/
Special Article all can be brought within the sphere of public health is another matter. In America and England and other western countries the idea is becoming widely accepted that the child should be cared for from the time of conception up to school age through the maternity and child-welfare service. Till recently the childwelfare service proper catered only for the first two years of life, but there is now a movement to carry the care of the child right on up to school age, so that there may be no break between the care of the child provided by the welfare service and the beginning of the care provided by the school medical inspection service. In child welfare, clinic doctors are paying more attention than formerly to the psychological factor in child development which is found to be almost inseparable from the physical. For the age period two to seven years, it is advocated that children should be cared for in nursery schools provided by the state. The necessity for the provision of this service has been accepted in principle by the Ministry of Health in England. Russia is I believe the only country where great progress in the provision of nursery schools and creches has been made. The need for these schools under modern conditions of life arises partly because of the large numbers of children growing up in cities in cramped surroundings which give them no outlet for play or free development, and partly because of the increasing numbers of small families in which there are only one, two or three children born at long intervals, the children thus being deprived of the opportunities for social development found in large families. The nursery school is therefore advocated :?
SEX EDUCATION* By JEAN BIGGAR, m.b., ch.B. (Edin.) ' Sex education has a definite role to play The in the sphere of preventive medicine. recent findings of child psychology show that the development of the sex instinct is affected by the attitude of the parents towards sex and by their giving of or by their denial of sex instruction in early childhood. It is now accepted that the correct attitude in the home and the willingness of parents to answer truthfully the sex questions of young children aged two to five play a most important part in promoting the mental health and balance of the adult, whereas a repressive attitude in the home towards sex sows the seeds of future neurotic illThese findings, first put forward ness. by Freud as a result of his analysis of psychopathic adults, were at first widely disputed, but I think it may be truthfully said to-day that they are everywhere accepted by psychologists, although not necessarily in the exact form given them by Freudians. Freud's findings led to an intensive study of child psychology. To the astonishment of many observers much of what Freud had concluded to be true of the development of the sex instinct, as a result of his analysis of neurotic patients, was actually to be found in the normal child's life when it was observed with a critical and scienof Freud's tific eye in the light theory. Whether the whole findings of Freud are accepted or not no one can deny to-day that the seeds of future neurotic illness are sown in childhood. If it may be said that the whole of preventive medicine is a field for public health activities undoubtedly the guidance of the development of the sex instinct in childhood should be included in that sphere. It need only be remembered that about one-third of the illnesses for which patients in England draw sickness benefit under the medical insurance acts are neurotic or psychological in origin to realize the necessity of the application of '
(?) (?) (c)
as
as measures against psychological against physical illness, if the commu-
is to be maintained in full health. How exactly guidance of the development of the sex instinct or indeed child psychology at
nity
*
A lecture delivered at the Public Health Society, on 28th September, 1937, at 4-30 p.m.
Calcutta,
give
j
the child
healthy surroundings,
promote his physical development, promote his social development by placing him amongst children of his own
age;
and
guide his psychological development during the early formative years. It is through nursery schools that the normal development of the sex instinct may be safeguarded by the public health service of the future which will have a psychological as well It has been recognized as a physical outlook. in England by the Ministry of Health that nursery schools should be provided as part of (d)
preventive well
to to to
to
Dec., 1937]
SEX EDUCATION
:
BIGGAll
745
upbringing from this point of view was not the child-welfare service but it lias not yet good, and feci that they would like the children been laid down that the teachers in charge of of the next generation to be brought up differthose schools should have any specialized ently; but, suffering from the disabilities of training. From the preventive medicine point their own upbringing, parents find it difficult of view it is most essential that these teachers to speak naturally about sex to their children. should have a training in child psychology as In spite of their desire to the contrary they are well as in the physical care of toddlers. At only too apt to pass on their repression to in a certain present amount their children. England there is of dispute going on between the Ministry of Now what do I mean when I say that sex Health and the nursery schools association of is artificially and knowledge unnaturally exGreat Britain as to whether specially trained cluded from the old-fashioned type of educawomen are for work in nursery tion. It is natural for the small necessary child to ask schools. The that maintains association the question ' where questions without end, and specially trained nursery school teachers should do babies come from ? ' is one that is almost be employed and that nursery schools should invariably asked somewhere between the age be made part of the permanent educational of two and four. In the type of I system of the country, and should not be condemn, this question and others upbringing of the same provided to promote the physical well-being kind are hushed up or are answered by unonly of children but their all round normal truths. This is surely unnatural and also development, both physical and mental. The wrong. of to Health is not prepared Ministry accept The next period of the child's this principle and holds the nursery school to upbringing be part of the welfare service to safeguard the begins when he goes to school. If he goes to a school where science is taught he will learn physical health of the toddler. the structure and functions of This introduction is just to show you the about living and animals, and later on he plants things, may place the subject of my lecture may hold in the future developments of public health. I learn human physiology and hygiene. In those will learn exactly how plants further want to say that the lecture was written lessons the child the lower animals reproduce and themselves, entirely in relation to the upbringing and education of children in the west, as I have not but the nearer he gets to the human species the and obscure indefinite will information sufficient experience of the attitude towards sex more regarding the reproductive system become. If in relation to in Indian children very young homes to be able to speak about conditions in we examine school books on human physiology this country. I must ask you from your own we find that all reference to the genital system omitted. Such omission of matters of fact knowledge to apply what I have to say, in so is far as it is applicable, to conditions in this from a supposedly scientific study cannot be country. Further, I would like to add that this justified. lecture was written for quite a different type of Turning to adult education we find here the audience and has only been rather hastily same state of affairs, even medical students are modified before being delivered to this learned not given the opportunity to read in their textsociety. If therefore it is in some respects not books of physiology an account of the mechanaltogether suitable, I must ask your indul- ism of the sexual act. In my time as a student the psychology of sex was gence. barely If the title of my lecture suggests that teach- touched on, and students qualified as doctors ing about sex should be given as a separate were quite unfitted to help patients who might educational subject in schools, then the title appeal to them for advice about sexual difficulconveys a wrong impression. What I have to ties. They also completely lacked the scientimake clear in it is that knowledge of the facts fic training in this aspect of physiology and of sex should not be denied to children, and psychology which would have helped them to such knowledge should be made accessible to suspect and diagnose sexual difficulties, which them as they acquire it in a natural way. patients seldom like to speak about unless Separate set lessons on sex would be unnatural, directly asked. If it be folly to discourage the for the sex function is only one of the many scientific study of one system of the body functions of the human body, which should be among school children and ordinary science studied as a whole in physiology or biology students, surely it is the height of folly to disclasses. The reason why I have to speak to courage it among medical students in whose hands are placed the future bodily and mental you on sex instruction, separating it artificially from the wholeness of human physiology and health of the community. This obscurantist psychology, is because many people have been attitude to sex is easily recognized as foolish in subjected to an education and upbringing from the case of the medical profession, but it is not which all knowledge of sex was rigorously and so easy to realize that it is equally foolish all artificially excluded. This type of upbringing through life and that it is during the first five produces repressions regarding sex and makes years of life that the seeds which produce this it difficult for people so brought up to take a attitude towards sex are sown. It grows from balanced view of it. Many realize that their ^
