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Children's Hearings The 1999 Kilbrandon Child Care Lecture

DescriptionChildren's Hearings: The 1999 Kilbrandon Child Care Lecture. Web version of document originally published in 2001.
Official Print Publication DateMarch 2001
Website Publication DateMarch 26, 2001


    Anthony Clare
    Clinical Professor of Psychiatry
    Trinity College Dublin

    This document is also available in pdf format (204k)


    by Anthony Clare
    Clinical Professor of Psychiatry
    Trinity College, Dublin
    in the Bute Hall, Glasgow University on Thursday 11 November 1999
    courtesy of
    Professor Sir Graeme Davies
    Principal Glasgow University

    Anthony W. Clare
    MD FRCPI FRCP FRC Psych Mphil

    Medical Director, St Patrick's Hospital, Dublin Clinical Professor of Psychiatry, Trinity College, Dublin

    1978-1983 Senior Lecturer and Deputy Director General Practice Research Unit Institute of Psychiatry
    1983-1989 Professor of Psychological Medicine St Bartholomew's Hospital Medical College

    In ancient shadows and twilights
    Where childhood had strayed
    The World's great sorrows were born
    and its heroes were made
    In the lost boyhood of Judas
    Christ was betrayed

    A E (G.W. Russell 1867-1935) from "Germinal"


    I am Rick Trainor, Vice-Principal, and on behalf of the University, I would like to welcome you to this evening's Fourth Kilbrandon Lecture. The name of this lecture is highly significant. The Committee which Lord Kilbrandon chaired in the 196()s established Scotland's unique system of juvenile care and justice - Children's Hearings. In many respects this system anticipated key aspects of the UN Convention on the Rights of the Child. This Convention has just passed its Tenth Anniversary and is one of the most ratified conventions in the history of human rights. Yet as the dire situation of many children in countries around the world indicates, the ideals of this Convention remain important, based as they are on a commitment to enhancing the life experiences of children to early intervention and to support for families and the communities. All of these principles can be found in the Kilbrandon Report which is as significant now as it was when it was published 35 years ago.

    In this context it is a great pleasure that we have with us tonight Lady Kilbrandon, her son the Honourable Michael Shaw, and her grandson Torquil Shaw. Like its predecessors this fourth lecture in the Kilbrandon series is a joint venture of the Scottish Executive and of the University's Centre for the Child and Society. We are pleased to have with us tonight Mr Sam Galbraith, Scotland's Minister for Children and Education and his Deputy, Mr Peter Peacock. And we already have with us a range of other individuals actively engaged in this field in Scotland.

    Tonight's Kilbrandon Lecturer, Professor Anthony Clare, needs no introduction. But for that very reason he particularly deserves one. Yet to introduce the person who himself has so engagingly introduced a range of distinguished people to a broadcast audience of millions is a slightly daunting prospect. This challenge is heightened by the illustrious nature of Professor Clare's career. Born in Ireland, Professor Clare qualified in medicine at University College, Dublin and trained in psychiatry at the Maudsley Hospital in London. He is a fellow of the Royal College of Physicians of Ireland, an honorary fellow of the Royal College of Physicians of London and a Fellow and Vice President of the Royal College of Psychiatrists. Professor Clare has also held a series of important posts in his field. In the late 1970s and early 1980s he was Senior Lecturer and Deputy Director of the General Practice Research Unit at the Institute of Psychiatry. Then from 1983 to 1989 he was Professor of Psychological Medicine and Head of Department at St Bartholomew's Hospital Medical College. Currently he is Medical Director of St Patrick's Hospital in Dublin and Clinical Professor of Psychiatry at Trinity College, Dublin.

    Professor Clare has also been active in the voluntary sector especially as Chair of the Prince of Wales Advisory Group on Disability. In addition he is the author of many books, including "Psychiatry in Dissent", "Depression and How to Survive It", and three volumes related to his series "In the Psychiatrist's Chair". Brilliant as these achievements are, Professor Clare's latest claim to our attention tonight is his outstanding talent for conveying to a diverse audience the complex origins and the widespread ramifications of the human personality. He has demystified his profession, encouraging people to understand their own personalities, to seek professional help when appropriate and to support others receiving such assistance. For our purposes tonight it is also important that in his broadcast Professor Clare and his guests have much of value to say about childhood. And Professor Clare's expertise about children is by no means solely academic for he is the father of 4 daughters and 3 sons.

    It is with great pleasure therefore that I call on Professor Anthony Clare to deliver his Kilbrandon lecture which is intriguingly entitled "The Lost Boyhood of Judas".

    Lady Kilbrandon, distinguished guests, ladies and gentlemen, Professor Trainor. I first of all would like to say how honoured I am to have been invited to give this lecture. Any of us involved as I am because of my profession, with the issue of children and family alike, have reasons to be grateful to Lord Kilbrandon's vision and struck by how much earlier the issue of, for instance children's hearings, was raised in Scotland compared to Ireland. I am also very honoured to be back in Glasgow.

    I seem destined to follow in the footsteps of a distinguished Scotsman. The last time I was here for anything as nerve-racking as this was back in the 1960s when and a colleague, Patrick Cosgrave who went on to be, amongst other things, Mrs Thatcher's speechwriter, came as students to the Glasgow University Union, which was and still is a citadel of debating expertise. In those days one had to debate motions, I think they still do, out of a hat and Patrick and I were given the task of proposing the motion "The British Empire has been a boon to humanity". Opposing us was the First Minister of Scotland, Donald Dewar - that is not what he was then, though I have a distinct recollection that actually that is what he looked like even then - and I think it was Neil MacCormick. To my great satisfaction, we two Irish Republicans defended successfully the name and glory of the British Empire against a man who was subsequently to become such a distinguished servant of Scotland.

