Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Thursday, May 26, 2011

Comments

I don't know what's going on with Blogspot today, but I seem to be able to publish people's comments but not respond to them. Sorry!

Jean

Monday, May 23, 2011

Reactive Attachment Disorder: Mistakes in a Master's Paper

NOTE: No sooner had I posted this comment than a message forwarded to me stated that UW staff had intended to take the paper down and somehow the process had not worked. I am going to leave this post in place in case there is some mysterious archive or cache where the paper I discuss remains, but I want to give credit where it is due for a good decision.



MY ORIGINAL POST
Some months ago, I came across a master’s thesis from the University of Wisconsin, with the title “Effective Interventions for Children With Reactive Attachment Disorder”. I read the document, which was on the Internet, and felt very disturbed by the misconceptions that it passed on to the public. Most unpublished master’s theses never really see the light of day and quickly tumble into the academic abyss, but when things are available on the Internet it’s a different story. I was concerned that this paper would be read, believed, and repeated in the form of undergraduate psychology or education papers handed in to unwary instructors who didn’t use turnitin.com. This would mean that the misunderstandings contained in the paper would multiply and multiply further, following the psychological version of Gresham’s law-- “bad ideas drive out good.”

Because of these concerns, I contacted the department that awarded the master’s degree and stated my concerns. They were very polite and said they would take down the document and discuss the matter, and I suppose they did. They didn’t tell me, and I could hardly expect them to.

But guess what: here’s the paper on line again, at minds.wisconsin.edu/bitstream/handle/1793/42939/2008/wiersumc.pdf?sequence=1.

The author begins her paper by referring to a claim by Nancy Thomas to the effect that Ted Bundy, Saddam Hussein, and Adolf Hitler probably all had Reactive Attachment Disorder. Thomas is a former dog trainer who has achieved a considerable following among a group of foster and adoptive parents by stating, among other things, that the way you know whether people are good parents to foster or adopted children is that the children still have their arms, legs, and heads attached. She is completely without training in child development or clinical psychology and is a most inappropriate source for a master’s thesis to quote as an authority. As for the statement about the three frightening figures, little accurate information about their childhoods exists, particularly about the preschool period in which it might be possible to diagnose Reactive Attachment Disorder, a problem that is difficult to identify in any case (as the author herself later notes).

The master’s candidate goes on to discuss Reactive Attachment Disorder, citing a couple of published sources. She then lists without citation characteristics that she attributes to RAD, including tantrums, destructive behavior toward self or property, problems making eye contact, and being affectionate toward strangers while failing to show affection to parents. None of these are characteristics of Reactive Attachment Disorder as it is described in the Diagnostic and Statistical Manual of the American Psychiatric Association. They are, however, included in various checklists available on line and recommended by their promulgators for use by parents deciding whether their child needs therapy for attachment problems or for diagnosis of the entirely notional “Attachment Disorder” suggested by various unconventional therapists. Our author, incidentally, does not reference DSM-IV-Tr and presumably has not read it; her only citation to this important volume is in a secondary source edited by Dziegielewski (of which the first edition recommended Holding Therapy and failed to discuss criticisms of that method).

By p. 5, the master’s candidate states that children with RAD have been unable to complete the “attachment cycle”, a term she fails to define or cite a source for, and one that is completely unknown to John Bowlby’s attachment theory. Although she refers to Bowlby, she does not reference his work and it is fairly clear that she has only come across it in secondary sources.

The author eventually concludes that there is no evidence supporting any of the methods of treatment she outlines, nor, for that matter, is there any clear method of diagnosing RAD. While I would certainly agree with these conclusions, I must point out that she discusses none of the efforts that have been made at testing the methods she refers to, nor does she touch on the numerous critiques of that research and of diagnostic approaches that have been published in the last 10 or 12 years. Neither does she refer to the 2006 report of the APSAC Task Force on Attachment Disorders, published in Child Maltreatment; instead, she cites authors who were specifically mentioned in that report as using inappropriate treatments. In addition, she omits to mention evidence-based treatments like Parent-Child Interaction Therapy.

I am especially concerned about the flaws in this master’s thesis (of which I have mentioned only a small portion) because the degree is in school psychology, an area where it is all too easy for professionals’ misunderstandings to spread to teachers, parents, and children themselves. The fact that a school psychology professional means well is not a sufficient saving grace when harm can be done in this way. As authors writing about fads in special education have pointed out, meaning well can be dangerous; “politically correct treatments are… adopted… because they resonate in their purported nature and effects with ideological perspectives, or because their use contributes to the realization of other, perhaps tangible, socially progressive goals… The rationale… may be no more complex than ‘ to do the right thing’ “ (Jacobson, J.W., Foxx, R.M., & Mulick, J.A. (2005). Preface. In J.W. Jacobson, R.M. Foxx, & J.A. Mulick [Eds.], Controversial therapies for developmental disabilities [pp.xi-xvii]. Mahwha, NJ: Erlbaum, p. xv).

It’s hard to see what motive other than political correctness allowed this paper to be approved and a degree awarded, or indeed any reason why the paper should be on the Internet to confuse and mislead readers who are unlikely to know how to critique it. What those reasons may be, I leave to others to consider. My sole hope is that when students or parents Google and find the master’s thesis, they will also find my comments-- and perhaps be warned by them.
.