746
THE INDIAN MEDICAL GAZETTE
seeds of shame and fear planted in the minds of young children by their mothers or those who stand to them in the place of mothers. The children are made to feel that there is a dark mystery in their bodies and about the origin of life, a mystery both horrifying and mysteriously fascinating. To be fascinated by that which they have been made to feel is shameful terrifies children, especially the more sensitive and intelligent ones, and they repress and deny all sex interest, and at the same time are driven to hate and fear their bodies, especially those parts of the bodies concerned with reproduction. This repression of the natural interest in sex persists throughout life. It is very difficult for people with this repression to read about sex or study it in a dispassionate way; they have the persistent feeling that it is shameful to look at or think about or take any interest in such things. This attitude rules out scientific study which demands a dispassionate and clear-sighted ability to look at facts. How then can this vicious circle be broken and the children of to-day be given the freedom of mind denied to many of the older generation. First by re-education, parents and teachers must be intellectually convinced that it is right and beneficial to allow the child sex information and then they must resolve to live up to intellectual convictions. Where intellect is at war with longfelt prejudice and false shame this is by no meatfS easy to do, but requires courage and resolution. The first step is the most difficult, but, if that is once successfully surmounted, it becomes easier. The small child's completely natural attitude helps and enlightens the mother who tries to answer all his questions naturally and truthfully. She soon realizes how lovely the human spirit uncontaminated by shame can be. She rejoices that she has been able to take the way to preserve this loveliness which is the true ' innocence ' of childhood. Parents sometimes ask whether information about sex should be given by the parents in the home or by the teachers in the school. The answer is that the right time to give the knowledge is when the children first ask for it. As we have seen already the first questions are usually asked in the third and fourth years, that is before school age, and therefore they must be answered by the parents. Not only is this age the time when the child first asks about sex, it is also the time when his emotional attitude to sex is formed. It is therefore more important that questions should be answered truthfully at this than at any later time. Child psychology shows us that this is the time when the child's character is formed, now his whole future life is being moulded. His reaction to his parents' attitude towards sex, as shown in their lives and in their method of dealing with his questions, has a profound influence on his future character. Instruction given later in life in school cannot wholly correct the evils brought
[Dec.,
1937
about by wrong answers given or wrong impressions made during the formative early period of life. There are many parents who say, ' But my child has never asked me any sex questions'. Such parents do not realize that the child's ability to ask these questions depends on factors operating before the age of two. Although the child cannot ask questions before two, yet from a much earlier age he has taken an interest in his own body, and in his bodily functions including the" excretory functions. If this interest is if the child is told such interest is checked, ' or that his excretory products are dirty', 1 dirty', or if his interest in his parents' bodies or the bodies of other children is discouraged, then the process of repression has already begun. Sometimes mothers think they ought to answer sex questions and yet dread them, and when the child gets near the subject there comes a change in the tone of her voice which the child feels, and he does not ask because he feels that his mother does not like these questions. The same tone used about the excretory functions will be carried over in the child's feeling to the genital organs, for he does not distinguish between the genital and excretory organs. If therefore the child is made to feel that there is something disgusting about his excretory organs, this false feeling of disgust will be carried over to the genital organs. Children who have thus early been repressed often fail to ask sex questions. If such questions are to be asked there must be complete confidence between mother and child, and to secure that the mother must understand how the child feels about his body, so that she may not unknowingly spoil his feeling. The attitude of the unspoiled child to the excretory processes' is well illustrated in the following story from New Babes for Old ', a book by Dr. Winifred de Kok. She relates how her little daughter, two years old, came into the room where her mother was changing a napkin which the new baby brother had soiled. At first the mother was put out, for she did not want the little girl to see the baby's excretions, thinking the child might find it disgusting, and not love the baby so well thereafter. However, she did not say anything to the child but let her watch what she was doing. The little girl pointed to the bright yellow motion on the baby's napkin and smilingly exclaimed ' Pretty, pretty sunflower '. The mother then felt thankful that she had not imparted to the child any feeling of disgust which it was obvious it would have been quite unnatural for her to feel. When mothers say therefore that their children never ask them any sex questions I know that these children have in some ways been repressed. They may have been subjected to too strict training in control of the bladder and bowel; or after failure of such control they may have been called 1 dirtyor they may have been made to feel that there is something shameful in nakedness. The most important thing for the small
Dec
1937]
SEX
EDUCATION
child is the love and approval of his mother. He will go without knowledge and give up his own feeling for truth if need be to gain her approval. Thus it is that the mother's attitude so easily produces repressions, and why it is the mother who is usually responsible for them. If a mother feels shame about the bodily functions she will impart her feeling to her child and he will repress his interest in those functions for fear of losing her love. If however the child is not so repressed he will ' sooner or later ask Where do babies come from ?' Mr. Maiti, in an interesting lec' ture, Children's Questions', pointed out that the child's questions are never asked purely for intellectual reasons, but that they always have roots in the child's emotional life as well. When the little boy asks ' Where do babies come from ? ' he asks, not only because he wants to know as a matter of intellectual knowledge, but also because the advent of a new baby in His his home is both feared and desired. emotions are involved. Perhaps he wants to know because he may fear that another baby will come and take his mother's love away from him; or perhaps because he feels that there is a love between his father and mother from which he is excluded and which he cannot understand. He may feel unsafe in the family relationship and want to be reassured. The best way for the mother to help the child to feel secure is to give truthful answers to all his questions. By so doing she will help him to feel that he is not shut out, and that he will not lose her love even should another baby come. By telling him beforehand that another baby is coming she will help him to accept the fact that he must share her love. The lesson that one cannot have an exclusive right to the love of any human being is a hard one to learn, but it is one that must be learned and mothers can do much to help their children to accept it easily. The only child stands at a disadvantage because he does not get the opportunity to learn this lesson in the formative period of his life.