    Donald Dewar gave the last Kilbrandon Lecture and if he spoke 2 years ago as he spoke in 1962 then it would have been a fast, speedy and committed one. He had the last laugh that year because we then met in the Observer Mace Final and Donald won it. We had to come back a year later and win it ourselves. He had then passed on to other things. I suspect he has not changed all that much. He looked to me a man unchangeable and I wish him well as First Minister of Scotland.

    I conic from a distinguished university, younger than yours, 400 /450 years I think. You are coming up to your 550th which is a magnificent moment in the history of not just the University but the city. I realised when coming here how much I personally owe Glasgow through one of your most complicated alumni. I refer to a man who himself made such an interesting contribution to the whole issue of childhood and families - the late R D Laing. Perhaps the most controversial of post-war psychiatrists Britain ever produced with whom I and others did have many disagreements. Laing was a passionate Glaswegian. It seemed to me he represented all that was best about this City: committed, articulate, apocalyptic, and absolutely spellbinding as an orator. He was certainly a very committed man to the ideas and issues of childhood and families and, if he took a bleaker vision than mine, he had good reason to in many ways. And the reason I pay a sort of tribute to him is that I received in the post today one of those requests that you get at the end of Millennia. I presume they got them in 999. It was to pick out the book that had influenced you most - it had to be published in the previous hundred years. I realised what I would have picked out was R D Laing's "Divided Self". Not because everything in it I agree with but because I realise that that was the book that turned me in the direction of psychiatry.

    I am now currently Medical Director of St Patrick's Hospital which itself was founded by Jonathan Swift. Swift was a curious and complicated man. He didn't have any children. He didn't marry, and the reasons for that are the stuff of historical speculation. But it is he who did something I recommend to all of you. He wrote his own epitaph. It is long and his Verses on the Death of Swift contain 4 lines which I always mention to foreign audiences. They relate to the fact that he left his estate to the foundation of my psychiatric hospital, St Patrick's. The 4 lines go "He gave all the wealth he had to found a place for fools and mad and showed by one satiric touch no nation needed it so much." And he was right because to this day St Patrick's Hospital, on its original site, still functions. It is now the oldest, purpose-built, psychiatric hospital still functioning on its original site in Europe. So age links us. It is a very young hospital only 254 years compared to a very old and great University. And so, I am very glad to be here.

    My choice of title is "In the Lost Boyhood of Judas, Christ was betrayed". It is a line that A E Green used and much quoted. It is a seminal line when you start to think about it. He said: if you wish to make sense of how it was that one of the Messiah's closest friends, a chosen disciple, came to betray him in the garden at Gethsemane, you would need to know something of his childhood. Those formative years when the foundations of adult behaviour are first laid down. Not necessarily in stone: they can be shaken. But that, as any of us involved in trying to alter change or shape human behaviour know, that can often be a difficult thing to do. It might appear a conventional wisdom that parents influence their children. But there are many voices to be heard, some within the behavioural sciences, suggesting that parental influence is exaggerated and that children growing up are much more significantly shaped and moulded by the influence of their peers, their teachers and the cultural atmosphere. I know my late mother would have derived some support from this. Anything we ever did she didn't like she attributed to the influence of our peers. Anything we ever did which was pretty modest but she did like, she attributed to her own influence. So our peers were seen then certainly as the shapers and moulders of what we got up to. It is 465 years since the formation of the Jesuits who educated mc. The great prophetic declaration attributed to that formidable pedagogic religious order is that of course: "give them a child for 7 years and he is theirs for life". Well, I was educated by those Jesuits for longer than 7 years and occasionally people write in, particularly in response to things which are asked on "In the Psychiatrist's Chair" and I can confirm that indeed at heart I am still a Jesuit. However, it is no longer an accepted axiom but one of the most hotly contested statements of child development. Does it matter what kind of parent one is? Do our children turn out the way they do not so much of because of what we do but in spite of what we do?

    When it comes to examining the role of parents, vis à vis their children, one is immediately confronted by a remarkable fact - for parent, read mother. Social science and behavioural psychology literature bulges with studies demonstrating the importance and the impact of the mother on the child's psychological and even physical development. And such a search, as many in this audience will know, includes video tape studies of mother and baby interactions, exploration of the development of things like infant vocalisation assessment of the relationship between maternal involvement, reading skills and calculations, of the impact of maternal disorder and stress on the development and health of children. Such preoccupation with the role and significance of the mother is not of course without its hazards. Just as she is credited with the major role in the positive development of her offspring, she, and not the father; is blamed whenever things do not work out so well. Indeed the growth of the behavioural sciences has been accompanied by what one researcher has termed "mother blaming". Many mothers report being blamed for causing their children's problems by professionals and the public. In a review of clinical journal articles from 1970, 1976 and 1982 in which the cause of someone's emotional problems was discussed Kaplin and McCorkadale concluded that "the overwhelming picture in all journals for more than 63 items, such as whether mother's pathology or father's affected the family, whether only mother or only father was involved in treatment, with the number of words to describe mother compared to the number used to describe father, the overwhelming picture was one of mother blaming. And in all, these authors document over 70 mental health problems that had been blamed on mothers including schizophrenia, anorexia nervosa, depression, enuresis, suicidal behaviour; truancy, autism and alcohol abuse. In contrast the research on the significance of the father is much more modest. Indeed, research that has been done has persuaded some quite influential commentators that actually fathers don't matter at all.

    The problem however lies with the paucity of the research. For example in 1997, when the academic journal "Demography" devoted a special edition to men in families, the guest editor, Suzanna Bianci remarked that "the question we discussed at some length was whether there was enough high quality social demographic work on men to constitute a special issue". It is hardly surprising that some enthusiastic social biologists have concluded that fathers contribute little to the survival of the species except their semen and that, increasingly, is often contributed anonymously.

