R. G. Gordon, M.D., D.Sc., F.R.C.P.E
It is perhaps not too much to say that the basis of mental welfare lies in habit formation. The foundation of habits, whether for good or ill, begins immediately after birth and only ceases with death. Before starting to pursue the subject in any detail, I would like to quote the opinion of two very dis- tinguished psychologists of a past generation on the subject of habit. The first of these is Dr Maudsley, the distinguished alienist. He says, ” If an act became no easier after being done several times, if the careful direction of con- sciousness were necessary to its accomplishment on each occasion, it is evident that the whole activity of a lifetime might be confined to one or two deeds? that no progress could take place in development. A man might be occupied all day in dressing and undressing himself; the attitude of his body would absorb all his attention and energy; the washing of his hands or die fastening of a button would be as difficult to him on each occasion as to the child on its first trial; and he would, furthermore, be completely exhausted by his exertions. Think of the pains necessary to teach a child to stand, of the many efforts which it must make, and of the ease with which it at last stands, unconscious of any effort. For while secondarily-automatic acts are accomplished with compara- 3? MENTAL WELFARE tively little weariness?in this regard approaching the organic movements, or the original reflex movements?the conscious effort of the will soon produces exhaustion.” The second of these is Professor William James. He says: ” Habit is thus the enormous fly-wheel of society, its most precious conservative agent. It alone is what keeps us all within the bounds of ordinance, and saves the child- ren of fortune from the envious upsprings of the poor. It alone prevents the hardest and most repulsive walks of life from being deserted by those brought up to tread therein. It keeps the fisherman and the deck-hand at sea through the winter; it holds the miner in his darkness, and nails the countryman to his log-cabin and his lonely farm through all the months of snow; it protects us from invasion by the natives of the desert and the frozen zone. It dooms us all to fight out the battle of life upon the lines of our nurture or our early choice, and to make the best of a pursuit that disagrees, because there is no other for which we are fitted, and it is too late to begin again. It keeps different social strata from mixing. Already at the age of twenty-five you see the pro- fessional mannerism settling down on the young commercial traveller, on the young doctor, on the young minister, on the young counsellor-at-law. You see the little lines of cleavage running through the character, the tricks of thought, the prejudices, the ways of the ‘ shop,’ in a word, from which the man can by- and-by no more escape than his coat-sleeve can suddenly fall into a new set of folds. On the whole, it is best he should not escape. It is well for the world that in most of us, by the age of thirty, the character has set like plaster, and will never soften again.” If the life period between twenty and thirty is critical in the formation of intellectual and professional habits, the period up to twenty is more important still for the fixing of personal habits, properly so-called. Professor James was of course more concerned with adult psychology than with child psychology, but he is very definite on the importance of early habit formation. The im- portant habits are established in childhood. The first habits develop from the instincts, and it may be worth while to consider the definition of these two terms. Both are what we call patterns of behaviour, that is to say, they are specific responses to a definite stimulus. For example, if a light is flashed in front of the eyes, the eyelids will close?the subject will blink?that is a pattern of behaviour. Again, if a person treads on something sharp he will withdraw his foot and perhaps utter a cry. Here is another pattern of behaviour but one that is more variable, for although he will always and in- evitably withdraw his foot, he may or may not always utter a cry. Again, if one is hungry, one will seek food and eat, but here the pattern is no longer ” specific,” for one may cook a meal and eat it in one’s own house or one may beg food from a friend or neighbour, or one may go out and buy it at a restaur- ant. Instincts and habits are, however, patterns of behaviour which are more or less specific, that is to say, the same response is always to be expected from MENTAL WELFARE 31 the same stimulus. In the case of the instinct the pattern is laid down at birth, and strictly speaking, in order to come within the true definition of an instinct should not be modifiable by the influence of environment. For example, when a duckling is put into water it swims; this is an instinctive pattern of behaviour which the duckling has never been taught, and which it performs almost per- fectly the first time it tries. The spider spins her web in a particular way and in a particular pattern from the first time to the last. This pattern of behaviour is probably never modified all through her life and is a true example of instinc- tive behaviour. The higher we ascend in the evolutionary scale, however, the less specific does instinctive behaviour become. Even the duckling improves his instinctive swimming and becomes more skilful. When we come to the human being, we still find examples of instinctive behaviour, but the patterns are much more plastic and capable of modification, and as a fact, for the most part become transformed into habits. The habit is also