Saturday, May 21, 2011

What is Floor Time? Well, Folks, It Isn't Physical Restraint

I’ve just been hearing some discussion at http://www.beyondconsequences.com/aggression/audio.html. In this audio presentation, preparatory to a weekend conference for adoptive parents concerned about aggressive children, Heather Forbes and Ronald Federici spoke of methods that involve physical restraint as a way to reduce child violence. It wasn’t clear exactly what methods were to be used, but presumably they resemble the ones talked about in Federici’s book.

Much has been said about physical restraint in a prone position and other aspects of Federici’s methods. I don’t plan to talk about those criticisms here. What I’m concerned about is terminology and what might be called “definition creep”. I’m especially concerned about the use of the term “Floor Time”.

In the audio presentation, Federici uses “Floor Time” to refer to physical restraint of a child lying on the floor. He also refers to Stanley Greenspan, the originator of the actual Floor Time approach. Whether Federici, who knows of Greenspan, also knows that the term Floor Time had been used for about 20 years to mean something quite different from physical restraint-- well, that I can’t tell. However, I hope this post will help readers differentiate between Floor Time as defined and practiced by the recently-deceased, much-admired child psychiatrist Stanley Greenspan, and the methods advocated by Federici. Incidentally, the term Floor Time is trademarked.

Floor Time (the TM kind developed by Greenspan) is an aspect of DIR-- Developmental, Individual Differences, Relationship-based therapy for autism and similar developmental disturbances. It’s not only a method, but a philosophy characterized by adult responsiveness to the child’s lead and the complete absence of coercion. Here is a description of the Floor Time method: http://www.icdl.com/dirFloortime/overview/documents/WhatFloortimeisandisnot.pdf.

Floor Time has been used for many years as a method for working with normal toddlers and preschoolers in child care and educational settings. It is an effective way to help anxious children communicate their fears and relax and play. Teachers trained in doing Floor Time learn to follow the child’s lead by accepting and encouraging whatever the child wants to deal with, rather than doing what is all too easy and trying to distract the child from themes that are “not nice” or too worrisome to the adult.

Parents can also do Floor Time by spending twenty minutes or half an hour not only “on the floor” (i.e.,at the child’s level) but carefully responding to the child’s ideas. This “following the child’s lead” does not mean getting bossed around by the child, and of course safety for people and property is a first rule. Instead, a parent who is following the child’s lead will accept a role to be played (“you be the fireman”) and will occasionally and cautiously make a suggestion that elaborates on the child’s thinking. Practice in Floor Time is enormously helpful to parents who don’t know how to play, or who get bored with the child, or who are concerned with their own dignity rather than with the developing relationship. Greenspan was known for his belief that emotional and intellectual abilities are deeply connected, and Floor Time is intended to support their intertwining development.

When you read about Floor Time or hear it mentioned, it might be a good idea to check whether the term is being used accurately or not. Not everything that happens on the floor is Floor Time! And I believe the idea that Floor Time is physical restraint would be shocking to Stanley Greenspan if he could know, to Gil Foley, and to other people involved with the Interdisciplinary Council on Developmental and Learning Disorders. I plan to pass my concern on to the latter.

Friday, May 20, 2011

Looking Backward: Sources of the "Primal Wound" Belief

Very few ideas get created out of nothing, so it’s always interesting to look for the “ancestors” of beliefs that seem to appear suddenly and be spoken of by a small number of people. Ever since I first came across the “Primal Wound” (the belief that newborn babies who are relinquished for adoption thereby sustain a deep, lifelong psychological wound) , I’ve been wanting to find time to look for some historical background. I’ve found quite a bit-- all confirming the statement attributed to Gershon Scholem, that “Nonsense is always nonsense, but the history of nonsense is scholarship”.

In an earlier post, I pointed out the roles of the Czech psychiatrist Stanislav Grof and the British “clinical theologian” Frank Lake in arguing that unborn babies are aware, not just at 34 weeks, but all the way back to conception. Grof and Lake believed it was possible to know what unborn babies felt, by means of LSD experiences that they thought allowed them to recall their prenatal lives.

Just a little earlier than Grof’s and Lake’s work, a book called The search for the beloved (1949) was published by Nandor Fodor. Fodor had been a psychic researcher, “ghost-hunter”, and exorcist in England before training as a psychoanalyst. In an interview published in Psychoanalytic Review not long before his death in 1964, Fodor asserted that there was telepathic contact between a mother and her unborn child (Spraggett, A., “Nandor Fodor: Analyst of the unexplained”. Vol. 56, pp. 128-137). In a 1957 article (Fodor, N. “Prenatal foundations of psychotic development”. Samiksa Vol. 11, pp. 1-42), Fodor advised that all births should be by Caesarean section in order to avoid the shock of birth and possible resulting schizophrenia. In The search for the beloved, incidentally, Fodor advised that no psychotherapeutic treatment was complete until it reached memories at the fetal level. Emphasizing the influence of the mother on the unborn baby, he suggested that birthmarks are indeed caused by mothers’ experiences. He rejected the idea that most maternal shocks are not followed by birthmarks, saying “the cases in which the shock of the mother is not followed by a marking of the child’s body furnish no contrary argument. Negatives never prove anything “ (p. 330)-- an argument that has emerged a number of times in discussion of the “Primal Wound”.