    From the outset psychological discussions of parenting have been heavily influenced by psychoanalysis. One of Freud's central tenets was that the relationship between mother and child established the style and pattern of child relationships. About this, as about so much else, he was quite emphatic and certain. For example, he said "the relationship to the mother is unique, without parallel, laid down unalterably for a whole lifetime, the first and strongest love object and the prototype of all later love relations".

    Freud may well have been influenced to a particular degree by his own experience. His mother, doting and domineering, appears to have been besotted with her eldest child, her "Golden Siggy", as she was fond of calling him. And later he was to remark that if a man has been his mother's undisputed darling he retains throughout life the triumphant feeling, the confidence in success, which not seldom brings actual success with it. If Donald Dewar comes I'll ask him about his mother.

    Freud had more ambivalent views of his father. One crucial childhood memory involved a story his father told him when Sigmund was about 10 or 11 years old. Apparently Jakob Freud described how, when he was a young man out walking, a Christian had knocked off his cap and shouted "Jew. Off the sidewalk!". Freud asked his father what he had done in response and was shocked when his father replied "I stepped into the road and picked up my cap." Freud was scornful of his father's submissiveness and lack of heroic qualities and was stunned by the spectacle of the cowardly Jew grovelling to a bullying Gentile. And if you are familiar with Freud's writings on his father; and indeed on his family, that story recurs. It did indeed sting and Freud is bitten by Freud when you then make the analysis that his views on men undoubtedly were affected by his views of Jakob.

    Whatever the reason, mothers rather than fathers attracted much more of Freud's consideration and were more central to his theories concerning the importance of a child's earliest years in the formation of the adult personality.

    The next most influential was probably John Bowlby in this part of the world, who became identified with a particular view. The hypothesis that children should not be deprived of contact with the mother during the critical period of infancy and early childhood when the primary attachment relationship is being formed, was first proposed by him in a 1951 report to the World Health Organisation. The report was originally written at the request of WHO for an assessment of the mental health consequences for; "children who are often separated from their families for other reasons and need care in foster homes, institutions or other types of group care."

    Bowlby proposed that maternal love and commitment are as important to the healthy development of a child as are vitamins and proteins for physical health. He went further; and a Ia Freud declared, "The prolonged deprivation of the young child of maternal care may have grave and far-reaching effects on his character and so on the whole of his future life". Bowlby had derived support for these arguments from observations of children separated from parents when placed for short stays in a hospital or institution; and children in long-term orphanages and foundling homes. He also drew support from animal studies of young rhesus monkeys separated from their mothers and raised in isolation, as well as studies which linked adolescent delinquency and behaviour problems to some form of separation in childhood. In subsequent writings he modified his argument concerning maternal deprivation to take into account the influence of other figures in a child's life. But the emphasis on the crucial role of the mother remained.

    Insofar as fathers figured at all, it was mainly in a supportive role. He did accept that as the children grew older the father would become more involved. But given the demands of work, the father could not be expected to exercise an influence comparable to that of the mother. Robert Karer who has written one of the most readable and dispassionate accounts of Bowlby and his work observes: "To Bowlby, a non-stop worker himself whose work was his life and whose rare displays of temper were occasioned by the intrusions of his children, it perhaps seemed inconceivable that a father could be more intimately involved so that his presence too would be a source of security. Bowlby's single-minded preoccupation with the mother's role exposed him to fierce criticism by many commentators who feared his argument would be used, and it was, to combat women's increasing independence, occupational mobility outside the home and the use of such supportive childcare facilities as crèches and nursery schools.

    Less controversial however; indeed almost ignored, was Bowlby's neglect of the father's role. Up to 30 years ago "parenting" in social science and psychological literature meant "mothering". Studies either frankly use the term mothering or, as one reviewer commented, one quickly learned that all the subjects were women though the title referred to parents. But whilst slowly the balance has been shifting within the research and academic world, the neglect of fathering has fuelled the growing assumption that fathers don't really matter. And that the reason they have been neglected reflects the fact that they are largely irrelevant to child rearing and child development. There is at the present time a prevailing sense of the ineffectiveness of men as fathers, indeed the ineffectiveness of men as anything, and a growing tendency to portray men as disinclined to take on the responsibilities of fatherhood and a readiness to discard them whenever there is trouble. There is concern too that so many men are removing themselves or allowing themselves to be removed from their children's lives. One factor could well be a seeming consensus that fathers don't actually matter. Yet fatherhood is the commonest experience of adult men. More than 90% of adult males in Britain marry and over 90% of these couples have one or more children in the home. How these fathers behave, how they express their feelings for their children, how they promote their development, varies considerably. And despite assumptions to the contrary, evidence is growing to support the instinctive feeling that, notwithstanding their obvious faults, there is a role for father and, like that of the mother; it is a role with both positive and negative implications.

    So let's just for a moment consider the issue of paternal deprivation, nearly 50 years on from Bowlby's revolutionary paper. It has been suggested that the increasing difficulty fathers have in sharing with their children the nature of their work creates a vacuum in the child's psyche which is filled by hostile fantasies of the father as bad and his work as evil. Widespread paternal deprivation or father-hunger results in a profound yearning for a good, or at least a good enough father. A variety of problems have recently started to be laid at the foot of paternal deprivation in a curious cyclical or pendulum swing so that some of the things I read to you attributed to mothers are now packaged in new parcels and laid at the feet of fathers. Children growing up without fathers, research is now suggesting, are more likely to fail at school or drop out, have emotional or behavioural problems necessitating psychiatric intervention and will develop alcohol and drug problems.

