James Robertson

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

In a 1959 review of the film, Donald Winnicott declared that he seldom met a nurse who had not seen the film and considered its great influence on the nursing profession.

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".

Life 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. He intrinsically understood that children needed their mother and was sensitive to pain due to separation. He became a Quaker in his late teens, and in the Second World War he registered as a conscientious objector.

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. The couple had both been working at the Bournville chocolate factory at the time they met. The couple had had two daughters, Katherine McGilly (born in 1944) and Jean Clelland (born in 1950). Later they had two grandchildren and three great grandchildren.

Career

When World War II broke out, Robertson registered as a conscientious objector. At the start of the work he began 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.

Hampstead Wartime Nurseries In January 1941 the couple began working with Anna Freud in the Hampstead War 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. 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. Robertson also acted in the role of a father figure to many of the children without fathers.

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

In 1945, the couples thirteen-month-old baby, Katherine had to go into hospital for a week for treatment. The couple were appalled to discover that they could not visit their child. Indeed, this was considered normal practice. 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 an editorial in The Lancet. This was widely practiced in UK hospitals. Robertson decided from that point onwards to only research mother/child separation due to hospital admission.

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. Out of the 191 children remaining at the nursery at the end of the war, Robertson returned 101 children to their parents. After the war, Robertson won a scholarship to the London School of Economics after the war to study psychiatry, graduating in 1947 as a psychiatric social worker. After his graduation he began training in psychoanalysis with the help of Freud.

Tavistock clinic In February 1948, Robertson was a co-founder along with John Bowlby's of the Tavistock Child Development Research Unit at the Tavistock Clinic. Bowlby had received a small grant from the Sir Halley Stewart Trust in 1948 to start researching the effects of separation and maternal deprivation of small children aged between 1 and 3 years that Bowlby called his sanatorium study. Robertson had been employed by Bowlby to make observations on separated young children and report the findings to Bowlby. Robertson had been trained in a strictly Freudian view of psychoanalysis that was not shared with Bowlby's. Bowlby at the time believed in what became known as the object relations theory of psychoanalysis that was developed in the early 1930s and 1940s by Melanie Klein and Donald Winnicott and formalised in 1952 by Scottish psychiatrist Ronald Fairbairn. Although for most practical purposes he was in agreement with Freud, when it came to discussing theory they had widely differening views. The German-American child psychologist Christoph Heinicke who specialised in mother/child separation (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. This perhaps reflects in Robertson and Bowlby's relationship and how each viewed different theoretical aspects of mother/child separation. Certainly they complemented each other work, Bowlby as theorist who would use Robertson material that he compiled from observation. Also at Tavistock was psychoanalyst Isobel Menzies, who studied the how the stress of working in hospital causes anxieties in nurses and how they dealt with it. Robertson used Menzies insights in his research.

Young children in hospital Beginning in February 1948, Robertson began observing young children at Central Middlesex and Harefield hospitals and made similar visits to local short and long-stay hospitals as well as residential nurseries. At the time, visiting of children in hospitals was still severely restricted. This was again illustrated by a 1949 letter to The Spectator by H.G. Monroe Davies who published a survey of visiting times to London Hospitals for parents. Some allowed no visiting, some no visiting for under three 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'.

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 three years old. The competent, efficient doctors and nurses gave good medical care but seemed unaware of the suffering around them. Robertson described his experience:

Naturalistic observations During this project, Robertson observed more than 50 children in both long and short stay wards, although not all of them were intensively observed. When Robertson and Bowlby analysed the observations they concluded that when the child lost their mother and their efforts to regain that contact failed, they responded by inhibiting their feelings. Bowlby assigned the term "Detachment" to this phase. In 1950, developmental psychologist Mary Ainsworth joined the clinic in 1950. She was assigned to analyse Robertson's observations and tried to persuade Bowlby that the term was misleading as she believed an inhibition was present that blocked intense feelings of attachment, i.e those intense feelings were still present but inhibited, whereas detachment indicated separation from the care-giver. Robertson and Bowlby believed this inhibition was responsible for the tic-like movements and avoidant behaviour and it was Robertson qualitative assessment that the longer it went on for the child who received less comfort from hospital staff, the more psychological disturbance the child would experience at home. The child became more aggressive and anxious, would seek less affection, which would likely to occur at odd moments and without explanation. An example was "Bobby" who would punch his father for a particular reason, but would smile and severely punch his mother, randomly and seemingly for no reason.