A number of Fodor’s remarks in The search for the beloved foreshadow statements by Nancy Verrier and her followers. Here are some of them: “At first, the child is unable to realize that the mother’s breasts are not part of its own physical and psychic organism, that the mother is a being apart” (p. 174). “[F]oster parents and institutions cannot enter into the same psychic bond which the pre-natal community of life and immediate post-natal maternal care established “ (p. 165). “In the case of illegitimate birth the child’s reactions to life are bound to be completely abnormal” (p. 166).

Next question: where did Fodor get his belief system? Some answers to this question can be found by looking at the authors whom Fodor quotes in The search for the beloved. There are two major sources cited, one of whom in turn quotes the other. The first is the psychiatrist J.Sadger (I can find no first name for him, and assume that he is not the same person as Freud’s colleague I.I. Sadger). In 1927, at a psychoanalytic conference in Innsbruck, Sadger spoke of the need for analytic patients to go back to memories from infancy, birth, or earlier; if neurotic symptoms did not dissipate at that point, they need to focus on the embryonic period in earliest pregnancy, or even on their memories as sperm or the ovum. In a 1941 Psychoanalytic Review paper (“Preliminary study of the psychic life of the fetus and the primary germ”, Vol. 28, pp. 327-358), Sadger discussed whether the ovum consciously selects one or another sperm for fertilization purposes, and whether the zygote contains an inheritance of “the rejection or inclination of one [parent] toward the other at the time” (p. 330). He asserted that “I believe first of all that the embryo already feels plainly whether its mother loves it or not, whether she gives it much love, little love, or none at all, in many instances in fact in place of love sheer hate” (p. 336). Assuming that all events, physical and mental, are overdetermined by psychological factors, Sadger opined that “many a fall or other accident of a pregnant woman is nothing else than an attempt at abortion on the part of the unconscious” (p. 336).

Sadger in his turn seems to have owed some of his thinking to Georg Walther Groddeck, a second source frequently cited by Fodor. Groddeck was a physician whose ideas had some influence on Freud’s later work. In 1923, Groddeck published Das Buch vom Es (The Book of the It), a volume in the form of letters to a female friend signed by “Patrik Troll”. This volume was translated and re-published in 1947 as The Book of the It, with a preface by the British novelist Lawrence Durell. The “It” of this title had nothing to do with the Addams family, but was a vaguely-defined combination of a universal vital force and the learned anxieties and desires of an individual, working together through the unconscious mind to shape both physical and psychological characteristics of the person. Groddeck considered the primary motivations to be the desire of the child for the mother and the mother’s experience of sexuality while holding the child inside her body and while giving birth, an event that Groddeck seemed to perceive as a sort of reverse intercourse with the object being expelled rather than penetrating. Groddeck’s belief that all aspects of life can be influenced by the unconscious shows in his anecdote about telling a woman with a breech presentation that giving birth vaginally with a head presentation felt very good; he claimed that the fetus reversed positions within half an hour after this discussion. He attributed both infertility and impotence to unconscious rejection of relevant aspects of life-- and, by the way, claimed that a man could not penetrate a woman unless she “unconsciously” wanted this to happen.

Here we see some, though by no means all, of the precursors whose ideas are responsible for Nancy Verrier’s “Primal Wound” belief. Need I point out that none of them have any basis in systematic study of psychology, biology, or medicine? These claims date back to a time when few people asked for the evidence behind assertions like those of Fodor, Sadger, and Groddeck (but even Freud numbered Groddeck among the “wild psychoanalysts). We’d do well to think of these ideas, including the “Primal Wound”, in 2011 terms, not those of 1923.

Myths and Misunderstandings, Ages and Stages, and "Parenting Within Reason"

A month or so ago I had the pleasure of being interviewed by Colin Thornton of Parenting Within Reason. He was interested in issues discussed in my book Child Development: Myths & Misunderstandings (Sage, 2009), and we got into some points from the book, some other points that have come up on this blog, and some brand-new things as well. You can hear the podcast at http://foundationbeyondbelief.org/fbbpodcast. (I warn you though-- it’s a whole hour long.)

Colin asked some excellent questions and made me glad I’ve spent a long time thinking about this stuff. Even so, there were some where I was tempted just to say “hommina hommina hommina.”

One question was an important one that I confess I would never have thought to talk about. Colin asked me about stages of development-- were there really stages, and is it essential to go through all of them? This is one of those questions where a simple Yes or No is not much help, so I tried to touch on a lot of issues (probably many more than Colin had in mind when he asked).

To begin with, “stage” is a metaphor. The use of metaphors for description in psychology is very common, because many of the events we need to talk about are not easy to observe directly. They may be mental events like attitudes, which we can only infer. Or they may be events that take a long time to unfold, as is usually the case in child development. “Stage” is a metaphor because it compares events in a child’s life to passages over spatial distance rather than focusing on them as changes over time. A stage is literally “a place to stand”, but that implies the possibility of standing in other places at other times. A stage coach was a vehicle that covered a set amount of distance and either dropped off passengers to catch another coach, or changed tired horses for fresh ones. Each stage or distance covered was thus not only farther away from the original one, but in other ways different from the ones before it.