    Adolescent males who attempt, and indeed complete, suicide would be more likely to come from homes where the father is absent. Other studies have found a statistically significant incidence of separation and divorce among parents of adolescents who attempt suicide as compared with control groups. Boys growing up without fathers are reported to experience difficulties in the areas of sexual and gender identity, school performance, social skills and the control of aggression.

    The second consequence of life without a father is that children, especially sons, grow up without direct access to him and view him, by necessity, through their mother's eyes. This experience, it is being argued, effectively alienates them from their sense of themselves as men and it effectively ruptures their natural translation of the role model of being a resident father; such that many boys and young men now, and I quote here from one particular critic, "faced their future with progressively reducing social pressures or social training to become responsible and competent father themselves".

    The yearning of a lost son for an absent father is a widespread, if not a universal, theme among the world's literature and religions. The dominant image in Christianity is Jesus, who never had a human father; never became a father, and dies on the cross lamenting his abandonment by the most powerful father of all. Shakespeare's Hamlet, Homer's Odysseus, the story of Joseph in the Bible, all involved the fate of a son separated from his father. However it is not the story of the absent father; as much as the violent one that it has had the most powerful influence on modern psychology.

    In the legend of Oedipus, Laius, the father of Oedipus orders his son to be killed and is left on a hillside to die. He is found by a shepherdess who raises him. Later; as a youth, he encounters an old man who refuses to stand out of his way as each tries to cross a narrow bridge. Oedipus kills the old man, who unknown to him is his own father Laius. Oedipus ends up saving the City of Thebes by answering the riddle of the Sphinx and marries the queen, who, again unknown to him, is his mother.

    Freud in his creation of the so-called Oedipus complex claimed the myth revealed the unconscious desire of every son to kill his father and marry his mother. It has however been pointed out, the story of Oedipus is much darker than even Freud's misreading would have it. It is after all a story of gross paternal aggression and abuse. The tragedy starts with the father; Laius, ordering his own son to be killed. It tells of the intense, potentially destructive conflict between the generations. The young Oedipus, and the old Laius competing to cross the bridge. But the story of Laius himself is relevant. Like Hamlet, Laius was a son displaced by his uncle who took refuge with the neighbouring King Pelops and ended up sexually abusing the king's own son. In turn, King Pelops curses Laius predicting correctly that he would be killed by his own son. Subsequently, Laius became King of Thebes and conceived Oedipus unwillingly. His wife got him drunk and seduced him. He wasn't the first father who didn't want his son. He then commanded her to kill the child by exposure and she agreed but failed to complete the task and woven into that myth, completely ignored by Freud, are many of today's most elemental preoccupations and anxieties: child abuse, paternal violence colluded with and participated in by mothers, jealousy and revenge within the family, and the sexual humiliation of women by men. It is a story which reveals the destructiveness of men, as does so much of Grecian mythology, but it is a story which should have appealed to Freud because, as you look at one generation and try to make sense of it, you then find yourself drawn inextricably back to the generation before Oedipus.

    In the main narrative text of the Bible are plenty of fathers, but precious few good ones here either. Adam, Noah, Isaac, Jacob, Abraham, Moses, Saul, David, even Solomon had been judged failures in some important aspect of their fathering. In seeming relief there is the New Testament, God the Father. This father embodies many of the strains and contradictions which in more human form bedevil those men struggling to be good enough fathers. On the one hand this Heavenly Father is loving, nurturing, forgiving, the provider of daily bread and the forgiver of sins. But on the other hand ~ is fierce, omnipotent, remorseless. He separates the goats from the sheep. He elevates those who have behaved to the highest realms of Heaven, damns those who transgressed to the deepest recesses of an infernal hell. Every so often in my clinical work I meet one or other. Thankfully as yet I have never met the combination, at least not the real one. I have met a few claiming to be, and one or two professors who clearly think they are.

    Henry Abramovich, in a rich examination of the archetypal images of the father; emphasises the extent to which the themes of death and continuity, separation and reconciliation, rejection and confirmation are enmeshed in the father/child relationship. In the story of Jacob and Joseph for example, Jacob, believing that his son Joseph is lost for ever, lapses into a protracted grief. Joseph succeeds in a foreign land but is cut off from his father. When finally they meet, they embrace. Joseph weeps while Jacob declares "Now I can die having seen for myself that you are alive". The difficulty for today's fathers is that, not only do they carry in their heads the memories and recollections of their fathers and the experience of being fathered, but expectations growing, changing, evolving in today's very changing world concern mg the need to be all manner of fathers, a just father; a wise father, an accessible father; an involved father, a loving father; a firm father, a disciplinarian father; a good father or; as one or two mothers I have heard say, just a father who is there. And on they struggle while all around rages the argument of whether it makes all that much difference what kind of father they are.

    What does the father offer? Early reviews concerning the amount of involvement of fathers in the lives of their children suggested the effects were minimal. However more recent research strongly suggests that pre-school children, whose fathers are substantially engaged with, and accessible to them, that is to say performing 40% or more of the care within the family, are more competent, more empathic, more self-confident, less stereo-typed in terms of gender roles. And those are quite interesting findings. That those fathers who are more involved in their families produce children who are less stereo-typed in terms of masculine, feminine gender role. It is quite different from the expectation that it is the absence of fathers which appears to be contributing to the emergence of macho-type young men, often exceedingly hostile to women.

    The evidence indicates that such positive effects begin early, for example the degree of positive paternal involvement in the month following birth is in a number of studies strongly associated with the infant's functioning at one year. It is too early to say whether that is a persistent or even an important change. Research has also shown significant positive relationships between positive father engagement and intelligence, academic achievement and social maturity at ages 6 and 7. The positive involvement of fathers has significantly raised a cluster of outcomes including self control, self esteem, life skills and social competence in both children and in adolescents. And, as I say, most striking is the finding that a more actively involved father leads not to more but less gender roles, stereotyping behaviour in children. That is to say children in adolescence with positively involved fathers hold less traditional views as adolescents about gender stereotypes, dual-earner parents and about the parental sharing of child care.

