I’m bemused. I’ve just been reading the anti-Amy-Chua, Bryan Caplan, whose “Selfish Reasons to Have More Kids” declares that parenting should not be hard or anxiety-provoking, because what parents do doesn’t have much long-term impact anyway. I must say it’s not so easy to make Caplan’s claims and citations congruent with much that’s known about child development. I wouldn’t want to say he’d been cherry-picking, but he seems to have used a peculiar pie recipe, and some of the fruit is hard to identify.
Let me begin my discussion of “Selfish Reasons” by saying that Caplan starts and ends with a surprising and ill-supported premise: that it’s better to have more people, better for the whole world and for you, too, even if they aren’t your children. If we don’t have lots of people, he says, much of the world will be like living in Hays, Kansas (Caplan’s example, not mine, and what he means is that it would be boring to him). This statement suggests some interesting ideas, because what if there were suddenly many fewer people? This has happened at times, for instance in the time of the Black Death in Europe, and the social consequences were enormous. But you can’t necessarily reason from one event’s results to the possible consequences of its opposite. Having no money is bad, and we can reason from that to the idea that lots of money is good. On the other hand, what about Vitamin A? A deficiency is a bad thing and can result in blindness-- a lot is also bad, as we see from the effects on Arctic explorers of eating polar bear livers.
Have we forgotten that much population growth would mean one of two things: either an increased and destructive demand for food and energy, or a great many starving and distressed people? To assert that it’s better to have more people, without providing a rationale that addresses these possibilities, is certainly to slide by an essential question.
However, I can accept with enthusiasm the idea that having more children [than you thought you’d want] would have a number of selfish benefits for the individual or couple. Yes, kids are a lot of fun, and in the words of Holly Near’s old song, “they remind us how to play”. Having a little crowd of people you know very well is a great idea in this age of high mobility, where the old gang of old friends may not be easy to reach. It’s great to see the grandchildren and watch the whole process of parenting from an intimate but safe distance.
Okay, so far we have two assertions by Caplan—first, that it’s good for the world to have more people (which I challenge), and second, it would be nice for me and others like me, and probably for my children and grandchildren too, to have a big family (which I accept).
But how about the assertion that it doesn’t really matter in the long run what parents do? Ah, here’s the crux, because now we run into matters of definition and of choices of information. Everyone is going to die, no matter what their parents did, so looking at occurrence of death would support the idea that parenting makes no difference, but naturally that’s not what Caplan or Judith Rich Harris mean when they make their claims.
I’m going to make a suggestion about what Caplan really does mean. I think he means that the small differences in childhood experiences for the families he knows don’t over-ride the effects of biological differences. Speaking about a highly restricted range of experiences, Caplan is saying that within that range experiences don’t have much long-term effect. Whether the child goes to a Montessori school or a Waldorf school doesn’t make much difference. Whether he’s given a time-out or a single smack on the behind doesn’t matter much in the long run. But Caplan knows that there are some things that do make a difference, because he points out (on p. 89 and elsewhere) that you ought to be kind to your children. He thinks, probably correctly, that unkindness is not inside that restricted range of circumstances where variations have little effect.
In warning against unkindness, Caplan stumbles into the area of parental attitudes and beliefs that help determine both parent and child behavior. Unkindness is not necessarily defined in the same way by people inside and outside Caplan’s circle. In Michael Pearl’s book, “To Train Up a Child”, Pearl and his wife propose that four-month-old infants who cry or resist a parent should be whipped with a willow switch, or, if no switch is available, a length of plumbing supply line is excellent for the purpose. The Pearls believe this is a kind thing to do, because a child who does not learn early to obey his parents will also defy God and be condemned to Hell. Naturally, if you take this view, you’ll consider it far kinder to save your child from Hell, at the expense of a few minutes of pain, rather than to let him roast for Eternity, just as some of us might think the pain of an immunization is kinder to cause than allowing the risk of death by tetanus.
Caplan’s advice to “be nice”, although undoubtedly valid, is in its vagueness a clue to the lack of real information and thought that went into this book. I can’t expect anyone to read on forever, so let me just address one example of incompleteness here: the discussion of behavior genetics. Caplan provides a handsome equation on pp. 73-74, describing the fraction of developmental variance explained by heredity, the fraction explained by shared family environment, and the fraction explained by aspects of family environment that are not shared by the family’s offspring. Very nice, but what is missing, and quite important, is the variety of interactions between heredity and environment. An example of such an interaction would be the custom in some parts of the world of giving available food to males in a family, and restricting females to whatever food is left over. This is particularly relevant to protein sources. The genetic factor, maleness or femaleness, determines how much food is consumed when resources are limited; the genetic factor thus causes an environmental effect that has a direct influence on development of both body and mind. In this type of interaction, the genetic characteristic actually evokes a response from the environment because of social attitudes.
Very well, you say, but I don’t feed my son more than I feed my daughter. What does this have to do with my parenting? What it has to do with the parenting of people who are likely to read this review is that discipline techniques, to work well, need to be matched to children’s biologically-determined temperaments, such as tendencies to explore or to withdraw from new things, or to have a generally positive or generally negative mood. (By the way, I expected Caplan’s interest in biological factors to lead him to temperament, but apparently it didn’t.) An example of research in this area is Kochanska, G., Aksan, N. & Carlson, J.J. (2005). Temperament, relationships, and young children’s receptive cooperation with their parents. Developmental Psychology, 41, 648-660.