a specific pattern of behaviour, but it has been learnt; it is acquired and not inherent. Habits may be good or bad, but whether good or bad, they have been learnt and can be unlearnt, and so are more within the control of the individual and his in- structors than are the instincts, though as we have seen, even the instincts of man are modifiable and therefore to some extent under control. I need make no further reference to the utility of habits, because this has already been des- cribed better than I could do in the quotations I have given, but it should be noted that as a rule a habit once acquired involves an activity, which is neither thought about nor felt about. As will be seen later, this is not universally true, for there are some habits which involve a lot of thought and a great deal of feeling, but these may be left for the moment. As an example of a typical habit, let us take walking. Consider the enormous interest and emotional accompaniment of the child’s first efforts to walk. Consider the thought that has to be given as to where his foot is to go and how he is to lift his leg. It may be said that a child of the age at which he learns to walk does not think or feel all this, but this is not so. No doubt he does not think and feel in the same way as does the adult, no doubt he is less aware of his thinking and feel- ing and is unable to reflect on it in the same way, but in his own way and at his own level he certainly does think and feel. Any person who has ever had an illness which involved the necessity of re-learning to walk, will know how much thought and how much feeling goes to the business. To most of us, however, walking is a well established habit and this pattern of behaviour has become what we call automatic. By this we mean that we walk without think- ing about it or having any particular interest in how we do it, unless, and here is an important point, something obstructs the smooth and accustomed per- formance of the activity. This may be seen, when for the first time, we walk ?n to a moving stairway and some people are so disturbed in the interruption in their normal habitual method of walking that they take a long time, or even perhaps never acquire the new modification, so that every time they come to the escalator they have to stop and think how they are going to step on to it. 32 MENTAL WELFARE It is obvious that it is impossible to discuss all the habits that should be acquired or avoided from the time of the child’s birth till man or woman’s estate is reached, and it is proposed to discuss four, three very early and one relatively late, which are of more than usual psychological interest. These four are eating, the elimination of waste products from the body, sleep, and self- abuse or masturbation. The first necessity for the new-born infant is to obtain nourishment, and this he does normally by suckling the mother’s breast. This process of suckling is a true instinct and is performed by the infant without learning, but none the less the process must be transformed into a habit in the sense that the infant must be taught to feed at definite times and at definite intervals. It is un- necessary to refer to the difficulties which ensue later, in the form of digestive disturbances if the infant is fed whenever it cries, but there is another aspect of this which deserves attention. It must be remembered that for the young infant, suckling is about the only or at any rate the chief activity of his day, and if he can get his own way about it on any occasion he wants, then he is apt to think, if we can describe the mental processes at such an early age as thinking, that he can always have his way, and he will start life at a disadvantage, for sooner or later, and of course sooner rather than later, he will find he cannot get his own way, and so will come up against a serious conflict. This will react on him in one of two ways. Either he will be discouraged and fail to make any more efforts, becoming depressed and sullen and with a sense of grievance against society. Or he may become aggressive, kicking vainly against the pricks, thus becoming an enemy to society. Such pictures are of course ex- treme, but these are the tendencies. If, on the other hand, the child from the beginning learns that he can only feed at stated times and after stated intervals, not only will his digestion be better, but he will start well, for he will be prepared to compromise with his environment, and will realise that there are times and seasons for everything. Later on regular habits with regard to meals are obviously advantageous to the child and quite often irrational likes and dislikes of articles of food are merely bad habits associated with the natural process of eating. This however, is not always so, and if a child shows a per- sistent dislike of all sweet things or all fat things, it may be because his body cannot cope with sugar or fat. Again, if a child persistently craves for sweets, it may be a bad habit, or it may be because he does not have enough sugar supplied to him because his body chemistry needs more than the normal amount. On more than one occasion this has been found to be the explanation of stealing by a child who never took anything except sweets, or money to buy sweets. Such a state of affairs is, however, the exception and not the rule. There are other habits in connection with infantile feeding which are not with- out importance. For example, if the child is allowed to suck the mother’s nipple too long, he gets a liking for the sucking motion for its own sake, apart from the real object of acquiring nourishment, and this may come out later as thumb-sucking, nail-biting