    But I hear you say, how can the effect of the mother's involvement be separated out from that of the father? Is it not possible that those fathers who seem very positively engaged in the care of their children are married to or living with exceedingly committed and involved mothers? The careful analysis of the American National Survey of family health results, controlled for the positive involvement of the mothers as well as ethnic background, income and social class, has shown that for both boys and girls a high positive involvement of fathers is significantly related to such social skills as getting along with others, carrying out responsibilities and this, a boon to any parents, doing what parents ask. I don't know - I always felt I was very involved with my children and I don't remember them doing anything I ever asked! But research shows you that you mustn't judge from personal experience. In addition, boys have fewer behavioural problems, while girls are more self-directed, more willing to try new things, be active and socially involved.

    This analysis, and I know of other studies and literature, confirm that a father's positive involvement with his children has beneficial effects, independent of any effect of the mother's own involvement. In the late 1930s, Sheldon and Eleanor Gluch of the Harvard Law School commenced a cross self-sectional study of 500 delinquent boys and 500 non-delinquent boys for comparison. The Gluchs followed their subjects for 25 years and during that time social workers, doctors, criminologists, psychoanalysts and social psychologists all recorded their contrasting views of the thousand inner city youths. Then a psychiatrist, a good friend of mine, George Vaillant took over and followed these men for a second generation, including their experience and behaviour as parents. In 1982 Professor john Snarey became involved in the longitudinal study and he spoke particularly of the children, the sons and the daughters of the original sample of men.

    This unique study, now of 4 generations of men, provides an unrivalled insight into the nature and state of fathering at the present time. Snarey writes of generative fathers, meaning fathers who contribute to and renew the ongoing cycle of the generations through the care they provide as birth fathers, biological fathers or as child-rearing fathers, parental gender activity and as cultural fathers, societal generativity. These concepts draw heavily on Erikson's model of human personality development. Erikson, the first Professor of Human Development at Harvard University, viewed generativity as the primary developmental task of adulthood.

    Leyland, in a 35 year study of college men, found that satisfaction with the paternal role was significantly and positively associated with other forms of caring and involvement outside the family home. Leyland found that those men who in Erikson's terms had become most generative, that is to say were the most truly responsible for other adults, were most involved, for example, in their community. They enjoyed their work, helped others to grow, and were also the men who had best mastered intimacy at an earlier period and maintained stable, first marriages. These findings flatly contradict the popular assumption that you find in the world of men, that somehow career achievement and involvement with children necessarily conflict. If I had to write a motto over the Committee Room at St Bartholomew's Hospital Medical College, it would have been the assumption made I think by every male medical professor, that somewhere there was an inherent conflict between the demands of being a husband and father and the demands of being a doctor.

    There was conflict of course. Yet there is absolutely no reason why the profession of medicine, like every other profession, dominated until now by men, could not so organise itself that the conflict between public and private could be far more sensibly organised than it is. And the only reason that it hasn't been is nothing to do with the elemental nature of the work, it has to do with the elemental nature of the workers.

    There is impressive research testifying to the fact that adult men with the poorest levels of professional and occupational achievement also manifest poorly developed generative traits. So the word goes forth to Tony Blair "Yes he can do it. He has just got to work harder as father and Prime Minister. Or maybe Donald, as First Minister". These findings support one of the most regularly made controversial assertions concerning marriage, child rearing and men. Namely, that family life is a civilising force for men. Women in the audience will have to bear with me for the moment as I concentrate on my own sex. But there is a point and a purpose to it.

    The sociologist David Popenue puts it bluntly, "whenever large numbers of young unattached males are concentrated in one place, the probability of social disorder greatly increases" - Hampden Park? David Blankenhorn, President of the Institute for American Values is no less convinced Across societies married fatherhood is the single most reliable and relied upon prescription for socialising males. Someone who agrees but doesn't share the enthusiasm for the consequences is Gore Vidal, who in a feisty article on sexual politics argued that in societies where it is necessary to force people to do work that they don't want to do, marriage at an early age is encouraged "on the sensible grounds that if a married man is fired his wife and children are going to starve too. That grim knowledge makes for docility." Vidal's waspish comment is a variant on Cyril Connelly's depiction of the pram in the hallway as the enemy of promise. However; confronted by the nature and extent of male violence, not everyone is as dismissive of social docility as Vidal. Others have argued that poorly fathered young men and young men reluctant to involve themselves within a relationship of commitment and intimacy become so vulnerable to and incompetent with women that they end up avoiding them, brutalising them or both.

    Disconnected young men are most likely to prove their manhood in crime and by violating those who represent outwardly the shameful, hated, feared, feminine part of themselves. In Britain, HaIsey has been amongst those most vocal, warning of the emergence of a new male who is in his words "weakly socialised and weakly socially controlled" so far as the responsibility of spousehood and fatherhood are concerned. He no longer feels that pressure his father and grandfather and previous generations of males felt to be a responsible adult in a functioning community. There is some persuasive evidence supportive of the view that men who are deprived of a father's influence are more likely to engage in what has been termed over-compensatory masculine behaviours which is jargon for crimes against property, child abuse and family violence. Such a protest, masculinity characterised by exaggerated attempts to prove manliness, seemed to arise from a basic fear of being feminine. That in turn arises in the absence of male models. Men from homes where there is a weaker; absent father learn that they are not expected to contribute to the work of the family and they have no great reproductive advantages to be gained by choosing a suitable mate and postponing reproduction. Instead such men compete and struggle with their peers in short-term sexual competitions exhibiting in the process aggressive, exhibitionist and exploitative behaviours.