inevitably
So far I have said that it is necessary to child's questions about sex truthfully because on so doing depends the child's future attitude towards sex. But of course there are other reasons why these questions should be answered truthfully. The first reason which I have just been explaining may be called 'the emotional reason'; the second reason is the intellectual one '. If questions about sex are repressed the child may get the idea that it is wrong to ask questions^ and this will retard his intellectual development. Also if he is made to feel that it is wrong to think about certain things, this feeling of wrongness may spread to other subjects such as mathematics, so that the repressions of a child's questions about sex may produce repression of the intellectual as well as of the emotional side of his character. The third reason, why questions should be answer a
'
:
BIGGAR
answered truthfully is ethical.
747
Although everyis convinced that one of the greatest human virtues is truth# yet many parents and teachers who believe this think it no shame to lie to children. We have seen already that the small child develops his emotional attitude from his mother. In the same way his feeling for truth is derived from his mother. If she lies to him his feeling for truth becomes impaired. For ' all these reasons when the child asks Where do babies come from ?' it is wrong to answer that they are brought by a stork or that the doctor brings them in his bag, or by any other of the fairy tales with which parents too often this question. The child answer seemingly accepts the story told him but deep down in him there is a feeling which tells him that the story is not true even though he may consciously accept it. The following is a true story about a small boy who had been told untruths about the birth of his little sister. The incident occurred when he was about four years old and had been sent away from home to stay for a time with friends. The mother of the family to whom he had been sent had three children of her own, one of whom was a baby, and all were younger than the visitor. She was a modern mother and had resolved that whatever questions her children asked should be truthfully answered, although she had often wondered how she would As it happened her first answer sex questions. little stranger child. experience came with this ' One day he said to her we got a present of a calf at home; was your calf a present?' She ' replied no it was not a present, the calf came the of cowAnother day the child said out ' We have a present of a baby at our home, the doctor brought it to us; did the doctor bring ' you your baby ?' And she replied No, my baby me '. In of me this story the came out telling mother said she had felt so indignant that the little boy had been told such lies, that she This tale answered frankly and naturally. shows that the little boy had not really believed what his mother had told him, and that he was taking the opportunity to test what she had said. Here is another story of a family in which the children had not asked any questions about sex, although the mother had been quite prepared to answer such questions truthfully. Yet in her dealings with her children there was a subtle change in her voice whenever the children asked questions relating to the excretory functions, and she often checked them when they referred loudly and clearly to these functions in the way that children do. I stayed with this family for several months and made great friends with the children. One evening the little boy aged five and the little girl aged three came into my room when I was having my bath. I could not help feeling slightly embarrassed at this intrusion into my privacy, but I realized that this was a wrong feeling and that one
748
THE INDIAN MEDICAL GAZETTE
I must not show it to the children because we were great friends. The little girls asked me several searching anatomical questions, also why I had no children, which I answered as best I could. Then she said, with a delightful oldthis fashioned turn of speech, ' What is all business of being married and not being married ' and of having babies and not having babies ? At this point the mother realized where the children were and called them away, seemingly rather shocked. Afterwards I told her the little girl had asked me and she questions her ' exclaimed, Fancy, I never realized that Mary thought about such things '. Now I shall give you an account of questions asked by a little boy, whose mother had been perfectly natural and frank with him always. They will show that the information that babies are made inside their mothers is not the only information the child requires regarding sex and that it is not enough to satisfy him. If he is allowed to, he will go on asking questions until he gets an explanation of the father's part I again emphasize that those further as well. questions will only be asked if the mother answers the first questions freely and without embarrassment. This little boy, whom we will call John, was the second child of a family of four boys. He was brought up on a farm where he had many opportunities to see the reproductive and sexual He knew from the age of processes in animals. three, when his youngest brother was born, that babies were made inside their mothers, and he accepted this as a matter of course, and had not at that time shown much curiosity. When he was four years old he began to ask many questions about sex. His mother wrote me the following account of these questions. John keeps plying me with questions about all kinds of things, lambs inside sheep, and babies inside their mothers. I said in a rash moment that the baby lived in a place like a little house inside his mother. ' Oh ', said John, ' did I sleep on a bed in that little house inside ' 1 you ? Oh, no, but you were very comfortable, were in a kind of bath I think '. ' Was the you 1 water warm ? ' ' Yes, it was warm '. And did I get food ?' 'Yes, certainly \ ' And did I wet inside you ? ' ' Well, not in the way you do now', I replied. ' Oh, and what was wrong and why didn't I ? ' Here I thought to myself ' insatiable Was child'. He continued William (his younger brother) there ? ' ' Not then'. He then asked if the other younger brother had been there at the same time and ' on being told No ', he asked whether his elder brother had been there at the same time and I told him no, he had come out already. Another day he asked why he had not got milk in his breasts. I replied 1 Because you are going to be a man when you grow up ', then he asked if Winnie, his nurse, had milk in her breasts. ' I replied, No, she hasn't because she has not ' got a baby '. He asked, Why hasn't she got ??