and other undesirable habits. MENTAL WELFARE 33 Next to turn to excretion. Modern psychology has laid a good deal of stress on the psychological effects of the good or bad habits acquired in relation to the excretory activities of the infant, and it may be admitted that at first reading, these claims appear very far fetched and quite incredible, but with in- creasing experience, one has found that one has changed one’s mind consider- ably, and while not prepared to agree with all the deductions made by certain schools, I do believe correct habit formation in these respects is of great im- portance to the child. It must be remembered that practically all infants take a good deal of interest in their excretory actions, partly because they form a relatively large part of their activities at an early age, and partly because it is something which they do entirely themselves. The psychologically important aspect, however, is in the attitude of the adult, for the infant finds himself encouraged to perform these actions, but directly he begins to display an undue interest, then he is met with disapproval and prohibitions. Hence the im- portance of inculcating into the child at a very early age, a regular habit from which all emotional interest is, so far as possible, excluded. If the habit is not regular and if the child becomes constipated, then he has to be encouraged and naturally his interests and attention are concentrated on this function, and from this he comes up against the ethical and aesthetic prohibitions of his elders. He does not understand this situation, and he is apt to develop a sense of guilt in face of anything he does not understand. He will almost certainly ask why he should not be interested and he will almost equally certainly be told because it is nasty or simply that he mustn’t, that is to say, that no real explanation is advanced. He may therefore develop a feeling that whatever he does is likely to be wrong. This guilt feeling is very common not only in children but all through life, and is an exceedingly distressing experience and a really serious handicap in life. In our attempts to remove this symptom, it is necessary to try to trace it to its origin. In so doing we very frequently find it figuring in connection with the sexual life, both in adults and adolescents, but as a rule we find that this is only a secondary manifestation, and that it had appeared in the life of the child before any of the sexual manifestations to which it later becomes attached have made their appearance, and if we take great pains, we can trace the feeling back in many cases to this conflict over the excretory habit when the parents have first encouraged the child to interest himself and then blamed him for doing exactly what they apparently wanted him to do. Apart from this, it is quite possible, as the psycho-analysts hold, that certain perversions and other aberrations of character depend on wrong habits in con- nection with these excretory activities, but with these we cannot occupy our- selves at present, though it may be useful to say a word about a very difficult and serious problem of childhood and adolescence?bedwetting. Bedwetting may be due to a great many causes and some of them are remediable and some not, and what follows does not apply to every case. Yet it is certain that a great many cases are due to the fact that the child fails to develop an unemotional habit in relation to the excretions. So great an author- 34 MENTAL WELFARE ity as Dr Hcctor Cameron has callcd bedwetting the ” what again habit.” By this he means that whenever the nocturnal accident happens, the child is met by a harassed and distressed mother, who exclaims, ” what again.” So very often one finds that bedwetting occurs when the family consists of an only child and an over-anxious mother. Mother expects her child to be very advanced and to develop clean habits earlier than other children. When her child, alas, does not prove itself so precocious as she expects, she begins to worry; she says to herself and then to the child, ” will you never stop wetting yourself.” The child, and especially the only child, loves to be fussed over and to be the centre of regard and excitement, and he becomes dimly aware that the more he wets the bed, the more of this delectable fuss there is. So instead of acquiring the un- emotional habit of control, there develops an excitable habit of bedwetting. Later, since the habit sinks below the level and control of consciousness, the bedwetting continues as an unconscious impulse, the nature and cause of which the older child is quite unaware. The following case exemplifies this. A girl of 13 suffered from persistent bedwetting. The fussy and perturbed attitude of the mother, and the somewhat self-satisfied attitude of this only child, were at once obvious, although superficially she professed herself concerned with the problem. I examined the child with some care and satisfied myself that none of the common physical causes of bedwetting were present, but suggested some simple remedies to gain time, as I realised that I was faced with a psychological situation in which the mother, far more than the child, required treatment, and this treatment was not going to be easy, for the mother was convinced that her attitude to the child was quite perfect, and that no more beautiful and loving relationship between mother and daughter could be imagined. I looked forward to the issue with no little gloom when fate came to my assistance. The mother became seriously ill and the situation was dramatically changed. In- stead of the mother continuously fussing over her daughter, the daughter had to turn to and fuss