    The absence from the home of a strong adult male figure has particular implications for mothers with growing, physically aggressive and assertive sons. Psychiatrists, psychologists and social workers are well versed through their professional work with the tensions in adolescent males when after a divorce the mother has to step in, as it were, into the departed father's shoes. In an article in a highly publicised case in Britain which involved the murder of a single mother by her 18 year old son, Lisa Jardine, Professor of Renaissance Studies at the University of London protested that often the deserted mothers find themselves then blamed for the aggressive behaviour which many adolescent 5on5 in this situation go on to display. She pointed out that boys who live with a lone mother are far more likely than girls to resort to violent behaviour. Studies do show that sons of absent fathers develop difficulty in controlling aggressive and compulsive behaviour.

    Among the growing reports of domestic violence there are increasing incidents in which the mother is beaten up by a son rather than an adult male partner. If the son is over 18 then he can be treated as an adult and a barring order obtained against him but if he is not technically an adult such an abusive young male is exceedingly difficult to manage legally as well as physically. Lisa Jardine deplored the fact that the murder of the mother in that instance by her son led to a media witch hunt in which alleged maternal deficiencies were in some rather murky way blamed for the killing. Her own more temperate and thoughtful analysis reflects the growing realisation of the importance of paternal discipline, example and control in the successful socialising of the growing adolescent male and the impact on single mothers and the dilemma for single mothers of the absence of an adult male.

    What are we to make of violence committed by children? This is a case of parenting gone wrong. In 1968 the murder of 2 boys aged 3 and 4 in Newcastle Upon Tyne by 11 year old Mary Bell was a cause celebre, a savage jolt to an easy assumption that children in general and girls in particular are incapable of such dreadful violence. Since then we have experienced 2 decades of a seemingly steady increase in violence committed by young boys, mainly male adolescents, in the suburbs, small towns and cities of most developed societies. These include the beating to death of the toddler James Bulger by two 10 year olds in Liverpool in February 1993; the dropping of 5 year old Eric Morse from a 14th floor window by two boys in Chicago aged 10 and 11 because he wouldn't steal candy for them; numerous teenage murders in the United States; and, most notably, a casual shooting to death of 12 fellow students and a teacher by 17 year old Eric Harrison Dylon, of a High School in Denver. Crises like these have provoked a kind of intellectual paralysis, an existential dismay reflected in the call by then Prime Minister; John Major in the aftermath of the Bulger murder that we must condemn a little more and understand a little less.

    Those who like Gita Sereny and Blake Morrison have argued against a view of some children as innately wicked, natural born killers and for a greater understanding of the factors that lead children to destroy, have encountered remarkable hostility. The public debate that follows such outrages is often more concerned with the simple-minded response of building more prisons and incarcerating more youngsters than with the need to understand and prevent such behaviour and to help young people if such preventive methods fail. This is particularly depressing given the degree of consistency within the research field concerning the causes of such violent behaviour in young people particularly males.

    One researcher who has explored why some American boys become violent is James Gaberino of Cornell University. In a pugnacious review of the area Gaberino teases out the melange of psychological, social, existential, constitutional factors that precipitate some disturbed boys to become violent. But what other factors emerge when violent young men are scrutinised? Are they the usual suspects - a lack of at least one loving, reliable and supportive adult figure, usually one parent, preferably both, living in a drug and crime-infested neighbourhood, suffering physical or sexual abuse or some other trauma and lacking the kind of philosophical or religious system of belief that provides meaning and purpose?

    Gaberino is convinced by a quarter of a century working with young boys that young people are really more angry and violent than ever. The struggle to answer the question "Why do human beings hurt each other?" has taken him all over the world to Yugoslavia, Mozambique, Kuwait and Iraq, Palestine, Israel and Northern Ireland. He has encountered children who have committed and been the victims of terrible acts of destruction. He has listened to their stories. His work and that of others has illustrated the appalling hypocrisy of a society that makes children responsible for their actions but doesn't accept its own responsibility for their wellbeing. It is not for the citizen from another land to comment on something here, but since it did not happen in Scotland I will comment nonetheless. I doubt if there is anything since the Blair Government has been elected that made me so depressed as watching that senior police officer formally apologise, for actually arguing that the Bulger boy killers might have served their debt and might be better rehabilitated now by taking them out of penal incarceration and into something that might look like human life. I think we have much to learn from a country such as Norway where, as I understand it, child killers are not even incarcerated but are left with their families and work is done not just with the victim's family but the killer's family and in a number of instances those families actually have come together and tried to make sense of what is after all an appallingly enmeshed tragedy.

    We have so much to learn and every incident that occurs is an opportunity for learning. I am always very struck by the field of cancer. These days when someone dies of cancer; particularly dramatic if the person is young and a star; it is used by the media to inform people of the nature of cancer; of what we know about its causes and the current state of treatment. The media use that opportunity to defuse and avoid people being frightened, to try and encourage people to be positive, to use the death to raise monies, shamelessly to milk public compassion and at all times to try and improve knowledge and understanding and disseminate what is know in the privileged professional world about the nature of cancer to the public.

    Contrast that with the areas of juvenile violence and disturbance and unhappiness. I would argue that quite the opposite occurs, each incidence of some appalling tragedy is used to perpetuate some of the most bigoted, intransigent and ignorant views on the nature of human misery, unhappiness, violence and discontent. The public learn absolutely nothing about what might go to make a child or children do such terrible things. Not surprisingly the public's reaction when it hears of such things is to demand that such children be categorised as monsters, be treated that way and be left, largely, to die. The victim's families learn nothing either. And so you find them if you are unfortunate enough sometimes to sit beside such a person on some ghastly television programme set up to educate the British public, but actually to engage them in a circus of confrontation. You find some dreadful survivor of a terrible murder of 20 or 30 years ago who has learned nothing, who has been helped with nothing, who understands nothing other than the most personal and bitter feelings of hatred and revenge. In a hundred years they will look back at us and wonder what kind of civilised savages we were.