[Dec.,
1937
' ?' I replied, Because she is not ' ' married '. He then said Are you married ? ' he to which I replied, YesOther questions ' ' asked at this time were Why have I bones ? ' ' ' ? Do cheviot Why do rams not have lambs ' sheep have cheviot lambs ? and so on. A month or two later his mother wrote again saying John's questions have been persistent. The cows are always going to the bull; we have two red cows and one had a black calf and the other had a red, and John asked why was this and why were they not both red. I answered ' Well, one cow went to a red bull and the other went to a black bull'. Another day he saw the cock mounting the hens; when I killed a cock and was cleaning it John wanted to be shown what it was that the cock gave to the hens. Another night when I was putting him ' to bed John asked, Why are not babies inside men ?' to I answered ' Men give babies ' ' women '. Where does a man put them ? he ' asked. Inside a woman beside the little house where babies grow '. 1 What does the man put there ? ' I replied ' Something like a very tiny bit of jelly '. ' How ? ' he began, when we were interrupted. The next evening at bedtime he told me quite correctly why one calf was black and the other red. Five days later John asked what his testicles were for. I replied that all men had them. He said ' You haven't ?' I I am a woman'. 'Oh because replied 'TNo, but why mother ? ' he asked. I replied ' The testicles are where the man keeps the seed he gives a woman to make a baby grow'. ' I haven't got seed' John said. I replied, ' Not yet but you will have when you grow up'. John said, 1 But how does the man get the seed ' ' No ', I said, ' It does out, it will hurt him ? ' not hurt'. But how does he put it inside the ' woman ? I said, ' By the penis '. ' Where does he put it in her ? ' ( Right up to where the little house is and there it will grow' And be a baby ? ' ' Yes '. Will it sleep all the time ? ? '' Yes '. ' Doesn't it hurt the penis put' the seed in ?' hurt ting No, it ' doesn't ' ' Won't the seed fall out again ? Oh, no You will see from these questions what very detailed information children really want. You will notice also the confusion in the child's mind about the difference between the sexes. As it happened he had had no opportunity of playing with little girls and the only women he knew were his own mother and the nurse. But it is well to remember that children have got to learn the difference between boys and girls, and the fact that girls grow up to be women and that boys grow up to be men. They don't know this as a matter of course without learning it. Thus an important part of sex education is to give the child opportunities to see other children and grown-up people, both men and women, naked. Even if they learn the difference between the sexes, still they may not realize that it is the function of women only
a
baby
'
Dec., 1937]
EDUCATION
SEX
BIGGAR
:
749
again. At the age of four years she went wedding and asked why the bride and don't share in this responsibility. I have known bridegroom were going to be married. Her a number of small boys who were very upset mother replied because they loved each other when they discovered that they would not be and wanted to have a house of their own and able to produce babies themselves when they perhaps after a time they would have a baby. grew up. They are also disappointed when Ann asked, Oh, will the baby be a bit like When she they are told that they will not have any milk Aunt A and a bit like Uncle B ? in their breasts. One small boy watched his was four years and four months old she asked mother nursing the baby and said When I am Can babies just have mummies or must they twins
to have babies and to nurse them and that men to
a
'
'
'
'
Her mother said that grown up I shall have lots and lots of milk in have daddies too ?' my breasts '. The same child said rather wist- they must have fathers too and Ann asked why. ' fully When I was a baby, did you give me Her mother explained that the speck of jelly inmilk like that ? ' As it happened he had been side the mother from which the baby grows mismanaged and half-starved during the first does not begin to grow until a speck of jelly six months of his life and I feel sure there was from the father is joined on to it. When Ann an emotional need behind that question. Freud was five her cat had kittens, and she noticed lays great stress on the part played in the girl's that the cat was in discomfort the day the psychological development by her envy of her kittens arrived. The next day she asked her brother's genital organ. I am inclined to think mother if the kittens hurt the cat when they that an equal, if not greater, effect is produced were born, and if it had hurt her mother when in a boy's psychology, when he discovers that she was born. Her mother replied ' It did hurt he cannot be a mother. a bit for both of us but the part I remember The following is an account of the sex ques- best was being so pleased to see you'. Ann tions asked by an English girl brought up in laughed and thought that was very funny. At India. She was the eldest child. At the age the age of six years and eleven months Ann of two years and nine months she saw her asked how and where the father's seed united mother knitting and asked her what she with the mother's seed to make a baby. After was making. Her mother told her she was her mother had explained that to her she asked a coat for a new baby that was coming if a baby began to grow every time the father's making to live with them. The little girl Ann at once seed was put inside the mother. At the age of ' said, I got lots of coats', and went to her seven years and one month she told her mother cupboard and proceeded to try on every coat that a little girl with whom she played thought that she could find regardless of the high tem- that babies came down the chimney, and that ' perature?100?F. Some days later she said this child's mother got kind of cross' when ' her asked about them. she questions Ann's suddenly When I am big I shall have a baby in my tummy '. When she was three years and mother asked if she told the other child what three months old her mother had twin babies, she knew about babies. Ann replied ' No, she both boys. At first Ann was delighted and seemed a bit funny and I don't think she showed no signs of jealousy. Two months later really wanted to know'. She then asked ' What happens to children whose mothers don't the twin babies were ill and her mother could them true things? Do they grow up-not tell Ann pay very little attention. Ann became very difficult and delighted in making scenes, knowing ?' Her mother said that sometimes and openly declared several times that she hated other people told them or they read about ' the babies and wished that they would go away things. Ann said I am glad you tell me things in a muddle'. I else or or die. get might About the same time Ann came to her mother almost beside herself with rage and The above description of children's questions said, 'My ayah tells me that the babies came has been given in detail to show you the kind children ask. in a parcel from Granny and my ayah is If of questions uninhibited wrong'. It took her mother some time to children are to be separated from their parents pacify her. It is very usual for children who for the greater part of the day between the ages have been told the truth to resent strongly any of two and seven, as they would be if they attended nursery schools, the nursery school subsequent effort to mislead them. At the same three years and five months, Ann asked teacher must be prepared to answer these quesage, ' Did you mean to have two babies or was it tions truthfully and it is necessary for the a mistake ? ' children's best psychological development that One day her mother was showing her a little book about the visit of the shepherds they should so answer them. It is most imto the manger. listened enthralled She portant that the teacher should not be sufferuntil they came to the first picture of the ing from repressions or a distorted attitude towards sex. The nursery school provides an enBaby Jesus, then she said firmly, ' I don't think I like about little babies'. A month later when vironment in which town children can learn Ann was 3^ her grandparents came to stay at something of the lives of plants and animals; her home and made a great fuss of her and did gardening and the care of pets are essential activnot like the wailing, sickly twin babies so much. ities of the nursery school. The care of animals From the day they arrived Ann's behaviour will help children to satisfy sex curiosity began to improve and she began to enjoy the
750
THE INDIAN MEDICAL GAZETTE
in a natural way especially if the teacher is not repressive and is prepared to help the child by allowing him to observe and ask questions freely. When sun-bathing, the children should be naked so that they may learn to recognize in a natural way the differences be-
tween the sexes.
[Dec.,
1937
By such measures the nursery schools of the future will promote the healthy and normal development of the sex instinct, and so doing will lessen the burden of neurotic illness which has to be borne by the adult community.
