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About 25 years ago, I was seeing an 8-year-old boy in the Psychiatric Department of Great Ormond Street Children's Hospital. He had been referred because of violence towards his younger brother and disruptive behaviour at school. I was treating him with play therapy, an unusual experience for me. As an academic child psychiatrist, most of my clinical practice involved assessments with onward referral when indicated. I only took on a small number of cases for treatment and even then preferred to use family rather than individual approaches. But at this time I had put myself under the supervision of a senior Kleinian child psychotherapist who worked some sessions at Great Ormond Street. On about the fifth occasion I was engaged in play with the boy, a hitherto unrewarding experience. I had failed to make much of a relationship with him and he had shown little interest in the proceedings. This time he began to play out a battle between two toy lions with great ferocity, accompanying his play with angry growling noises. I said something about how the lions were so angry, maybe how he felt with his little brother. He looked up and, for the first time, gave me an encouraging look that made me think that, for a brief moment, he did not think I was wasting his time. The next time his mother brought him she told me that his behaviour was much improved and indeed it remained so for the next month, after which I discharged him.It seemed a rather improbable outcome but nevertheless I felt rather pleased with myself at having, as I thought, made a difference. I rang the school to see if his behaviour had changed there. The primary head teacher said his behaviour was much improved. She attributed this change entirely to the fact that his class teacher had, at her suggestion, changed the seating in the classroom so that he was now sitting with a group of well-behaved girls rather than with the group of troublesome boys with whom he had previously been seated. I then rang the family doctor who had referred the boy. He confirmed improvement, which he put down to the fact that about 6 weeks previously he had started the mother on antidepressants that had, he thought, much reduced her level of irritability and thus made the boy feel less of a nuisance. Hadn't we all done well? Or maybe none of us had; perhaps the three of us were all infected with therapeutic omnipotence. There was an epidemic of this condition at the time, mainly, but by no means exclusively, confined to family therapists belonging to different schools.

Japan and the UK are compared in relation to various child health outcomes. It is noted that in the rates of child abuse and criminal activity. Japan is in a more favorable position. Rates of behavior problems and suicide rates are very similar in the two countries. Consideration is given to the reasons for the diflferences. The rates of single parents and divorce are much lower in Japan. The rates of working mothers are about the same, but Japanese women work longer hours. However. it is suggested that inore important differences may lie in the greater respect for authority and emphasis on discipline and conformity in Japan. The effects of industrialization o n family life and on child development are summarized. It is suggested that the separation of the adolescent age group from the rest of the population has had especially negative results in Western industrialized countries. Various suggestions are made concerning the positive role that pediatricians can play in promoting child development. In particular, pediatricians are encouraged to support and not undermine parents, to involve fathers in management of illness and disability. to press for full implementation of the United Nations Convention on the Rights of the Child. and for ready availability of good substitute child care fac Key words child. child care. Japan. UK.Comparisons of child rearing and child outcomes in different countries have a long tradition. Japan has a unique position among industrialized countries. in that industrialization has occurred late. and has not been accompanied by the loss of ti-aditional customs that has occurred in Western nations. On the other hand. the United Kingdom is. in many ways. rather typical of Western industrialized countries in its pattern of family structure and function. and in its experience of social change over the pa\t 50 years.Comparisons between the two countries are therefore iinpoi.tm not only for Japan and for the UK. but also for other industrialized countries throughout the world. and nor only for the present generation of children. but also for t'uture gcneratinns of children who will be parents then>-wlves before too long. In the prcsent paper I shall attempt four task\. First. 1 shall contrast the child outcomes in the two countries in terms of child abuse. behavior problems. suicide rates and delinquent, especially violent behavior. Second. I shall contrast the method5 of child rearing. Third.