Similarly, the metaphorical stages of development also have each their specific distance (time) from the starting point, and they have both quantitative and qualitative differences from the previous stages. “Quantitative” differences are obvious enough-- at later stages, many things (like walking or talking) may be done faster or more often than at earlier stages. “Qualitative” differences are not just more or less, but new and different ways of doing things. A baby who crawls moves in a different way than a toddler who walks, and the toddler’s stiff-legged, wide-based walk is in turn a different kind of movement than the 8-year-old’s free rope-jumping, dancing, or hopscotch-playing. Each stage of development is not only more advanced toward maturity than the stages before it, but is qualitatively different both from the previous and the succeeding stages.

So, Colin Thornton asked me, do people have to go through all the stages? What if a baby doesn’t show much evidence of a particular stage, but instead goes right on to the next one? Is that child going to miss something developmentally? How about crawling, particularly-- a stage that many parents have worried about over the years? No, the fact is that if a child has not developed to the point where the actions of the “next” stage are possible, he or she can’t do those things. Whatever the child does, that by definition shows his or her level of development. And children don’t all spend the same amount of time on each stage. It’s as if some have very fresh horses to pull their stage coach through one part of development, and tired ones for another stage. Some crawl for months and months before standing to walk holding on, others crawl for a day or two, and still others just sit around until they’re ready to stand, or scoot on their bottoms to get where they want to go. In the long run, it makes little or no difference to the child’s general development. (And there’s certainly no reason to try to insist that a child crawl; like trying to teach a pig to sing, it doesn’t work, and it annoys the pupil.)

There are a couple of other points I’d like to make with respect to stages of development, and these are things that Colin and I never got to. One is that although there’s no reason to be concerned about a “skipped” stage, there may be reason for concern if a child has been able to do some movement or task consistently and then “drops back" to an earlier stage. An example would be a child who has been walking holding on and now goes back to crawling exclusively (not just for convenience). It’s important to find out whether there’s a physical problem causing this apparent regression.

Second, one factor in whether a child seems to move beyond a particular stage has to do with what the Russian psychologist Lev Vygotsky many years ago called the Zone of Proximal Development. This term describes a phenomenon common throughout development: a child can perform an act when a parent or familiar caregiver is watching from nearby, but not when alone. The social and emotional support of a smiling, encouraging adult seems to help the child (or even a teenager) organize a new and difficult behavior which may not be possible when alone. We don’t “teach” a child to walk, but our encouragement may actually make it possible for actions to be accomplished at the beginning of a new stage. (Look away, or go and answer the phone, and the baby gets disorganized and falls down.)

There’s more about development on the podcast, and I promise you that although I sometimes thought “hommina” I never actually said it. I’m embarrassed to urge you to buy the book, but if you’re interested in what I say on this blog you might like it (see Amazon for a sample).

Wednesday, May 18, 2011

More About Infants and Eye Contact: Gaze, Words, Gestures

How and why people make “eye contact” is a source of never-ending interest, especially to parents and caregivers of infants and toddlers. Experiencing a mutual gaze (which is probably a better term for eye contact) can be very gratifying to adults; it seems to tell us that some other person thinks we are really worth paying attention to. We don’t care for a stare-- when another person keeps his or her gaze ready to “catch” ours even though we pointedly look away-- but when we gaze at another, we are happy to find that that person gazes back at us. Because we find mutual gaze pleasing, parents are delighted when their infants return their gaze and carry on a prolonged shared look. When infants don’t do this after a few months of development after birth, their parents may also worry that there is something wrong. Perhaps the child’s vision is not normal, or perhaps there’s some burgeoning problem of early mental health. Autism is commonly feared by modern parents who have heard that lack of eye contact is characteristic of children with serious developmental problems of this type.

It’s true that in typical development, there is a growing use of the gaze in communication. It’s not just relevant to love and attachment, but to thinking about and understanding what other people want and do. Watching another person’s gaze gives more than emotional gratification—in combination with facial expression, it can tell you what he knows about, what he’s afraid of, what he wants you to do, and so on. All these are important things for a baby to figure out. Let’s not forget, though, that visually-impaired babies, children, and adults usually manage to learn these things about other people even though they do not have the capacity for mutual gaze or for monitoring the direction of another person’s gaze. The typical pattern of development for the normally-sighted baby is probably the easiest to manage, but it is not the only way human beings can learn to communicate with others and we should not give it so much importance that we think of it as a magical factor.

A recent study by Eugenio Parise et al. (“Influence of eye gaze on spoken word processing: An ERP study with infants”, Child Development , 2011,Vol. 82, pp. 842-853) examined whether a person’s gaze, seen before speaking began, made a difference to the way 5-month-old babies’ brains processed the speech they heard. The babies sometimes saw a face gazing directly at them and sometimes saw one with averted eyes; they sometimes hear a voice speaking normally (“forward”) and sometimes heard a voice speaking backward. They seemed to be especially interested in the direct gaze-- perhaps signaling “Hey, I’m talking to you, kiddo”-- combined with the unfamiliar backward-spoken words. The point about their responding differently is that the babies did not act as if what they saw and what they heard were unrelated. Instead, their listening was partly guided by what they saw, and especially by whether there was mutual gaze or not. What they saw seemed to have a role to play in their attention to and learning of the spoken language-- an exceedingly important step in child development.