Special Article all can be brought within the sphere of public health is another matter. In America and England and other western countries the idea is becoming widely accepted that the child should be cared for from the time of conception up to school age through the maternity and child-welfare service. Till recently the childwelfare service proper catered only for the first two years of life, but there is now a movement to carry the care of the child right on up to school age, so that there may be no break between the care of the child provided by the welfare service and the beginning of the care provided by the school medical inspection service. In child welfare, clinic doctors are paying more attention than formerly to the psychological factor in child development which is found to be almost inseparable from the physical. For the age period two to seven years, it is advocated that children should be cared for in nursery schools provided by the state. The necessity for the provision of this service has been accepted in principle by the Ministry of Health in England. Russia is I believe the only country where great progress in the provision of nursery schools and creches has been made. The need for these schools under modern conditions of life arises partly because of the large numbers of children growing up in cities in cramped surroundings which give them no outlet for play or free development, and partly because of the increasing numbers of small families in which there are only one, two or three children born at long intervals, the children thus being deprived of the opportunities for social development found in large families. The nursery school is therefore advocated :?
SEX EDUCATION* By JEAN BIGGAR, m.b., ch.B. (Edin.) ' Sex education has a definite role to play The in the sphere of preventive medicine. recent findings of child psychology show that the development of the sex instinct is affected by the attitude of the parents towards sex and by their giving of or by their denial of sex instruction in early childhood. It is now accepted that the correct attitude in the home and the willingness of parents to answer truthfully the sex questions of young children aged two to five play a most important part in promoting the mental health and balance of the adult, whereas a repressive attitude in the home towards sex sows the seeds of future neurotic illThese findings, first put forward ness. by Freud as a result of his analysis of psychopathic adults, were at first widely disputed, but I think it may be truthfully said to-day that they are everywhere accepted by psychologists, although not necessarily in the exact form given them by Freudians. Freud's findings led to an intensive study of child psychology. To the astonishment of many observers much of what Freud had concluded to be true of the development of the sex instinct, as a result of his analysis of neurotic patients, was actually to be found in the normal child's life when it was observed with a critical and scienof Freud's tific eye in the light theory. Whether the whole findings of Freud are accepted or not no one can deny to-day that the seeds of future neurotic illness are sown in childhood. If it may be said that the whole of preventive medicine is a field for public health activities undoubtedly the guidance of the development of the sex instinct in childhood should be included in that sphere. It need only be remembered that about one-third of the illnesses for which patients in England draw sickness benefit under the medical insurance acts are neurotic or psychological in origin to realize the necessity of the application of '
(?) (?) (c)
as
as measures against psychological against physical illness, if the commu-
is to be maintained in full health. How exactly guidance of the development of the sex instinct or indeed child psychology at
nity
*
A lecture delivered at the Public Health Society, on 28th September, 1937, at 4-30 p.m.
Calcutta,
give
j
the child
healthy surroundings,
promote his physical development, promote his social development by placing him amongst children of his own
age;
and
guide his psychological development during the early formative years. It is through nursery schools that the normal development of the sex instinct may be safeguarded by the public health service of the future which will have a psychological as well It has been recognized as a physical outlook. in England by the Ministry of Health that nursery schools should be provided as part of (d)
preventive well
to to to
to
Dec., 1937]
SEX EDUCATION
:
BIGGAll
745
upbringing from this point of view was not the child-welfare service but it lias not yet good, and feci that they would like the children been laid down that the teachers in charge of of the next generation to be brought up differthose schools should have any specialized ently; but, suffering from the disabilities of training. From the preventive medicine point their own upbringing, parents find it difficult of view it is most essential that these teachers to speak naturally about sex to their children. should have a training in child psychology as In spite of their desire to the contrary they are well as in the physical care of toddlers. At only too apt to pass on their repression to in a certain present amount their children. England there is of dispute going on between the Ministry of Now what do I mean when I say that sex Health and the nursery schools association of is artificially and knowledge unnaturally exGreat Britain as to whether specially trained cluded from the old-fashioned type of educawomen are for work in nursery tion. It is natural for the small necessary child to ask schools. The that maintains association the question ' where questions without end, and specially trained nursery school teachers should do babies come from ? ' is one that is almost be employed and that nursery schools should invariably asked somewhere between the age be made part of the permanent educational of two and four. In the type of I system of the country, and should not be condemn, this question and others upbringing of the same provided to promote the physical well-being kind are hushed up or are answered by unonly of children but their all round normal truths. This is surely unnatural and also development, both physical and mental. The wrong. of to Health is not prepared Ministry accept The next period of the child's this principle and holds the nursery school to upbringing be part of the welfare service to safeguard the begins when he goes to school. If he goes to a school where science is taught he will learn physical health of the toddler. the structure and functions of This introduction is just to show you the about living and animals, and later on he plants things, may place the subject of my lecture may hold in the future developments of public health. I learn human physiology and hygiene. In those will learn exactly how plants further want to say that the lecture was written lessons the child the lower animals reproduce and themselves, entirely in relation to the upbringing and education of children in the west, as I have not but the nearer he gets to the human species the and obscure indefinite will information sufficient experience of the attitude towards sex more regarding the reproductive system become. If in relation to in Indian children very young homes to be able to speak about conditions in we examine school books on human physiology this country. I must ask you from your own we find that all reference to the genital system omitted. Such omission of matters of fact knowledge to apply what I have to say, in so is far as it is applicable, to conditions in this from a supposedly scientific study cannot be country. Further, I would like to add that this justified. lecture was written for quite a different type of Turning to adult education we find here the audience and has only been rather hastily same state of affairs, even medical students are modified before being delivered to this learned not given the opportunity to read in their textsociety. If therefore it is in some respects not books of physiology an account of the mechanaltogether suitable, I must ask your indul- ism of the sexual act. In my time as a student the psychology of sex was gence. barely If the title of my lecture suggests that teach- touched on, and students qualified as doctors ing about sex should be given as a separate were quite unfitted to help patients who might educational subject in schools, then the title appeal to them for advice about sexual difficulconveys a wrong impression. What I have to ties. They also completely lacked the scientimake clear in it is that knowledge of the facts fic training in this aspect of physiology and of sex should not be denied to children, and psychology which would have helped them to such knowledge should be made accessible to suspect and diagnose sexual difficulties, which them as they acquire it in a natural way. patients seldom like to speak about unless Separate set lessons on sex would be unnatural, directly asked. If it be folly to discourage the for the sex function is only one of the many scientific study of one system of the body functions of the human body, which should be among school children and ordinary science studied as a whole in physiology or biology students, surely it is the height of folly to disclasses. The reason why I have to speak to courage it among medical students in whose hands are placed the future bodily and mental you on sex instruction, separating it artificially from the wholeness of human physiology and health of the community. This obscurantist psychology, is because many people have been attitude to sex is easily recognized as foolish in subjected to an education and upbringing from the case of the medical profession, but it is not which all knowledge of sex was rigorously and so easy to realize that it is equally foolish all artificially excluded. This type of upbringing through life and that it is during the first five produces repressions regarding sex and makes years of life that the seeds which produce this it difficult for people so brought up to take a attitude towards sex are sown. It grows from balanced view of it. Many realize that their ^