    So to Jack Straw I say "For God's sake, start standing up and speaking about what we know is good for people who have been in trouble and what we know of the reasons that they have got into that trouble in the first place." It is not as if the research isn't there - it is in there in its tens of hundreds of hard sweated PhDs and MAs. It is the same catalogue of factors. Yes, of course, every now and again somebody emerges out of a pure, decent, balanced, happy, harmonious, middle class home and creates mayhem. But for every one of those there are hundreds of others in whose lost boyhood the seeds of their subsequent destructiveness and destruction can easily be identified.

    Insofar as biology is involved in young male violence, it is as one factor among many. Just consider the difficulties. The child who suffers repeated jolts of stress such as is experienced in a family characterised by, say, alcohol abuse, drug abuse or violence or repeated separation, or emotional rejection, or all of those things, is the child who grows up to develop impulsive anger and aggression. One biological theory is that the increased outpouring of stressed hormones resets the brain system for regulating flight or fight responses, such that they remain on a hair-trigger alert all the time. It is certainly a useful model. I use it when I am dealing with adults -I am an adult psychiatrist not a child psychiatrist - who appear to be like that, on a hair trigger alert all the time. One senses that some kind of thermometer is set differently. The early environment programmes the nervous system to make an individual more or less reactive to stress according to a McGill University biologist, Michael Mean. I quote "If parental care is inadequate or unsupportive, the brain may decide that the world stinks and it better be ready to meet the challenge".

    In other children, repeated exposure to humiliation, bullying, physical or emotional violence can shut down the brain's responsiveness. These are the hollow young men who have little or no feeling for others and whose sensitivity to the needs and experiences of others is non-existent. Their ability to feel, react, bond, has been seriously infringed. Such self-esteem as they have is grounded in the extent to which they feel superior to rules and conduct and controls and can live by their violence. Most of the available models and scripts for this kind of anti-social individual are male, although the increase in media portrayals of female super heroes who engage in murder sprees and uninhibited violence, may lead to a growth in the currently tiny proportion of adolescent girls to be found in the catalogue of teenage destructiveness. In general however young girls internalise shame, humiliation and ostracism and turn these against themselves in the form of depression. Whereas in young men, so many turn it outwards in anger, in paranoia in drug and alcohol abuse, in delinquency. My conclusion from my understanding of the literature is that early family life predicts much in later life. Fortunately not everything. Fortunately it is a matter of probabilities not certainties.

    Just consider two studies from my own speciality, medicine. I selected them from a vast array and I don't understand the links, but they intrigue me. The first involves self-reported information on the closeness that 1337 white male medical students felt towards their parents at the start of training. Physicians who went on to develop malignant tumours showed a statistically lower mean level of perceived closeness to, or intimacy, with their parents.

    The second study was undertaken by George Vaillant and his colleagues at Harvard. They followed a group of 47 physicians and a matched control group of non-physicians for 30 years. Using both questionnaire and occasional interview formats they collected data on marital history, drinking and drug use, childhood and family functioning. The physicians with the least stable childhoods and most maladjustment were at highest risk for poor marriages, drug and alcohol abuse and for recourse to psychiatrists.

    Any emphasis on the importance of parenting and the influence of family life, particularly when expressed by a male, risks accusations of a return to patriarchy, of wanting women to stay back in the home where they belong. But it is a risk worth taking if it leads to a truly radical examination of where the mixing of the two spheres of work and family life is taking all of us, men as well as women. Modern politicians and many men and women, appear to believe that the solution to the problem of balancing work and family life lies in the development of better professional childcare and crèche facilities, the payment of larger childcare payment credits and the provision of larger periods of maternity and paternity leave. But in fact it is proving difficult to finance, recruit, train sufficient professional childcare workers and staff sufficient crèches, even when the political will to fund such developments occurs. That is true across Europe. A greater shortcoming inherent in such demands however is the fact that they re-emphasise the dominance of the public arena of work over the nurturing, education and development of the next generation.

    The entry of increasing numbers of well-educated and highly skilled women into the world of public work challenges us to respond in one of two ways. The first leaves the way in which we organise public work essentially unchanged. Women must subordinate their personal family and domestic lives to the needs of work as men have done for the past two centuries and more. If they decide to have children they must take the maternity leave entitlement and no more, quickly arrange appropriate childcare such that no intrusion on their professional duties by the lives of their children takes place and return to the workplace. Should they do this, then they stand a better chance of breaking through that resistant glass ceiling and taking their rightful share of the powerful jobs in the boardroom instead of languishing in lower middle management posts, low paid part time jobs, in jobs with little security and less status.

    The second involves a genuine revolution in the way we organise work that has implications not merely for women but for men too. It takes seriously the way work is organised, the hours we work and how we work them. The extent to which work can be organised around our personal and family lives rather than the other way around. Such a revolution starts with the premise that there can be no distinction between work inside and outside the home.

    I am always struck by the fact that those social theories which tell you that the family is a relatively recent construction are actually quite wrong. It is the oldest institution in human biological evolution. But what is very recent is the division between work and family. That is exceedingly recent and indeed in certain occupations it hasn't happened. For instance in good Irish and, I suspect, Scottish general practice many general practitioners until relatively recently worked from the home, fathers or mothers or both, and indeed it may account for such strong family tradition until recently, in Scottish and Irish medicine. Of course there was no division. What the parents did and what they did at home were enmeshed. What we have seen happen since the industrial revolution has had appalling consequences for us, particularly us men, but for women too. How often one hears women who work outside the home casually described as working women but those who choose to or have to work inside the home are described equally casually as women who do not work. Those individual parents, male and female, who opt to remain in a full time parenting role should clearly receive some form of remuneration equivalent to that which would otherwise be paid to a childcare professional that would in effect be a parenting wage and would, like a childcare professional wage, reflect the number and age of the children being cared for. The summary of responses to the British Government supporting families initiative reveals that only a small number of employers responded to the question concerning ways in which they have introduced family friendly employment policies and their views on what works. Of those few employers who did reply, some responded that making family friendly working conditions a reality and I quote "is as much about changing the culture in the workplace as about policies on paper".