to some purpose over her mother. The bedwetting stopped like magic and when the mother recovered, she wrote me a most grateful letter thanking me for my skill in curing her daughter. I asked to see her and tried to explain to her that it was not I who had stopped the bedwetting, but her own illness. I am very doubtful if I succeeded, and I only hope the child will not relapse, for the treatment was really somewhat drastic, at any rate from the mother’s point of view. This gives an idea how ill-founded some medical reputations are, but still, what we gain on the roundabouts we lose on the swings, for it often happens that when we really think we have done something useful for our patients we get nothing but abuse! The next subject is sleep, and here, a somewhat different problem presents itself. Without going into all the theories of sleep it would seem that the most likely explanation is that sleep occurs when all or almost all stimuli are with- held from the brain. If and when a new centre of stimulation is started up, the person wakes up again and sleep is prevented. It is desirable, therefore, that from the earliest age the child should be taught to regard his bed time and MENTAL WELFARE 35 sleep time as a matter of course and not to expect any stimuli at that time. If he expects his mother to sing him to sleep or to rock his cradle, he is developing a wrong habit, for although the monotony of sound or movement may shut out other stimuli and the child may go to sleep, he is developing a situation in which sleep is associated in his mind with the expectation of stimuli and basically sleep and stimuli are incompatible. Later on, bed time may become associated with an expectation of wakefulness and a real insomnia is developed. The business of going to sleep, then, should be as negative as possible* and the happy child is he who learns to be left to go to sleep and to leave his workaday world behind him when he goes to bed. Lastly, the habit of self-abuse or masturbation. It is probable that more nonsense is talked about masturbation than about anything else on earth and more cruelty applied in the name of morality than in any other held. I obstinately refuse to be shocked by masturbation, and regard it as an activity, or a habit which is practically universally practised at some time or other during life. Let us consider for a moment the two great appetites of humanity, hunger and sex. Hunger is the appetite which ensures the survival of the individual, and sex is the appetite which ensures the survival of the race, and in the eyes of nature one is as important as the other. In the case of hunger, satisfaction is always guaranteed under civilised conditions, and from the very earliest years, the child is taught to control and regulate this appetite, so that his behaviour in relation to it is in accordance with the demands of society. Even if he does not observe these demands and is gluttonous and greedy, then it is no great matter and the child is not made to feel that he is outside the pale or in danger of damnation either in this world or the next. In the case of sex, things are very different. No provision for gratification is offered by civilisation, indeed, the very opposite pertains and economic conditions cause marriage, the only recognised circumstance of gratification, to be postponed to a later and later age. No systematised instruction is offered to the child, so that he may realise clearly even what is the nature of this new urge which comes upon him, often so suddenly and overwhelmingly. Far from this, the preliminary curiosity which should lead up to an understanding of puberty when this comes along, is too often met by statements which the child soon finds out to be lies and by avoidances and subterfuges by which the child is mystified and hurt. Even before the onset of puberty, the child is vaguely aware of a tension, of a sort of bodily restlessness which makes him uncomfortable, ind this tension is enor- mously increased at the onset of puberty. Almost inevitably sooner or later, either by accident or by instruction from other children, he learns that certain movements and functions are not only pleasurable in themselves, but bring about a welcome relief of this restlessness and tension. Then he is met by a bombshell. Grown-ups swoop down on him or her and tell him he is a wicked child and threaten him with all sorts of moral and physical disasters if he con- tinues in this disgusting habit. Why the habit is disgusting is not explained, and of course, if he has already acquired a sense of guilt, this will be intensified 36 MENTAL WELFARE a thousandfold. I maintain that it is not the child who is wicked under these circumstances, but the parents who are wicked and cowardly and cruel. They have shirked telling the child the truth, and let me repeat, there is no real difficulty in telling the child without in any way stimulating undesirable curiosity, or giving the child information beyond his capacity to understand. Having shirked this duty, they try to impose their will by presenting the child with bogeys, so that they may restrain an activity by fear of consequences, which all educationalists will tell you is the lowest level of compulsion, only to be used if all else fails and then hardly ever successful. These bogies take the most extraordinary forms. The child is told he will suffer from all sorts of diseases, that he will go mad, that everybody will be able to know if he ever indulges in this practice and so on. Let me say quite clearly, that no disease cither mental or physical has ever been caused by masturbation, and no one on earth can tell by looking at him whether a child or