746
THE INDIAN MEDICAL GAZETTE
seeds of shame and fear planted in the minds of young children by their mothers or those who stand to them in the place of mothers. The children are made to feel that there is a dark mystery in their bodies and about the origin of life, a mystery both horrifying and mysteriously fascinating. To be fascinated by that which they have been made to feel is shameful terrifies children, especially the more sensitive and intelligent ones, and they repress and deny all sex interest, and at the same time are driven to hate and fear their bodies, especially those parts of the bodies concerned with reproduction. This repression of the natural interest in sex persists throughout life. It is very difficult for people with this repression to read about sex or study it in a dispassionate way; they have the persistent feeling that it is shameful to look at or think about or take any interest in such things. This attitude rules out scientific study which demands a dispassionate and clear-sighted ability to look at facts. How then can this vicious circle be broken and the children of to-day be given the freedom of mind denied to many of the older generation. First by re-education, parents and teachers must be intellectually convinced that it is right and beneficial to allow the child sex information and then they must resolve to live up to intellectual convictions. Where intellect is at war with longfelt prejudice and false shame this is by no meatfS easy to do, but requires courage and resolution. The first step is the most difficult, but, if that is once successfully surmounted, it becomes easier. The small child's completely natural attitude helps and enlightens the mother who tries to answer all his questions naturally and truthfully. She soon realizes how lovely the human spirit uncontaminated by shame can be. She rejoices that she has been able to take the way to preserve this loveliness which is the true ' innocence ' of childhood. Parents sometimes ask whether information about sex should be given by the parents in the home or by the teachers in the school. The answer is that the right time to give the knowledge is when the children first ask for it. As we have seen already the first questions are usually asked in the third and fourth years, that is before school age, and therefore they must be answered by the parents. Not only is this age the time when the child first asks about sex, it is also the time when his emotional attitude to sex is formed. It is therefore more important that questions should be answered truthfully at this than at any later time. Child psychology shows us that this is the time when the child's character is formed, now his whole future life is being moulded. His reaction to his parents' attitude towards sex, as shown in their lives and in their method of dealing with his questions, has a profound influence on his future character. Instruction given later in life in school cannot wholly correct the evils brought
[Dec.,
1937
about by wrong answers given or wrong impressions made during the formative early period of life. There are many parents who say, ' But my child has never asked me any sex questions'. Such parents do not realize that the child's ability to ask these questions depends on factors operating before the age of two. Although the child cannot ask questions before two, yet from a much earlier age he has taken an interest in his own body, and in his bodily functions including the" excretory functions. If this interest is if the child is told such interest is checked, ' or that his excretory products are dirty', 1 dirty', or if his interest in his parents' bodies or the bodies of other children is discouraged, then the process of repression has already begun. Sometimes mothers think they ought to answer sex questions and yet dread them, and when the child gets near the subject there comes a change in the tone of her voice which the child feels, and he does not ask because he feels that his mother does not like these questions. The same tone used about the excretory functions will be carried over in the child's feeling to the genital organs, for he does not distinguish between the genital and excretory organs. If therefore the child is made to feel that there is something disgusting about his excretory organs, this false feeling of disgust will be carried over to the genital organs. Children who have thus early been repressed often fail to ask sex questions. If such questions are to be asked there must be complete confidence between mother and child, and to secure that the mother must understand how the child feels about his body, so that she may not unknowingly spoil his feeling. The attitude of the unspoiled child to the excretory processes' is well illustrated in the following story from New Babes for Old ', a book by Dr. Winifred de Kok. She relates how her little daughter, two years old, came into the room where her mother was changing a napkin which the new baby brother had soiled. At first the mother was put out, for she did not want the little girl to see the baby's excretions, thinking the child might find it disgusting, and not love the baby so well thereafter. However, she did not say anything to the child but let her watch what she was doing. The little girl pointed to the bright yellow motion on the baby's napkin and smilingly exclaimed ' Pretty, pretty sunflower '. The mother then felt thankful that she had not imparted to the child any feeling of disgust which it was obvious it would have been quite unnatural for her to feel. When mothers say therefore that their children never ask them any sex questions I know that these children have in some ways been repressed. They may have been subjected to too strict training in control of the bladder and bowel; or after failure of such control they may have been called 1 dirtyor they may have been made to feel that there is something shameful in nakedness. The most important thing for the small
Dec
1937]
SEX
EDUCATION
child is the love and approval of his mother. He will go without knowledge and give up his own feeling for truth if need be to gain her approval. Thus it is that the mother's attitude so easily produces repressions, and why it is the mother who is usually responsible for them. If a mother feels shame about the bodily functions she will impart her feeling to her child and he will repress his interest in those functions for fear of losing her love. If however the child is not so repressed he will ' sooner or later ask Where do babies come from ?' Mr. Maiti, in an interesting lec' ture, Children's Questions', pointed out that the child's questions are never asked purely for intellectual reasons, but that they always have roots in the child's emotional life as well. When the little boy asks ' Where do babies come from ? ' he asks, not only because he wants to know as a matter of intellectual knowledge, but also because the advent of a new baby in His his home is both feared and desired. emotions are involved. Perhaps he wants to know because he may fear that another baby will come and take his mother's love away from him; or perhaps because he feels that there is a love between his father and mother from which he is excluded and which he cannot understand. He may feel unsafe in the family relationship and want to be reassured. The best way for the mother to help the child to feel secure is to give truthful answers to all his questions. By so doing she will help him to feel that he is not shut out, and that he will not lose her love even should another baby come. By telling him beforehand that another baby is coming she will help him to accept the fact that he must share her love. The lesson that one cannot have an exclusive right to the love of any human being is a hard one to learn, but it is one that must be learned and mothers can do much to help their children to accept it easily. The only child stands at a disadvantage because he does not get the opportunity to learn this lesson in the formative period of his life.