One thing this tells us is that caregivers who look at infants infrequently are not giving them as many opportunities to learn as they may need. Caregivers who use their gaze, either in direct looking at the baby’s face, to “point” to an interesting object, or to avert when occasionally avoiding social contact, are providing much more information about language than dozens of flashcards pinned around the room. Caregivers who rarely use the gaze in ways babies can learn from may be depressed, sick, tired, or overwhelmed with work --- an example might be day care providers who have too many babies to care for.

Now, here’s what I want to know, and to the best of my knowledge no one has asked or answered this question: what about gesture language? It’s presently quite fashionable to use gesture language with infants and toddlers, to teach it and to encourage the children to use it, either at home or in group child care settings. Where does the adult’s gaze come into this? Can a direct gaze guide the child to be especially attentive to a gesture? If the child has to look at the hands to see the gesture, rather than listening while following the adult’s gaze to see an object referred to, how is language learning influenced? The great advantage of spoken language is that we can look at the thing talked about while listening to speech at one moment, and look at the speaker’s gaze while still listening to speech at the next moment. This seems to be a pattern that comes easily to sighted babies by about 5 months of age, but what if they don’t often get to do it, or do it only while simultaneously trying to look at a gesture?

I don’t want to suggest that gesture language in some way interferes with the typical process of learning. Babies with both visual and hearing impairments learn to communicate, but they follow their own patterns of growth and development. Is the same true for babies who are taught to use and understand gestures? It might be. There’s much still to learn, but it’s clear that eye contact can play a complicated role in both social and cognitive development.

Tuesday, May 17, 2011

Young Children and Prison Visits

On a listserv that deals with psychology and the law, the following question was recently asked: “how can the impact on a preschool child be softened when he is taken to visit his father who is in prison after being convicted of murder?”. Some contributors asked why he should be taken at all, given that there would be little relationship in the future. Others pointed out that the father might be exonerated, or even if not exonerated might be released on parole before the child was an adult, and it would be to the benefit of both of them to have some sort of connection. (It happens that in this particular case they had not spent much time together, but that might be considered even more reason to foster the relationship.)

It’s sad that the question needs to be asked at all, but it may be useful to think about it in a general way. Similar questions might be asked about taking a young child to visit the mother in prison, or a parent or grandparent in a hospital, or about paying a visit to a parent or grandparent who lives in another country and for financial or political reasons can’t live near the child. There are even similar concerns when a parent has supervised visitation with a child. All of those are situations where emotional tightropes are being walked. We don’t want the child to be terrified and traumatized by the visit, but neither do we want the visited adult to be so distressed or disappointed or angry that they prefer to break off the relationship rather than suffer that way. Unfortunately, while young children want to be with people they care about, no matter what, adults sometimes feel that unless the contact is very enjoyable and can be counted on for the future, there is no point going on with it. Adults can prefer an abrupt, permanent break to making an effort to preserve a weak or problematic relationship. (Think divorce…)

So, what can we do to make something like a prison visit good enough so a two- or three-year-old is not upset and frightened, and also so the prisoner finds it gratifying enough to be motivated to try to be a parent or grandparent? Let’s assume for the sake of discussion that the child will be safe and nothing scary or bad will happen in the prison situation.

A first step is to give the child the social support he or she needs to help tolerate this strange experience. It’s clear that young children in unfamiliar surroundings benefit from having familiar people with them. Ideally, the child will be accompanied by an attachment figure-- that means someone to whom he can turn as a secure base when frightened, someone whose presence gives him the security and confidence to explore new places and people. That familiar adult should be with the child throughout the trip, and that means from the time he or she is picked up at home, in the car, going into the prison, in the visiting area, and going home. There should be no handing off to an unfamiliar CPS driver or a corrections official, however kind those people may be.

The presence of a familiar adult buffers or “immunizes” young children against the effects of their natural fear of the unknown. A jail is a sad and scary place to adults who know about crimes and their punishments, and a hospital can also feel like a place of terrible unknown dangers. Young children don’t know from prisons or hospitals, but are no more-- and no less— scared in those institutions than they would be in any other strange place. In all these cases, a familiar, protective adult does a vast amount to make the experience good enough for the child’s comfort.

A second step is to help the child know what is going to happen. There are a lot of things in a prison that are different from the outside world. There will be security procedures, lots of policeman or guards (let’s hope nobody has used threats of these people to discipline the child), people crying or looking sad or angry, and probably a visiting area in which no touching is allowed, but where a more-or-less familiar person is sitting behind a barrier.

You can’t tell a young child about these things-- or rather, you can tell, but it’s not going to sink in. How, then, to prepare? A good possibility is to use dolls or handpuppets to enact what’s going to occur. The child can have a puppet representing himself and talk or move it to practice how to respond to security procedures and so on.

Third, it would be very wise to prepare both the adult visitor and the prisoner for their roles in the meeting. The imprisoned father (in the listserv’s example)may have no idea how to talk to a child who is unfamiliar and whom he can’t touch or kiss. But he might be able to talk about how the child can handle a child puppet and a father puppet-- for instance, he might suggest that the father puppet pick up or hug the child, then ask what the child puppet wants to do.