When Robertson completed the study, Bowlby uses a quantitative metric on Robertson's data, based on IQ and teachers ratings of the children, to form a hypothesis that could prove the children would suffer consequences in later life due to separation, but was unable to do so. The results were withheld from publication. However, the qualitative results of the naturalistic observations by Robertson were considered by Ainsworth to be "entrancing’ and ‘deeply impressive". She stated:

One of the most influential observations Robertson made concerned "ambivalent anxiety/preoccupation" and avoidant behaviour that manifested as being withdrawn. After the child was separated from his mother, followed by protest, the behaviours were seen over an extended period of time that decreased as time went on. This led to a preoccupation of the child with the caregiver. Upon reunion, the child would display avoidant behaviour that could lead to withdrawal when the child returned home.

Other behaviours As well as ambivalent and avoidant behaviours, Robertson observed a number of other behaviours that was later important for the formation of attachment theory. These were behaviours associated with separation but also reunion. For over a decade, between the mid-1950s and the mid-1960s, Bowlby would record these observations in a book, writing and rewriting them as the context changed and new knowledge emerged. The core of these behaviours that Robertson observed was one of disorientation. Both Bowlby and Robertson suggested they indicated some form disruption of the attachment response, but weren't sure what it signified. The lack of clarity by Bowlby, led him to prevent the book being published, which resulted in a gradual separation by Robertson from the Tavistock Clinic in the early 1960's. Ainsworth saw the lack of publication as a major loss to development psychology.

Disorientation Robertson noted that children could change between ambivalent and avoidant behaviour without an external input. An example patient, Jacqueline, after five months at home, would seek "baby cuddles" from her mother in the evening and daytime, but between the two extremes of behaviour, of being a baby and being detached and independent, she would exhibit little evidence of a moderate behaviour expected of a young child. Essentially she would swing between the two behaviours.

Robertson also observed disorientation during a reunion between mother and child. During a visit by Laura's mother Robertson described the disorientation:

Robertson thought that avoidant behaviour was often associated with disorientation and interpreted these behaviours as repressing attachment behaviour. A different child was fearful when she was reunited with her mother. Robertson believed that the child thought the mother was a stranger due the attachment behaviour being repressed. He noted:

Another behaviour he observed was the child freezing when scared instead of seeking help with an caregiver. This was evidenced by a patient, Vicky, who had returned from hospital:

Another observation that Robertson observed was the child seeking care from strangers instead of the caregiver, a form of disorientation. Robertson called this "disinhibited social engagement". An example patient was Jacqueline:

He believed that some children who had been in hospital would make shallow relationships with everybody was present. An example patient was Stephanie, who:

Film – A Two-year-old Goes to Hospital (1952) Robertson decided to make a film documentary of a young child's stay in hospital. He sought to create an objective film that would enable visual communication to take place in a way that the spoken word could not. Bowlby insisted that the film production was carefully planned so they could not be accused of any bias. A child was randomly selected for the experiment and a clock was always visible to show when the filming took place, which always took place at specific times. With a grant of £150 from Thomas Main, he purchased a Paillard Bolex H16 16mm cine camera and 80 minutes of black-and-white film. In August 1952, he made the film, shot it silently then added commentary later. Robertson called it a "A Two-year-old Goes to Hospital". Before releasing the film, Robertson released "A Two-Year-Old Goes to Hospital: A Guide to the Film" to guide the audience to understand what was being conveyed.

The patient was Laura, a scientific pseudonym, aged 2, in hospital for eight days for surgical repair of a umbilical hernia in Amersham Hospital. 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. The hospital treatment was considered examplary without any operational complications. Robertson and Bowlby were planning to abandon the documentary since Laura did not cry much. It was Joyce who made the critical breakthrough in realising why Laura was not crying, being a desperate attempt by the tiny girl to control her feelings. In the film Robertson observes the mother leaving the child, assured by the nurse that she would settle down when she leaves. When the mother does leave, Laura reacts violently, protesting 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. Laura also exhibits tic-like movements caused by stress.

When her husband and Bowlby showed her the film, it was Joyce who made the critical breakthrough in realising why Laura was not crying, being a desperate attempt by the tiny girl to control her feelings. For two days after Laura left the hospital, Laura was "unusually anxious and irritable. Her voice took on a higher pitch. She slept badly. She soiled herself several times. She became distressed if mother was even momentarily out of sight". Three months later, Laura's mother had another baby. When she returned from hospital, Laura displayed avoidant behaviour, particularly with her mother and seemed to be disorientated. Robert observed that:

Robertson showed the film to Laura's parents six months later and when Laura caught a glimpse of it, she became angry and distressed stating: "'Where was you all the time, Mummy? Where was you?' Then she burst into loud crying and turned to her father for comfort." When Laura was shown the film again when she was 16, she again grabbed her father tie as she had done when she in hospital.

