmate of Louisiana State Penitentiary, who’d been in solitary confinement for 30 years, was describing his experiences. He highlighted, not so much the social isolation, as the sensory deprivation. He’d had a long time to think about what it was he missed; it would be all too easy to assume in the same situation we’d miss other human beings, when what we might actually miss is the complex sensory input we get from interactions with other people. I’m not trying to reduce social contact to sensory stimuli – social contact is clearly more than the sum of its parts – I’m just saying that it’s very difficult to make a distinction between social interaction and the sensory input that comes with it.

The benefits of hindsight

I’ve been quite critical of psychodynamic theorists, but I’m very aware that they were working with the knowledge that was available at the time. I think what we need to be wary of is assuming that knowledge develops in a straight line; that Freud, Bowlby, Harlow and Kanner were basically right but we now know more than they did. With the benefit of hindsight we can see which aspects of earlier theories are supported by later research and which aren’t. I don’t think there’s much evidence to support the idea of social instinct. What the evidence does suggest is that although instinctive behaviours are quite likely involved in social interaction they are only part of the story.

turning Kanner’s model of autism upside-down

Kanner’s model of autism should be turned on its head.
The idea that Kanner’s syndrome was caused by a fundamental impairment in social interaction has prevented us discovering the causes of autism.
Those are quite bold claims. In the next couple of posts I’ll explain why I made them.

Previously, I suggested that Kanner was using two theoretical frameworks to analyse the behaviour of the 11 children with his unique syndrome; Kraepelin’s classification of mental disorders and psychodynamic theory. Kanner’s comments imply that he interpreted abnormalities in feeding, speech and movement in social and sexual terms because of the psychodynamic framework. I want to look more closely at psychodynamic theory and explain my claim that viewing Kanner’s syndrome as caused by a fundamental impairment in social interaction has proved an obstacle to research into the causes of autism.

How the brain works: the psychodynamic model

As I pointed out earlier, three of the founders of psychodynamic theory, Freud, Jung and Adler, had neurological experience and would have known a fair amount about brain anatomy and about the specific functions of different parts of the brain. What they also would have known about was the patterns of electrical activity that had been observed in the brain. What was little understood at the time was how the brain worked, so the psychodynamic theorists had to make an educated guess based on their observations of people’s behaviour.

What Freud came up with was the idea that human behaviour is driven by life instincts such as the will to survive, to eat, to seek pleasure and sexual gratification. He eventually grouped these instincts together into a primary life instinct or ‘drive’ (Eros) that created flows of energy through the brain. The life drive was the origin of all behaviours that increased the chance of survival, such as an awareness of one’s surroundings and the ability to interact and communicate with others. (Freud later added a death drive (Thanatos) to explain aggression and destructive behaviour). In the light of what we now know about how the brain works, it’s clear that some aspects of Freud’s model were very insightful but others weren’t.

How the brain works: the information-processing model

Fifteen years after Kanner first described his syndrome, David Hubel and Torsten Wiesel began publishing their work on the visual cortex of the cat. Hubel and Wiesel’s research was significant, not just because it told us a lot about how cat vision develops, but because it provided some important insights into how brains in general process information – the mechanism that the psychodynamic theorists were trying to figure out.

Hubel and Wiesel’s research, and the work that followed it, revealed some key principles about how the human brain processes information.

1. All information about the outside world enters the brain via the senses.

2. Sensory information is processed in a hierarchical way, from simple to complex – broadly speaking, from the back to the front of the brain.

3. Different parts of the sense organs respond to different aspects of sensory information and that information is then integrated increasingly as it’s transmitted through the brain.

Say, for example, that I am looking at a table. Different cells in my retina respond to different properties of the pattern of light reflected off the table and entering my eye; some cells respond to the boundaries between light and dark areas, others to light of different wavelengths (colour). This very basic information about the pattern of light from the table is then integrated as it passes through my brain; first it’s chunked up to form a pattern that represents the table I’m looking at. This representation is then linked with stored representations of other images, such as other tables and chairs, and is then integrated with information from other sensory modalities such as what the word ‘table’ sounds like, what the written word ‘table’ looks like, what tables feel like and so on. This information ends up in the frontal area of the brain, which has been described as having an ‘executive function’ – it integrates information from all over the brain and makes decisions on the basis of that information. Except that information doesn’t actually ‘end up’ anywhere, because the brain has a complex series of feedback loops that send information from higher-level areas back to lower-level ones.

What does the way sensory information is processed have to do with Kanner’s syndrome?

Kanner concluded that the ‘…fundamental disorder is the children’s inability to relate themselves in the ordinary way to people and situations’ because he was working within the psychodynamic framework. He saw the children’s abnormal behaviours essentially as caused by a disruption in ‘the usual biologically provided affective contact’ – an instinct that emerged from the life drive. Kanner doesn’t use the terms ‘instinct’ or ‘life drive’ – he doesn’t need to because all his readers would be familiar with that framework – but he makes it clear that he sees affective contact as an innate, biologically-based ability that the children didn’t have.

I can understand where the psychodynamic idea of instincts came from. Most children develop skills like eating, walking, responding to the world around them, interacting with and communicating with other people, without any apparent effort on their part or any significant intervention from adults. Indeed, psychodynamic theorists felt that adult intervention often disrupted normal development. It made sense to assume that natural selection had ensured the ability to relate to people and situations developed instinctively – as automatically as growth or sexual development, or the way the heart, lungs and digestive system function.

I think Kanner’s conceptual model of his syndrome could be represented like this:

Kanner's conceptual model

But from what we now know about brain function, as far as the brain is concerned the ability to relate in the ordinary way to people and situations is exactly the opposite of a basic instinctive drive. There are areas of the brain that specialise in relating to people and situations; they are in the frontal lobes where information from many other brain areas is integrated. Relating to people and situations requires monitoring a constantly changing flow of complex information from a wide range of sources and constant feedback to other parts of the brain. The frontal lobes and their functions develop slowly and mature late – often not until early adulthood. Even after maturity, because of the plasticity of the brain, the frontal lobes continue to change in response to the environment.

Highly over-simplified schematic showing flow of sensory information to frontal lobes

We’re not usually aware of all this complex integration, monitoring and feedback of information; what we usually experience in ourselves, and observe in others, is that responses to the environment and to one another happen instinctively and automatically – that is, until something goes wrong. When we find we have too much or too little information, or that information is ambiguous, or we feel tired, hungry or anxious, then behaviours that most of the time feel and look instinctive and automatic, feel and look a bit less instinctive and automatic.

An impairment in processing any of the streams of information about people and situations would, to some extent, disrupt normal responses to people and situations. In the light of what we now know about the way the brain works, I propose that Kanner’s causal model should have looked more like this;

alternative model for Kanner's syndrome

What we now know about how the brain works suggests that Kanner’s conceptual model of his syndrome should actually be reversed; that relating to people and situations is the outcome of some very complex information-processing requiring input from many parts of the brain, rather than a basic, automatic instinct that drives other behaviours. The implication is that rather than a disturbance in affective contact causing problems with feeding, speech, body movements, social interaction and communication, what’s more likely is that problems with motor function, sensory processing, speech and language resulted in the children’s problems with relating to people and situations in the ordinary way; that Kanner’s model should be turned upside-down.

More on this later, but next I want to look again at Kraepelin’s classification system and find out what happened to Kanner’s syndrome after 1943.