James Robertson (psychoanalyst)

James Robertson (1911 – 1988) was a Psychiatric Social Worker and Psychoanalyst based at the Tavistock Clinic and Institute, London from 1948 until 1976.

'(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.' – John Bowlby.

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Background

James Robertson was born in Glasgow and grew up in a closely-knit working class family. He became a Quaker in his late teens and when war broke out, he registered as a conscientious objector. In 1941, James and his wife Joyce Robertson joined Anna Freud in the Hampstead Wartime Nurseries. Joyce was a student caring for the infants who had lost family life due to the war. James began by organising the maintenance and firewatching but later became the social worker. Both James and Joyce benefited from teaching given by Anna Freud.

After the war, James trained as a Psychiatric Social Worker and joined John Bowlby at the Tavistock Clinic in 1948, to make observations on separated young children. As a convenient way to do so, he was sent to the short stay children's ward at the Central Middlesex Hospital in London.

Young Children in Hospital

At the time, visiting of children in hospitals was severely restricted. In a survey of London Hospitals (Munro-Davies, 1949) the visiting hours were:

• Guy's Hospital, Sundays, 2-4pm;
• St Bartholomew's, Wednesdays 2-3.30pm;
• St Thomas's Hospital,first month no visits, but parents could see children asleep between 7 and 8pm;
• Westminster Hospital, Wednesdays 2-3pm,Sundays 2-3pm;
• West London Hospital, no visiting;
• Charing Cross Hospital, Sundays, 3-4pm;
• London Hospital, under 3 years old, no visits, but parents could see children through partitions. Over 3 years old, twice weekly.

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.

When James Robertson first entered the children's ward to make observations, he was shocked by the unhappiness he saw among the youngest children, in particular those aged under 3. The competent, efficient doctors and nurses gave good medical care but seemed unaware of the suffering around them. They saw that children initially protested at separation from the parents, but then settled, becoming quiet and compliant. However, Robertson saw this as a danger signal.

Based on several years of observations in long and short stay wards, James Robertson formed a theory of phases of response of the under 3's to a stay in hospital without the mother: Protest, Despair and Denial/Detachment (James Robertson, 1953a). In the protest phase, the child is visibly distressed, cries and calls for his mother. In the despair phase, the child gives up hope of his mother returning and becomes withdrawn and quiet, and may appear to be 'settling'. 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. Finally, the child seems not to need any mothering at all. His relationships with others are shallow and untrusting.

Robertson's research was met with hostility by the medical profession. Even his colleagues at the Tavistock Clinic, although accepting, did not feel the same sense of urgency. They had not seen the same things he had seen.

Film - A Two-year-old goes to Hospital (1952)

James decided to make a film record of a young child's stay in hospital. It would allow the evidence to be examined and re-examined. He hoped it would pierce defences that the spoken word could not. With a grant of £150 he purchased a cine camera and 80 minutes of black-and-white film. He had never used a cine camera before.

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

Laura, aged 2, is in hospital for 8 days to have a minor operation. She is too young to understand her mother's absence. Because her mother is not there and the nurses change frequently, she has to face the fears, frights and hurts with no familiar person to cling to. She is extremely upset by a rectal anaesthetic. Then she becomes quiet and "settles". But at the end of her stay she is withdrawn from her mother, shaken in her trust.

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

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

“The restraint and objectivity of the film may at first re­assure, for the child is unusually composed for her age, but few nurses will doubt the degree of her distress, the signs of which they have so often felt powerless to relieve.”—Nursing Times. “. . . explodes the belief that a ‘good’ child is well­-adjusted.”—Nursing Outlook. Though the standard of care in the hospital was high she undoubtedly fretted." -British Medical Journal. “. . . convincing and brilliant demonstration ad oculos of the outward manifestations of the inner processes that occur in infants who find themselves unexpec­tedly and traumatically without their families.”—Anna Freud, LL.D., International Journal of Psychoanalysis."...a connected and credible demonstration of stress, separation anxiety, early defensive manoeuvres, and topics akin. .also a social document of honest power. Without preaching, it bears a message of reform. . ."—Contemporary Psychology.

References

• Munro-Davies, H.G. (1949) 'Visits to Children in Hospital', Spectator, 18 March.