    How right they are is exemplified by the experiences of young solicitors. This is a profession in which it should be perfectly possible for a woman to excel. The majority of entrants in this profession as in so many others are women; I learned from Lord Kilbrandon's grandson, who is a first year law student in this university. He is outnumbered 3 to 1 by women entrants to the field of law. Thank God for that. But my anxiety is that those women when they graduate through law will take a look at what it looks like at the top and being civilised, sensible, balanced people will have nothing to do with it. And that is the problem. In practice I am told it is possible for women or men to use flexible or part time working while rearing an infant or small child. I learned this because I was at the Millennial Conference of the Law Society in Paris and I was immensely heartened by the extent to which young male and female solicitors are articulating views about how they want to see their professional and family life integrated that are truly revolutionary. Whether they succeed or not I don't know. I was a bit upset that the radical leader sitting on the platform suddenly started to look a little less radical as some of these views were expressed.

    In practice any woman seeking such an option of flexible or part time working risks being seen by her colleagues as showing insufficient commitment to her work. tier chances of a partnership we know are greatly reduced or at any rate are believed to be. The problem with the culture in the workplace at the present time is that part time work, flexi time, career breaks, work shared in the home are seen as something women do when they have children. The implementation of so-called family friendly policies in the workplace has been promoted almost entirely in terms of the advancement of women's equality, which I solidly support, and opportunity within the labour market, which I have considerable reservations about. Yet family friendly policies have important implications for men. Not least those men who have been earnestly hoping, and I count myself as one of them, that the greater involvement of women in the workplace might bring about much greater flexibility in work hours and patterns of work and styles of work and systems of remuneration for parents to care for infant and very small children on a par with hourly rates for trained childcare workers. A greater emphasis on work undertaken in the home, and imaginative responses to the issue to time off for urgent family reasons.

    It is as if, for example, issues like caring for elderly relatives or caring for small children are separate issues from getting family work policies. Read some of the recent statements emanating from the British Government and it is very difficult to resist the suspicion that what is driving family-friendly policies, quite frankly, is the desire of the great capitalist economy to feed itself with more and more women having virtually exhausted the male supply. Be very careful that what we are now not being sold is just another variant on the old issue that "Labour drives everything else". We will, 10 years on from the fall of the Berlin Wall, begin to be saying "come back Karl Marx, all is almost forgiven". The immediate response to truly radical proposals concerning work and family life is quite simply that, desirable and all as they are, they simply cost too much. A similar argument I recall was made when it was suggested that slaves be freed, children be removed from degrading employment and, perhaps most revolutionary of all, women be paid the same hourly wage as men doing the same work.

    In November1995 the organisation Parents at Work published a report which revealed that 64% of those surveyed complained they did not see enough of their children and reported that their partners also worked such long hours that it was difficult for them to spend time together. The summary of responses to the British Government's 1999 Supporting Families Consultation Document quoted this survey and with it the dilemma whereby employees' need for flexibility could well conflict with employers' need for an efficient, reliable workforce. It is indeed a difficult dilemma which is not however new, nor is it insoluble. It has hitherto been solved by simply ensuring that the demands of the workplace always take priority over personal, domestic and family responsibilities.

    Meanwhile the studies pour out, testifying to the extent to which we are failing to resolve this particular dilemma. In one of the largest and most publicised, a three year study entitled "The Big Picture" undertaken by the Mental Health Foundation here in Britain, the conclusions were that children are failing to thrive emotionally, are becoming less resilient and less able to cope with the ups and downs of life. Cited amongst these ups and downs were divorce, violence, abuse, alcoholism, inconsistent or unclear discipline and a lack of basic parenting skills. At the launch of the report one of its authors, Dr Steven Scott of the Maudsley Hospital in London declared "More children now have parents under stress. Their mother or parent is more isolated and more unsupported, trying to juggle 2 or 3 things at once, such as home and work, without any support". The usual suspects identified: lack of time, cost of childcare, stress of balancing work and home life. The Government's response, understandable but symptomatic rather than truly radical, was to announce another f84m for services for young people in trouble.

    The central point of this lecture is, it may be self evident, that parents matter. Maybe not so self evident, is that fathers matter as well as mothers. We who are parents can console ourselves that we are but one of a number of factors, genetic and environmental that help shape and mould and develop the next generation. But we are a factor and as the research I have but touched on suggests, an important one. In a recently published editorial in the Acta Psychiatrica Scandinavica entitled "Parental Influences Do Matter!" William Allendal and Carlo Perris, two distinguished Scandinavian psychiatrists, challenged the assumption that the cross sectional associations between parental rearing factors and psychological states and traits are extremely small. They countered by showing that the effect of parents is on a par with increasing the success of a treatment from 34% to 660/0. So, if you are trying, you parents, to think how roughly you equate, you double the effectiveness of Valium or, dare I say it, Viagra. Parenting, they remind their readers, is a complex, multi determined set of behaviours influenced by parental personality, psychopathology, values and marital quality. They also remind us that the elicitation of parenting is itself influenced by the temperamental traits of the children which are in turn under partial genetic control. That is to say: as we shape our children, they shape us. And we are together shaped by our genes. How much do they shape us? Well that is for another lecture, and I am relieved to say another lecturer.