One more caution about the meeting: this is not the time for the adult visitor and the prisoner to quarrel or cast blame on each other, or even pay much attention to each other. The goal should be to create the maximum pleasant interaction between father and child during the short time available for the meeting. Ideally, each will go away with the sense that they would like to do that again. That outcome will minimize any ill effect on the child, and will help the father feel it’s worthwhile to work toward a genuine relationship with the child.

Friday, May 13, 2011

The Newborn and the Auxiliary Ego

The anthropologist-author Ashley Montagu famously suggested that humans are characterized by “exterogestation”-- a continuation of prenatal development that takes at least the first three months after birth. Montagu held that the early development of human infants actually takes a year from conception before the baby has the minimal ability to cope with the environment. It might well be more appropriate for human pregnancy to last a year, but our large brains and heads, combined with the small pelvic opening needed for upright walking, would make it impossible for a baby to be born after a year’s gestation.

Because they are born at an immature stage of development, there are a lot of important things newborn humans cannot do for themselves. An obvious one is the manufacture of immunoglobulins by the immune system. Caregivers provide an auxiliary immune system that helps out until the baby’s own system begins to mature at about a year of age. Breastfeeding mothers make immunoglobulins that protect against infections that enter through the mouth and gut (gastrointestinal infections, polio, and so on), and these are passed on in their milk. Both breastfeeding and non breastfeeding caregivers also provide auxiliary immune functions by keeping the environment clean, watching what the baby puts into her mouth, making careful choices of clean food and drink for the child, and preventing exposure to contagious disease if possible. (In modern societies, this auxiliary immune function includes providing immunization against disease.)

In addition to their auxiliary immune functions, caregivers also provide the baby with an auxiliary ego. The term “ego” here refers not to pride or self-esteem, but to the ability to carry out reality functions and to deal effectively with the environment. Ego functions include movement, motor skills, learned behavior, problem-solving, and memory. The caregiver acts as an auxiliary ego when doing tasks the infant needs done but cannot do.

It’s obvious that auxiliary ego functions including picking up the young infant, feeding, and cleaning. But a less obvious auxiliary ego function is fostering the infant’s organization of behavior. Newborns have difficulty organizing the timing and sequencing of behavior, and they show this in their disturbed and broken sleep and in the awkwardness they often show in taking the nipple and feeding, sometimes even choking when the milk comes so fast that they cannot co-ordinate sucking and swallowing.

Difficulties in organizing behavior are increased when bright lights, loud noises, or unpredictable movements influence the process. A baby may be very hungry or tired but unable to sleep or eat unless the caregiver’s auxiliary ego functions help to organize the behavior.

How does the caregiver manage to help in organization? One way is to reduce the amount of disturbing sensory stimulation the baby is receiving. Dimming the lights, reducing the noise level, or going to a place where there are fewer people may all be helpful to the baby’s organization of behavior, and they are all things the baby cannot do alone—ego functions that demand more maturity than he or she has.

A second way to help the baby organize behavior like sleeping or eating is to provide the baby with some sensory stimulation that has a predictable rhythm and intensity, like rocking, singing, or patting. The framework of this rhythm helps give the baby a pattern to follow as he or she establishes the rhythm necessary to organize the needed behavior. Sleeping, for instance, is aided by a pattern of slow, regular breathing, and feeding by a regular sequence of sucking and swallowing at given intervals.

When a baby is really distressed and too disorganized to do the sleeping or feeding that is needed, a caregiver may help by an auxiliary ego function known as “overriding the baby’s tempo”. The adult begins with a fairly intense, rapid rhythm of stimulation like fast rocking or singing and then gradually slows and quiets the stimulation. The baby’s rhythm of crying, breathing, and moving slows and regularizes in response, until it is calm and organized enough to sleep or eat.

It’s all too common for parents or their advisers to forget auxiliary ego functions, or to reject them as ways to “spoil” a young baby. It’s often said that parents should start as they mean to go on and should train their babies to independence by demanding that they organize their own behavior from birth. But it’s pointless to demand something a baby is incapable of doing. A better foundation for early development, and a happier household, will result from accepting auxiliary ego functions as an essential part of nurture. Providing such help to very young babies no more ruins their independence than their milk diet will later make them unable to eat pizza.

I would speculate that parents and other caregivers can learn much from helping a young baby organize behavior that will be useful to them when they have older children. Two related tasks of caregivers are buffering (helping older children deal with the impact of environmental problems like bullying) and scaffolding (helping children learn by methods like breaking a problem into parts). Each of these is a type of auxiliary ego function that enables children to do what they can rather than be overwhelmed by difficulty. Parents may be able to do a better job on these tasks if they have learned from seeing the effect of auxiliary ego functions on their young babies. Being an auxiliary ego for the newborn is really starting parenting as it would be a good idea to go on.

Friday, May 6, 2011

Newborns, Emotions, and Adultomorphism: Sources of the Primal Wound Myth

On several occasions, I’ve argued on this blog about some exaggerated views of newborn babies as adult-like in their feelings and thoughts. Those views may be described as “adultomorphic”-- a made-up word that’s parallel to the term “anthropomorphic” (meaning assigning human characteristics to something that is not human). “Adultomorphic” thinking attributes adult characteristics to infants and young children, and sometimes even to unborn babies. The myth of the “primal wound”, according to Nancy Verrier an emotional scar caused by early separation from the birthmother, is an example of adultomorphic thought.

