How important is the family? Is there compelling scientific evidence demonstrating its importance for mental public health? Is youth crime related to family breakdown?

This article weaves together three strands of evidence. First is the research on imprinting of the psychosocial environment in the neurological development of the brain. [1] Second is the data on family breakdown and the consequent impact on mental health set out in the recent Social Justice Policy Group report. [2] The third strand gives the perspective of a Christian child psychiatrist using Systems Theory (the basis of family therapy) to understand how the moral values of society hold the family together and determine the welfare of the next generation. This thesis is set out in the CMF book Mad, Bad or Sad? [3]

The Christian faith, which has shaped our family life for centuries, is no longer the dominant influence. The media nowadays dictates our moral code in the form of 'political correctness'.

Neuroplasticity

The nature/nurture debate has moved on. The genetic blueprint (nature) interacts with the psychosocial imprint (nurture) to form the personality. The infant brain has few connections. It is like a highly sensitive photographic film. Whatever comes in repeatedly from the psychosocial environment through the five senses gets imprinted. This process is called neuroplasticity. It 'wires up' the brain by repeated passage of incoming stimuli 'treading out' new circuits. In infancy it programmes in the basic functions. In adolescence it remodels the brain to produce the complex cerebral networks for the higher cognitive functions of the adult brain.

Brain imaging techniques have mapped out the components. First comes a massive overgrowth of neurones just before and after birth, and again during puberty. This is followed by drastic pruning on a 'use it or lose it' basis. 'Neurones that fire, wire.' Unstimulated neurones die. Appropriate stimuli are expected by certain sensitive areas during specific critical periods. Some periods are very short, such as those for vision and hearing. The time scales for important psychological functions such as attachment formation and emotional regulation are longer – three years.

In the first year the pre-frontal cortex 'expects' the essential psychosocial stimuli related to bonding. These come from the relationship with the mother. Breast feeding provides the right environment without any contrivance – through frequent and lengthy closeness, warmth, and eye contact. The mother picks up the baby's cues, initiating the beginnings of communication. She responds to him joyfully, interpreting to him that it is good to be human. John Bowlby, founder of Attachment Theory, said that a baby needs 'a besotted caretaker'. The quality of this primary attachment largely determines emotional health and future capacity to form relationships.

What can go wrong?

The attachment figure does not have to be the biological mother but must be a consistent one. Frequent changes of carer, such as in extensive crèche rearing of infants, can disturb attachment. [4] The steep learning curve continues as the parents begin to socialise the child. Both warmth and authority are needed, with the setting of limits and with harmonious family dynamics. The father's role becomes increasingly important. Consistency is vital when 'the rules for living' are being imprinted upon the brain. Family breakdown imperils this. Lone parents find it hard to provide everything necessary single handed. Divorce tears attachments apart. Step families must forge a new family system. Multiply reconstituted families, in which the ground rules of the family keep changing, give a very confused imprint.

Good genetic endowment can protect. However, in the development of criminality, genetic vulnerability can be exacerbated by an adverse rearing environment. [5] For example, there is a high rate of Attention Deficit Disorder (ADD) in the prison population but ADD per se does not produce criminality, but only when it is combined with harsh and inconsistent parenting. Good parenting with routine and structure can minimise the impact of ADD.

Attachment disorder

The most severe form of attachment disorder results from global stimulus neglect when the infant is left alone in a cot 24 hours a day, such as in badly run orphanages or with drug abusing mothers. The brain cannot develop properly. The Maudsley Romanian orphanage follow up study has explored the extent of this.

However, the commonest cause of attachment disorder is maternal depression. The withdrawn miserable mother cannot respond intuitively to her infant's cues. A severe impact can actually be demonstrated in the child's brain structure. The right frontal cortex, which is responsible for withdrawal and aggressive reactions, becomes overdeveloped compared with the left, which deals with positive social advances. The late result of maternal depression is a well recognised preventable child psychiatric disorder, Hostile Avoidant Attachment Disorder. It places the child on the pathway to delinquency.

There are now many health visitor programmes for the early detection of maternal depression. A supportive father is vital for minimising the effect on the infant. Single parents are inevitably more vulnerable. In chaotic dysfunctional families the problem can be compounded by domestic violence. Chronic stress to the young child during the first three years of maximum neuroplasticity produces physical damage to the brain from high cortisol levels as well as an imprint of trauma and confusion. This scenario is common on the big dysfunctional inner city estates with their high crime rates.