adult practises this mastur- bation. No doubt the idea may have grown up amongst the laity from these sorts of reasons. It is undoubtedly the case that many mental defectives and many of those who suffer from mental disease do practise masturbation to excess, but they are not mentally defective or mad because they practise self- abuse, it is the other way round. Defectives and those who are insane are not possessed with the power of self-control over their appetites which are enjoyed by the mentally healthy and so far as sex is concerned have no opportunity of normal gratification, so that it is not surprising that they practise self-abuse. Again, it is not uncommon for adolescents to be spotty about the face and it is by no means uncommon for adolescents to practise self-abuse, but there is not a shred of evidence that the two are in any way connected. I think you will agree then, if these facts are so, that it is not very surprising that self-abuse is a common practise at or about puberty, and I repeat that, if kept within bounds, it is not going to be attended with any great disaster as, incidentally, the great majority of people have found from their own experience, but I do maintain that if a child really gets a sense of guilt and starts to worry over it and feel inferior about it, then serious disaster may ensue. I have no hesitation in saying from my own experience in treating patients that many a so-called nervous breakdown is caused not by self-abuse itself, but by the worry and mental con- flict engendered by a wrong attitude towards it. Moreover, while such a conflict may not actually cause insanity, I have no hesitation in saying that many an attack has been precipitated by it and many a suicide determined by it. Arc we to say then, from the psychological point of view, that masturba- tion docs not matter or is even to be encouraged? The answer is certainly in the negative for two reasons. In the first place, we are dealing with an appetite and its direct and easy gratification. Let us take the example from hunger again. It is generally agreed that those human races who live in places where food grows literally ready to hand so that they have to make no effort to gratify the appetite of hunger and so to preserve their individual existence, do not advance very far in the scale of civilisation. The people that come out MENTAL WELFARE 37 on top in the long run are those for whom individual survival is a continuous struggle, requiring the exercise of those qualities which human beings enjoy in contradistinction from the animals, in virtue of their more highly organised nervous systems. So it is with sex, it can never be good for an individual to gratify any low level impulse without an effort, therefore on these grounds masturbation is to be discouraged. In the second place there is a more subtle reason which is no less important. Until adolescence, the human boy or girl has not developed to any extent a social sense or an altruistic appreciation of life. He still loves himself before everything and anyone else, but with the advance of adolescence this alters and his personality unfolds so that he begins to con- sider others before himself. Now this is a very important development both from the individual and social point of view, and one, though not the only, drive towards this unfolding of the personality, is sex. When the young person first falls in love, then for the first time does he or she think another person of more worth than herself, and the drive towards falling in love is, of course, the sex appetite. If then this sex appetite is gratified in and by the self, it stands to reason that the personality will tend to remain self centred and unexpanded. I do believe that this result may be observed, but I am by no means sure yet whether, to put it broadly, the person who continues to gratify his sex impulse by masturbation, remains shy and sensitive, or whether it is the other way round, that the shy, sensitive person is more likely to gratify his sex impulse by masturbation, than to go out into the world and find a mate, but I have very little doubt that the two do tend to go together. I would maintain then, that the boy or girl should have their curiosity satisfied simply and placidly about sexual matters, as and when it arises, without going into unnecessary details or making any sort of fuss about it. I believe that the nature of the sex appetite can be explained to him as being analagous to hunger. I think that quite young children can appreciate the necessity and desirability of controlling such an appetite. They themselves would check a younger brother or sister who, on being given a box of chocolates, finished it at a sitting, and so it can be pointed out to them that this tension will arise and may from time to time be so in- sistent that it cannot be denied. If so, they need not regard this as anything disastrous or to be frightened about, but at the same time, it is not an excuse to indulge the practise unnecessarily or unduly. The future purpose of the impulse, to continue the race through the best means, namely, marriage and the upbringing of a family, can be pointed out to them, and the second argu- ment which I have advanced is usually understood by an intelligent child with- out difficulty. Admittedly, it is not an easy subject, but that is the fault of the civilisation, not of the individual, and personally I have no hesitation in saying I would far rather have a person who occasionally gives way to masturbation, than one who is hag ridden by all the fears which so often accompanied the old methods of trying to prevent it.
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