Some authors offer adultomorphic descriptions of newborn babies and claim that they are supported by empirical investigations. This fact raises the question: who and what were the sources of the “primal wound” and similar ideas? I would suggest that a major contributor to this belief was David Chamberlain, a psychologist who was one of the founders of the Association for Pre- and Perinatal Psychology and Health (APPPAH), an organization that supports a variety of unorthodox beliefs about prenatal life and even the influence of past lives. Chamberlain was also one of the founders of the Santa Barbara Graduate Institute, a nonaccredited organization that specializes in unconventional methods and belief systems.

In 1988, Chamberlain published a book called Babies Remember Birth; ten years later, that publication became part of The Mind of Your Newborn Baby. Chamberlain cites Nancy Verrier’s The Primal Wound but does not use that specific term. Nevertheless, he advocates strongly for the belief that babies before and at birth experience a range of emotions similar to those adults can experience, as well as thinking in adult-like ways. If this were true, of course, events like immediate separation from the birthmother could certainly have the impact claimed by proponents of the primal wound belief.

But let’s look at the evidence Chamberlain puts together to support his belief in the adult-like minds of newborn babies.

He argues first of all that the psychoanalyst Otto Rank believed that birth trauma was at the root of all psychological problems. This in itself might be irrelevant, but according to Chamberlain, Rank found that focusing on birth trauma enabled him to reduce the length of therapy from years to months. Chamberlain concluded that this supported the idea that experiences at the time of birth are highly significant.

Second, Chamberlain refers to the Vienna-born psychoanalyst Nandor Fodor, who “described many examples of adult memory flashes, dreams, or symptoms linked with birth” (Chamberlain, 1998, p. 89). He notes Fodor’s suggestion that telepathic communication between mother and unborn baby has an effect on the baby. (However, Chamberlain does not refer to Fodor’s extensive dream analyses, with their meticulous interpretation of symbols, including the meaning of specific numbers in dreams, and their interpretation of the letters Y and V as having sexual significance. Fodor also believed that infertility resulted from fear of responsibility and/or rejection of one’s femininity.)

Third, Chamberlain cites L. Ron Hubbard, founder of the “Church of Scientology”, and his “auditing” methods that “frequently uncovered birth memories. His handbook of techniques for ‘auditors’ taught a method of tracing symptoms back to their origins, some of which were at birth or in the womb… he found that people were capable of going into a mental state called ‘dianetic reverie’ … in which they could have access to painful ‘recordings’ (not memories) ‘locked’ in the cells of the body… during dianetic reverie, Hubbard claimed, people could relive traumatic incidents that had occurred at any stage of cellular development from zygote to newborn… Hubbard was elated to report that the recording of a mother and child pair in dianetic therapy compared word for word, detail for detail, and name for name” (Chamberlain, p. 91). (This claim of “recording” seems comparable to Verrier’s belief that “cellular memory” is involved in the primal wound she posits.)

Chamberlain goes on to refer to the investigations by Stanislav Grof of experiences during LSD use. Grof “found his clients [on LSD] constantly returning to aspects of their birth experience. Grof developed the conviction that labor and delivery exerted a profound and lasting effect on personality… Grof has developed a system of ‘holotropic’ therapy in which-- by a variety of sounds, music, and movements-- memories of childhood, birth, and before birth are evoked without drugs” (Chamberlain, p. 95).

Chamberlain also states his belief that children sometimes describe their births spontaneously and correctly, although their parents report that they have not described the births to the children. (He does not, however, note whether the children have seen pictures or heard stories of births which they may adapt to their own story, or whether they have overheard adult conversations.) Chamberlain reports having hypnotized ten pairs of mothers and their children ages 9 to 23 years, elicited their birth descriptions, and found many similarities.

Here is the evidence on which claims of adult-like emotions and thoughts among newborns are based: a claim of efficacy of birth-focused psychotherapy; a claim of telepathic communication; the views of Scientologists; reports of experiences under LSD treatment; hypnotic recall (incidentally, long ago shown not to be more accurate than ordinary memory); and unverified reports that children have told birth stories without receiving information from adults. Are these sufficient to establish the idea that newborns have adult-like emotions and cognitions? It does not appear to me that these reports are even relevant to the question.

The primal wound idea rests on the assumption that adult-like emotions exist before, during, and immediately after birth. The natural history of emotional development contradicts this idea, and the points put forward by Chamberlain appear to play no role in the argument.

Chamberlain’s book repeatedly emphasizes the idea that because newborns share characteristics of adults, they need and deserve careful treatment. Like many other authors dealing with issues about newborns, he seems to feel that if newborns are not seen as adult-like, people will feel that they do not need excellent nurturing and thoughtful care, but that instead they are simple “masses of cells” without thought or feeling. Let me point out, however, that a newborn need not have to be like an adult in order to require tender care. He or she can simply be a newborn-- what a newborn really is-- neither an insentient machine of flesh, nor an adult mind in a tiny body, but a human being whose needs are all the greater because of the early stage of development. That those needs are very different from the needs of an adult does not make them unimportant. It does mean, though, that we grown-ups may need to work hard, and pay attention to relevant empirical research, in order to avoid “adultomorphizing” and drawing very wrong conclusions.