inevitably
So far I have said that it is necessary to child's questions about sex truthfully because on so doing depends the child's future attitude towards sex. But of course there are other reasons why these questions should be answered truthfully. The first reason which I have just been explaining may be called 'the emotional reason'; the second reason is the intellectual one '. If questions about sex are repressed the child may get the idea that it is wrong to ask questions^ and this will retard his intellectual development. Also if he is made to feel that it is wrong to think about certain things, this feeling of wrongness may spread to other subjects such as mathematics, so that the repressions of a child's questions about sex may produce repression of the intellectual as well as of the emotional side of his character. The third reason, why questions should be answer a
'
:
BIGGAR
answered truthfully is ethical.
747
Although everyis convinced that one of the greatest human virtues is truth# yet many parents and teachers who believe this think it no shame to lie to children. We have seen already that the small child develops his emotional attitude from his mother. In the same way his feeling for truth is derived from his mother. If she lies to him his feeling for truth becomes impaired. For ' all these reasons when the child asks Where do babies come from ?' it is wrong to answer that they are brought by a stork or that the doctor brings them in his bag, or by any other of the fairy tales with which parents too often this question. The child answer seemingly accepts the story told him but deep down in him there is a feeling which tells him that the story is not true even though he may consciously accept it. The following is a true story about a small boy who had been told untruths about the birth of his little sister. The incident occurred when he was about four years old and had been sent away from home to stay for a time with friends. The mother of the family to whom he had been sent had three children of her own, one of whom was a baby, and all were younger than the visitor. She was a modern mother and had resolved that whatever questions her children asked should be truthfully answered, although she had often wondered how she would As it happened her first answer sex questions. little stranger child. experience came with this ' One day he said to her we got a present of a calf at home; was your calf a present?' She ' replied no it was not a present, the calf came the of cowAnother day the child said out ' We have a present of a baby at our home, the doctor brought it to us; did the doctor bring ' you your baby ?' And she replied No, my baby me '. In of me this story the came out telling mother said she had felt so indignant that the little boy had been told such lies, that she This tale answered frankly and naturally. shows that the little boy had not really believed what his mother had told him, and that he was taking the opportunity to test what she had said. Here is another story of a family in which the children had not asked any questions about sex, although the mother had been quite prepared to answer such questions truthfully. Yet in her dealings with her children there was a subtle change in her voice whenever the children asked questions relating to the excretory functions, and she often checked them when they referred loudly and clearly to these functions in the way that children do. I stayed with this family for several months and made great friends with the children. One evening the little boy aged five and the little girl aged three came into my room when I was having my bath. I could not help feeling slightly embarrassed at this intrusion into my privacy, but I realized that this was a wrong feeling and that one
748
THE INDIAN MEDICAL GAZETTE
I must not show it to the children because we were great friends. The little girls asked me several searching anatomical questions, also why I had no children, which I answered as best I could. Then she said, with a delightful oldthis fashioned turn of speech, ' What is all business of being married and not being married ' and of having babies and not having babies ? At this point the mother realized where the children were and called them away, seemingly rather shocked. Afterwards I told her the little girl had asked me and she questions her ' exclaimed, Fancy, I never realized that Mary thought about such things '. Now I shall give you an account of questions asked by a little boy, whose mother had been perfectly natural and frank with him always. They will show that the information that babies are made inside their mothers is not the only information the child requires regarding sex and that it is not enough to satisfy him. If he is allowed to, he will go on asking questions until he gets an explanation of the father's part I again emphasize that those further as well. questions will only be asked if the mother answers the first questions freely and without embarrassment. This little boy, whom we will call John, was the second child of a family of four boys. He was brought up on a farm where he had many opportunities to see the reproductive and sexual He knew from the age of processes in animals. three, when his youngest brother was born, that babies were made inside their mothers, and he accepted this as a matter of course, and had not at that time shown much curiosity. When he was four years old he began to ask many questions about sex. His mother wrote me the following account of these questions. John keeps plying me with questions about all kinds of things, lambs inside sheep, and babies inside their mothers. I said in a rash moment that the baby lived in a place like a little house inside his mother. ' Oh ', said John, ' did I sleep on a bed in that little house inside ' 1 you ? Oh, no, but you were very comfortable, were in a kind of bath I think '. ' Was the you 1 water warm ? ' ' Yes, it was warm '. And did I get food ?' 'Yes, certainly \ ' And did I wet inside you ? ' ' Well, not in the way you do now', I replied. ' Oh, and what was wrong and why didn't I ? ' Here I thought to myself ' insatiable Was child'. He continued William (his younger brother) there ? ' ' Not then'. He then asked if the other younger brother had been there at the same time and ' on being told No ', he asked whether his elder brother had been there at the same time and I told him no, he had come out already. Another day he asked why he had not got milk in his breasts. I replied 1 Because you are going to be a man when you grow up ', then he asked if Winnie, his nurse, had milk in her breasts. ' I replied, No, she hasn't because she has not ' got a baby '. He asked, Why hasn't she got ??