Robertson later wrote of the experience of making the film:

Film distribution In 29 February 1952, an early version of the film that had not been edited, was shown to the British Psychoanalytical Society in London. On 5 March 1952, Bowbly read the paper "A Two-Year-Old Goes to Hospital" to the society to describ its function. In the summer of 1952, the film was shown alongside René Spitz Grief: A Peril in Infancy (a film about motherless babies) at the International Seminar on Mental Health and Infant Development held between 19 July and 10 August in Chichester. In reviewing the film, cultural anthropologist Margaret Mead described how the audience believed a similar experience could happen to their own children. On 28 November 1952, the film had its official premiere at the paediatric section of the Royal Society of Medicine in London to an audience of medical professionals where it was introduced by Bowlby who described its setting. 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. According to The lancet reaction to the film was controversial and ranged from disbelief to anger. There was even calls for the film to withdrawn. The BMJ described the film as a detailed depiction of the observable manifestations of emotional processes in infants separated from their families and wondered if it led to permanent damage in children and whether it was common effect of hospital admission. Both The Lancet and the BMJ toned down the level of anger in their responses. Anna Freud, writing in the The International Journal of Psychoanalysis, referred to it as a connected and credible account of stress and separation anxiety and complained how often the childs illness of the body had to be addressed before the child emotional state could be considered. Nursing Times reviewers observed that the film challenged assumptions about children's adjustment to hospitalisation. Robertson described the premiere as:

Due to the negative reaction of the medical community in the UK, the film was not distributed to the general public until 1959. It was reasoned that this was to ensure that child hospitalization could be reformed without segments of the medical community resisting that reform effort. The British Film Institute considered the film was of "national and historic importance" and archived it. When the World Health Organization saw the film, they bought the distribution rights and provided funding to distribute it in Africa and India.

Responses to children separated from their parents

Robertson and Bowlby 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. After several years of observations, he formed a theory based on the typical sequence of responses of children aged between 18 and 24 months who had lost the care of their mother.

In 1952, Robertson and Bowlby published "Responses of Young Children to Separation From Their Mothers". Robertson and Bowlby theorised that breaks in a child's attachment bonds were emotional responses to 'phases of protest, despair and detachment'.

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'. 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'. If however 'the separation continues for longer...the child may go on to the stage known as "despair" where they very quiet, withdrawn, miserable and apathetic. They stops playing and seems to lose interest in everything'. 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'. 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'. 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'. When eventually reunited with the family, 'the child can seem quite changed and now appears superficial, emotionally distant'. His relationships with others are shallow and untrusting. 'This is the most difficult stage to undo'.

Robertson's research was met with hostility by the medical profession. Even his colleagues at the Tavistock Clinic did not feel the same sense of urgency. They did accept 'that anything that breaks up the child's life into fragments is harmful' and understood that mothers knew this, but they failed to pick up the visual cues that were so obvious to Robertson.

In April 1953, Robertson published "Some responses of young children to loss of maternal care" in the Nursing Times.

Between 1953 and 1954 Robertson visited peadiatric professionals in Denmark, France, Germany, Netherlands and Norway and Yugoslavia to promote the film. He found the same lack of knowledge in the professionals that limited their effectiveness.

Film – Going to Hospital with Mother (1958) A key figure who was present at the Royal Society of Medicine meeting and who saw the film was Dermod MacCarthy, consultant peaditrician at Amersham Hospital. MacCarthy had originally reacted with hostility to the film, until his ward sister Ivy Morris who attended the meeting with him, informed hin that Robertson was right and that she allowed mothers to tend to their children when he was not present. From that moment, MacCarthy could not look at the young children on his wards without being reminded of the film and so decided in January 1953 to convert the wards to enable the mothers to stay in the hospital with their children.

Robertson stated of the film:

Platt Report The glacial process recognising the need for reform in welfare of children in hospital in the 1950s and earlier, had finally reached the level of the government when they decided to investigate the matter. Minister of Health Robin Turton commissioned the Central Health Services Council, that was part of the Ministry of Health, to establish a committee to undertake a special study of the arrangements made in hospital for children and the very young and to make recommendations to those hospitals.