A chance to put things right

Adolescence can be a chance to put things right because of the second phase of intense neuroplasticity, when the brain is remodelled into adult form. [6] However, the time frame involved indicates the need for structure and supervision of teenagers. The initial surge in the part of the brain responsible for independence, social bonding and sexuality occurs at the start of puberty, around the age of twelve to thirteen. The adolescent has to cope with these strong feelings without the cognitive controls which develop three years later in the frontal cortex. These are vital for the mature adult personality. They include the ability to inhibit inappropriate behaviour, to perceive a situation from another person's perspective, to plan ahead, organise, contextualise, prioritise, and make judgments and decisions. Adverse psychosocial environments can jeopardise this vital development. Confused youth takes refuge in drugs and alcohol.

Father involvement is a key protective factor, giving authoritative parenting with warmth and boundaries. Gone are the customs which formerly structured adolescence. Negotiating modern youth culture is a hazardous passage. Local communities can help by creating a subculture with more positive values with which teenagers can identify (for example, a church youth group).

Changes in family structure

Clearly the family is a vital part of the 'human ecosystem'. It creates the psychosocial environment to be imprinted. Yet in the UK there has been a steady erosion of family life over the past 60 years. Births outside marriage have increased from 1.5 percent in 1960 to an astonishing 43 percent in 2005. Both cohabitation and solo mothering are increasing. Twenty-six percent of British children live in single parent households. Such children risk twice the rate of mental health problems compared with those in nuclear families. There used to be a painful stigma in illegitimacy but it had the same function as does bodily pain: it prevented further harm.

Many factors have contributed to these changes in families: demographic shifts, birth control, social mobility, the status of women, changes in sexual morality and the devaluing of motherhood. However, it is disconcerting to find that both the tax structure and the legal framework for family law have also contributed (for example, by removing the discrimination of illegitimacy from inheritance in 1987 Family Law Reform, and by reducing parental control over children's sexuality in the Gillick decision of 1985). Moreover, the welfare state has actually made it possible to be a single mother: the unemployed lone parent is the family model that maximises state benefits.

An interesting study on marriage in men's lives finds a difference in commitment between men and women (in terms of long term view of the relationship, and willingness to sacrifice). [7] Women commit on attachment; men need formal commitment before witnesses. Yet outcome for the children reflects involvement of the father and 40 percent of cohabiting partners split up before the child is five years old. The decline in marriage suggests reluctance by men to accept this rite of passage to full responsible adulthood. Yet married men are healthier, happier, earn more and are less antisocial. Marriage is a support system.

There are many studies into the vexed question of divorce. The legacy for the children is impaired psychological well being, reduced educational attainment, and less marital success. Although high levels of marital conflict also harm children, surprisingly the harm has been found to be just as great when a low conflict partnership breaks up. [8]

Media influence on social sanctions

In traditional cultures religion delineated and enforced the responsibilities of family life. The World Health Organisation has warned how loss of these social safeguards in rapidly changing societies imperils mental health. [9]

Systems Theory is the best way of understanding how the media (among other factors) is altering the ground rules of society. Political correctness has become our new morality, replacing religion. It can be defined as the unacknowledged beliefs of the suprasystem. As such it dictates what we think and what is allowed.

Yet who controls it? The boundaries of socially acceptable behaviour are being pushed further away from former norms in the interests of advertisements and drama which exploit human passions. Television scripts for soaps do not have a high moral tone; that would not be politically correct. Children watch too much television and imbibe its values; indeed, a senior child psychotherapist has described it as 'an open sewer running through the sitting room'. Browne has shown how screen violence promotes violent behaviour in young people who have already been sensitised to violence by chaotic family backgrounds. [10] Ironically, teenage violence then causes media hype! Thus the media has a twofold impact in contributing to youth crime. First it erodes family life; secondly it models violent behaviour.

Moreover, the media message in general is often the opposite from that required to readjust the dysfunctional system. The bad guys win, sexual appetites are titillated, authority is questioned, and children are vaunted above parents. There needs to be a systemic re-evaluation of the place of the media in safeguarding the human ecosystem. This will be difficult. Morality is not popular and market forces are powerful.

The Christian model

Consider the Christian blueprint for family life. The Ten Commandments have two family related commands: 'Honour your father and your mother' [11] and 'You shall not commit adultery'. [12] These set out the mutual responsibility between the generations and between husband and wife. The biblical stricture limiting sex to the marriage relationship harnesses the power of the sexual instinct to energise the family. Man and wife are to complement each other rather than compete. This enshrines the innate differences in temperament between men and women that equip them for family life. Thus women are the emotional caregivers and men are the defenders and providers.

The husband is to be the head of the family but husbands are to 'love your wives, just as Christ loved the church and gave himself up for her'. [13] This is a high ideal that gives no place for a dictatorial husband. Indeed, his leadership must cherish and empower his wife. A woman who gives out emotionally must be replenished by her husband. Moreover, in 'systems terms' a healthy family requires clear leadership, not disputed power. The children need a combination of warmth and authority. The headship of the father represents the authority of society. It teaches self-control and respect.