[Dec.,
1937
' ?' I replied, Because she is not ' ' married '. He then said Are you married ? ' he to which I replied, YesOther questions ' ' asked at this time were Why have I bones ? ' ' ' ? Do cheviot Why do rams not have lambs ' sheep have cheviot lambs ? and so on. A month or two later his mother wrote again saying John's questions have been persistent. The cows are always going to the bull; we have two red cows and one had a black calf and the other had a red, and John asked why was this and why were they not both red. I answered ' Well, one cow went to a red bull and the other went to a black bull'. Another day he saw the cock mounting the hens; when I killed a cock and was cleaning it John wanted to be shown what it was that the cock gave to the hens. Another night when I was putting him ' to bed John asked, Why are not babies inside men ?' to I answered ' Men give babies ' ' women '. Where does a man put them ? he ' asked. Inside a woman beside the little house where babies grow '. 1 What does the man put there ? ' I replied ' Something like a very tiny bit of jelly '. ' How ? ' he began, when we were interrupted. The next evening at bedtime he told me quite correctly why one calf was black and the other red. Five days later John asked what his testicles were for. I replied that all men had them. He said ' You haven't ?' I I am a woman'. 'Oh because replied 'TNo, but why mother ? ' he asked. I replied ' The testicles are where the man keeps the seed he gives a woman to make a baby grow'. ' I haven't got seed' John said. I replied, ' Not yet but you will have when you grow up'. John said, 1 But how does the man get the seed ' ' No ', I said, ' It does out, it will hurt him ? ' not hurt'. But how does he put it inside the ' woman ? I said, ' By the penis '. ' Where does he put it in her ? ' ( Right up to where the little house is and there it will grow' And be a baby ? ' ' Yes '. Will it sleep all the time ? ? '' Yes '. ' Doesn't it hurt the penis put' the seed in ?' hurt ting No, it ' doesn't ' ' Won't the seed fall out again ? Oh, no You will see from these questions what very detailed information children really want. You will notice also the confusion in the child's mind about the difference between the sexes. As it happened he had had no opportunity of playing with little girls and the only women he knew were his own mother and the nurse. But it is well to remember that children have got to learn the difference between boys and girls, and the fact that girls grow up to be women and that boys grow up to be men. They don't know this as a matter of course without learning it. Thus an important part of sex education is to give the child opportunities to see other children and grown-up people, both men and women, naked. Even if they learn the difference between the sexes, still they may not realize that it is the function of women only
a
baby
'
Dec., 1937]
EDUCATION
SEX
BIGGAR
:
749
again. At the age of four years she went wedding and asked why the bride and don't share in this responsibility. I have known bridegroom were going to be married. Her a number of small boys who were very upset mother replied because they loved each other when they discovered that they would not be and wanted to have a house of their own and able to produce babies themselves when they perhaps after a time they would have a baby. grew up. They are also disappointed when Ann asked, Oh, will the baby be a bit like When she they are told that they will not have any milk Aunt A and a bit like Uncle B ? in their breasts. One small boy watched his was four years and four months old she asked mother nursing the baby and said When I am Can babies just have mummies or must they twins
to have babies and to nurse them and that men to
a
'
'
'
'
Her mother said that grown up I shall have lots and lots of milk in have daddies too ?' my breasts '. The same child said rather wist- they must have fathers too and Ann asked why. ' fully When I was a baby, did you give me Her mother explained that the speck of jelly inmilk like that ? ' As it happened he had been side the mother from which the baby grows mismanaged and half-starved during the first does not begin to grow until a speck of jelly six months of his life and I feel sure there was from the father is joined on to it. When Ann an emotional need behind that question. Freud was five her cat had kittens, and she noticed lays great stress on the part played in the girl's that the cat was in discomfort the day the psychological development by her envy of her kittens arrived. The next day she asked her brother's genital organ. I am inclined to think mother if the kittens hurt the cat when they that an equal, if not greater, effect is produced were born, and if it had hurt her mother when in a boy's psychology, when he discovers that she was born. Her mother replied ' It did hurt he cannot be a mother. a bit for both of us but the part I remember The following is an account of the sex ques- best was being so pleased to see you'. Ann tions asked by an English girl brought up in laughed and thought that was very funny. At India. She was the eldest child. At the age the age of six years and eleven months Ann of two years and nine months she saw her asked how and where the father's seed united mother knitting and asked her what she with the mother's seed to make a baby. After was making. Her mother told her she was her mother had explained that to her she asked a coat for a new baby that was coming if a baby began to grow every time the father's making to live with them. The little girl Ann at once seed was put inside the mother. At the age of ' said, I got lots of coats', and went to her seven years and one month she told her mother cupboard and proceeded to try on every coat that a little girl with whom she played thought that she could find regardless of the high tem- that babies came down the chimney, and that ' perature?100?F. Some days later she said this child's mother got kind of cross' when ' her asked about them. she questions Ann's suddenly When I am big I shall have a baby in my tummy '. When she was three years and mother asked if she told the other child what three months old her mother had twin babies, she knew about babies. Ann replied ' No, she both boys. At first Ann was delighted and seemed a bit funny and I don't think she showed no signs of jealousy. Two months later really wanted to know'. She then asked ' What happens to children whose mothers don't the twin babies were ill and her mother could them true things? Do they grow up-not tell Ann pay very little attention. Ann became very difficult and delighted in making scenes, knowing ?' Her mother said that sometimes and openly declared several times that she hated other people told them or they read about ' the babies and wished that they would go away things. Ann said I am glad you tell me things in a muddle'. I else or or die. get might About the same time Ann came to her mother almost beside herself with rage and The above description of children's questions said, 'My ayah tells me that the babies came has been given in detail to show you the kind children ask. in a parcel from Granny and my ayah is If of questions uninhibited wrong'. It took her mother some time to children are to be separated from their parents pacify her. It is very usual for children who for the greater part of the day between the ages have been told the truth to resent strongly any of two and seven, as they would be if they attended nursery schools, the nursery school subsequent effort to mislead them. At the same three years and five months, Ann asked teacher must be prepared to answer these quesage, ' Did you mean to have two babies or was it tions truthfully and it is necessary for the a mistake ? ' children's best psychological development that One day her mother was showing her a little book about the visit of the shepherds they should so answer them. It is most imto the manger. listened enthralled She portant that the teacher should not be sufferuntil they came to the first picture of the ing from repressions or a distorted attitude towards sex. The nursery school provides an enBaby Jesus, then she said firmly, ' I don't think I like about little babies'. A month later when vironment in which town children can learn Ann was 3^ her grandparents came to stay at something of the lives of plants and animals; her home and made a great fuss of her and did gardening and the care of pets are essential activnot like the wailing, sickly twin babies so much. ities of the nursery school. The care of animals From the day they arrived Ann's behaviour will help children to satisfy sex curiosity began to improve and she began to enjoy the
750
THE INDIAN MEDICAL GAZETTE
in a natural way especially if the teacher is not repressive and is prepared to help the child by allowing him to observe and ask questions freely. When sun-bathing, the children should be naked so that they may learn to recognize in a natural way the differences be-
tween the sexes.
[Dec.,
1937
By such measures the nursery schools of the future will promote the healthy and normal development of the sex instinct, and so doing will lessen the burden of neurotic illness which has to be borne by the adult community.