On 12 June 1956, Sir Harry Platt, an orthopaedic surgeon who was President of the Royal College of Surgeons of England, formed the committee to examine the welfare of children going into hospital that went beyond their medical needs. Their recommendations became the Platt Report, published in 1959. In 1956, Robertson, representing the Tavistock clinic, contributed a memorandum of recommendations based on his research to the committee and also showed them the two films. In 1958, Robertson formalised the memorandum into the book titled: "Young children in hospital" that was designed as a companion to the second film. The book was translated into nine languages. The rationale of Robertson's memo had largely the same sentiments that was expressed in a report "Maternal Care and Mental Health" - on maternal deprivation, that Bowlby submitted to the WHO in 1951. Robertson posited that family life was a microcosm that existed with a larger society and that child development as an adult into that society was dependent on a care and love the young child received. He argued that the child would have better confidence and capacity for forming relationships as an adult. Yet if the child was admitted to hospital and separated from their mother, the psychological damage might affect the child in later life. He simply advised that mothers should be allowed to stay with their children in hospital. He concluded:

The Platt committee accepted all of the recommendations prepared by Robertson.

Campaigning In 1958, Robertson prepared a programme for the BBC on the two films, but was informed by them they had decided not to proceed after receiving medical advice, as they were worried that the programme would cause too much anxiety in the general public. Beginning in January 1961, Robertson began publishing a series of articles in the The Observer. The first starting on the 15 January titled "The Truth of Settling In", described the current situation and the need for maternal contact in children under two years. The second and third articles were published on the 22 and 29 January and advocated for closer contact between mother and child and "How parents can help now". The last printed on 12 February 1961, was a review of several readers letters by Robertson and called for parents to take a more active role with the provacative title: "Now over to mothers". In the same period, Robertson also wrote a article for the The Guardian where he advocated for parents to push for the implementation of the Platt Report. By that point, the BBC realised there was significant public sentiment with Robertson as the locus. So in March 1961, the BBC invited Robertson to a live show where he would present sequences from his film and give a talk. Ronald MacKeith, a paediatric neurologist, MacCarthy and Ivy Morris were also invited to discuss the films. As the show was live, Robertson, against instructions, spoke directly to the camera to ask parents to inform them of their experiences. The response was 400 letters. Robertson published them the following year in book form: "Hospitals and children: a parent's eye view; a review of letters from parents to the Observer and the BBC".

In 1960, four young mothers from Battersea who had seen the programme met with Robertson at the Tavistock clinic. Robertson urged them to organise which resulted the establishment of "Mother Care for Children in Hospital" charity in 1961. In 1963, the organisation changed its name to National Association for the Welfare of Children in Hospital. During this period, Robertson campaigned across the country with his first two films.

During next few years, Robertson held public meets across the kingdom to campaign for the group.

Fostering Introduction The Robertson’s went on to make 'a series of harrowing films that revealed the true nature and extent of distress shown by separated young children' 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'. 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'.

Grief during separation In the late 1950s, Robertson and Bowlby began to disagree on the factors involved in separating children from their parents. Little is known about these disagreements and indeed Bowbly took pains to ensure that Robertson was credited with his discoveries, particularly in his books. Certainly there was never any disagreement in public. However, in 1960, Bowlby published Grief and Mourning in Infancy and Early Childhood which was the point that Robertson and Bowbly's views began to diverge. This was Bowlby's third paper in his seminal series that led to the formulation of attachment theory but was his most controversial. In the paper, he made two assertions. Firstly that protest, despair and detachment were habitual responses in children who had been separated from their mother and secondly, that children could feel grief and mourn in the same manner as adults. He stated that:

The second assertion questioned Freud's argument that infants don't mourn due to insufficient ego development but instead they feel separation anxiety, if an appropriate caregiver is not present. Instead, Bowlby believed that infants experience grief when "attachment behaviours" are activated when the mother is absent, but no appropriate caregiver is present.

Evidence against When the paper was presented to the British Psychoanalytic Society, many in the profession considered it no more than generalisations without evidence and several members including Freud, Spitz and Max Schur were tasked to submit reponses. Freud criticised Bowlby's approach stating:

Freud stressed the lack of relevant data in which to draw conclusions, "we need to supplement our observations, excluding group or ward conditions". In a paper entitled Brief separations, psychologist Christoph M. Heinicke and psychiatric social worker Ilse J Westheimer, both colleagues of Bowlby at the clinic, discussed their observations, stating that their data could not determine the influence of institutional factors, including that of multiple caretakers. They speculated that:

In a paper published in 1961 entitled Maternal deprivation: Toward an empirical and conceptual re-evaluation, the paediatrician and psychologist Leon J. Yarrow conducted a review of the research and concluded that maternal separation had never been studied under pure conditions. Yarrow believed the complicating factors were always present.

Awards and honours

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.