Sunday, May 1, 2011

Ages and Stages of Baby Emotion: A Natural History

In a recent query apparently directed to another reader, one reader of this blog asked, “when do babies start to feel grief and other emotions?” This is a question that can be talked about a lot. Whether it can be completely answered, or even what the reader meant exactly, is not so certain. I’m going to make some efforts at the “talking about” part.

There are some real difficulties about knowing the answer to this apparently simple question. One is that we can’t really know what any other person feels, in the sense that we can know what we feel ourselves. Even if someone can tell us in words, we can’t be sure that the feelings they experience are connected with the words in the same way that our own feelings would connect with those words. This is a basic problem of the human condition and one reason why most of us experience times of feeling isolated even though we are with other people. Babies, of course, can’t even tell us in words what they feel, so we are in especially deep waters when we try to know something like when they begin to have certain feelings. We have to use things like facial expressions, crying or other vocalizing, posture and gestures to guide us to some idea of the baby’s emotions. Even then, what we’re usually doing is asking ourselves, “all right, if I made that face or sound, what would I be feeling like?” Then we take our own feelings as a best guess about what is going on inside the baby.

A second complication is that all emotions may not begin at the same point in development. We can’t just assume that a display of one emotion means that all other emotions are possible for a baby at that same age. Different emotions may (and in fact apparently do) have different “natural histories”. Some are present at birth, it seems, but others may not come into play until 12 to 15 months of age.

A third complication is that there are probably big differences between a baby’s own experience of feeling and its responses to an adult’s emotions. Babies can have emotional responses to adult facial expressions that do not necessarily involve the same emotion as the one the adult shows. Edward Tronick, the leading infancy researcher, recently published an article showing a picture of a mother playing with her 4-month-old by tickling the baby with her hair. The baby grabbed the hair and gave it a good yank, and the mother tried to pull away, with a brief expression of pain and anger on her face-- whereupon the baby flung up its hands to cover its face and avoid seeing that expression.

What emotional behaviors does the baby have at birth? Just about the only thing that seems to be an expression of emotion is crying. Not surprisingly, newborn babies cry with hunger and with pain (and with different cry patterns in the two situations), but they also cry with anger or frustration, for instance when their arms are held down in dressing or bathing. They may also smile, but it doesn’t seem to matter to them whether they’re looking at a person or at the wall-- the smile is not really an indication of social pleasure at this point. Babies in the first few days also have a suprising ability to imitate the facial expressions of people whose faces are very near them, and will open their mouths, put out their tongues, and mimic happy, sad, or surprised expressions.

By about 4 months, babies become quite sociable, smile at people (including strangers), and will chuckle when tickled lightly. They get angry when frustrated. They are already beginning to be disturbed by an unresponsive face staring at them without responding to their sounds or expressions-- they turn away or even begin to cry within a short time after they begin to see this “still face”. What they don’t show at this age is fear. They are not afraid of strangers, separation, the dark, big dogs, snakes, or loud noises (although they might begin to cry when startled by a noise).

At 6 or 7 months, babies become wary about strange people. Rather than smiling at once, they look suspicious and give a new person the “once-over”, gradually warming up to them. Between 7 and 10 months, fear develops and becomes a major and dramatic feature of the baby’s life . An approaching stranger, no matter how friendly; a brief loss of balance; the noise of the garbage truck that has come once a week for the baby’s whole life-- these may all trigger a fearful expression, wailing, and clutching at a familiar caregiver. Now the baby shows a new interest in facial expressions, and when in a new situation carefully checks out the expression of a familiar adult. If that person looks frightened, the baby looks serious and does not move to explore new things or people; if the adult looks happy, the baby will gradually start to explore.

The new capacity for anxiety and fear are associated with attachment behavior. The baby is able to feel calm and comforted when in contact with a familiar caregiver; alone in a new situation (or with a stranger), he or she may be overwhelmed by the fear of the unfamiliar. Some people suggest that there would be a great evolutionary advantage to this, because most babies crawl or start to walk by this point and could easily move into danger if not “tied” by their fearfulness.

It’s when attachment and fearfulness have emerged that babies begin to have intense grief reactions to separation and loss of familiar people. An abrupt and long-term separation leads to many months of withdrawal, sadness, crying, difficulties in sleeping and eating, even weakened immunity, and there is only a little that unfamiliar people can do to help with this. Eventually, though, given good circumstances, separated babies can recover and be comfortable with new caregivers when they have become familiar.

It’s not until between 12 and 15 months that babies seem to develop the social emotions-- strong feelings that are based on what we expect other people to feel about us. These include shame, embarrassment, and pride. It seems that the baby has to be able to recognize himself or herself in the mirror before embarrassment is possible. (How do you know a child recognizes herself? Put a dab of lipstick on her nose and put her in front of the mirror. One who doesn’t recognize herself just looks at “that person” for a minute and walks away; one who does recognize immediately puts her hand to her nose.)

As you can see, emotions don’t all develop or appear at the same time, as far as we can tell. Some abilities, like imitating a facial expression, are surprisingly early in the schedule; others, like fear, are surprisingly late. It just goes to show that we can only understand infant development by looking carefully at infants rather than trying to work backward from adult characteristics.