Another important point about interactions between heredity and environment has to do with age. It’s so easy to assume that whatever is true about “nature” and “nurture” in infancy will be true in childhood, adolescence, and so on. But this is not the case, and statements about heredity and environment need to consider events across the developmental trajectory. Take for example Williams syndrome, a genetic disorder that has obvious effects but is not very debilitating. Adult Williams syndrome individuals have wonderful language abilities and are extremely sociable, although because they have little social anxiety they may make things awkward for others. So what would you think they were like as babies? Friendly, early talkers? No, they are not at all the way you would expect them to be. They have horrible colic, which lasts longer than with most babies and makes them extremely irritable. When they begin to recover from the colic, rather than laughing and smiling, they stare at people as if longing for eye contact. They don’t even begin to talk until about age two, rather than the typical 12 months or so.
These are just a few examples of the failings of Caplan’s book, which may have started as a desirable antidote to Amy Chua’s drag-them-by-the-hair philosophy, but which has ended up omitting too many details to provide useful arguments. I notice that the Wall Street Journal review admires the book for its omission of abstruse psychological concepts; that’s okay with me, but I do want to see evidence and reasoning that are relevant to claims, not just evidence that “shows the flag” but does not actually speak to the premises of the book.
[Disclosure: This review was written at the instigation of my son. Now may I play with the grandchildren?]
Saturday, June 18, 2011
Thursday, June 16, 2011
Gotta Pass the Physical: Child Psychotherapy as a Contact Sport
A friend recently passed on to me some interesting information about some Ohio practitioners who employ holding therapy (HT), a physically-intrusive procedure, as a method of purportedly establishing a child’s emotional attachment to his or her parents. Like many proponents of the Attachment Therapy approach, these particular people attribute a great many childhood problems to a lack of attachment, believe that establishing attachment will solve the problems, and also believe that their HT methods create attachment.
There are quite a few proponents of this unconventional form of treatment, in spite of the fact that HT, a type of physical restraint, has been associated with injuries and even deaths of children, and is remembered with terror by adults who were formerly subjected to it. (For more information on this point, see Attachment Therapy on Trial [Mercer, Sarner, & Rosa; Praeger, 2003]). What makes the subjects of today’s post a bit different is that they require a physical examination before accepting a child into their treatment program. Children aren’t treated unless there’s medical evidence that they can stand the treatment.
I will bet a large amount of money-- even the amount an unconventional practitioner recently sued me for unsuccessfully-- that nobody can find me a conventional psychotherapist who has this requirement for treating a child. (Asking for a general medical exam, to make sure there is no physical reason for mood or behavior problems, is not the same thing.)
The HT practitioners in question are at an Ohio counseling center (www.lake-cc.com). Here is what they say about the need for a preliminary physical examination: “… some attachment and bonding interventions evoke anger or anxiety responses similar to those found after exercise. … at times during the treatment process elevated emotional states are expected. If at any time a participant’s behavior creates a risk of physical harm to themselves or others, brief periods of physical holding (i.e., several minutes) to ensure safety may be indicated. In order to further ensure the safety and wellbeing of all participants in attachment therapy using holding interventions, we require participants to pass a physical exam from their medical provider (similar to those given for sports activities) prior to participation.” (Incidentally, these practitioners also state that they abide by the safety standards of ATTACh, the Association for Treatment and Training of Attachment in Children (www.attach.org), a group that has been stating that its members use only mild holding since shortly after the 2000 death of 10-year-old Candace Newmaker at the hands of holding therapists.)
Let’s examine the claims of the Ohio therapists under a strong light. “Anger or anxiety responses similar to those found after exercise.” What anger or anxiety responses are found after exercise and actually caused by exercise, as opposed to anger at getting a red card or anxiety that your ankle injury will sideline you for the season? As an every-other-day gym attender, and mother or grandmother of four sports enthusiasts, one whom lifts 500 pounds, I have never seen or heard of exercise-caused anger or exercise-caused anxiety. On the contrary, exercise is usually thought of as having a calming effect. Why would we contribute to the YMCA swim team if it made kids unnecessarily upset? Wouldn’t there be a nation-wide anti-youth-sports movement if there were any truth to this idea?
So what’s the point of making this claim, equating exercise and sports activities with the experience of being restrained? It would appear that the goal here is to “normalize” the use of physical restraint in child psychotherapy, to make it appear to be common and acceptable, just like Little League-- when in fact it is not only unconventional but has been established as a potentially harmful treatment as defined by the Emory University psychologist Scott Lilienfeld. By introducing the exercise concept early in their discussion of HT, these practitioners pave the way for their later statement requiring a physical examination, and they close the persuasive bracket by another reference to sports. The "logic" then becomes the following: childhood sports are normal and acceptable; childhood sports require a physical examination; HT requires a physical examination; therefore HT is, like childhood sports, normal and acceptable…. so don’t be alarmed at the idea that there might be some potential for harm in HT; there’s some risk in everything, even being on the swim team.
This is really quite a beautiful and expert use of persuasive techniques, and one almost has to admire the author of the document. Almost--- until it’s remembered that HT is a method whose effectiveness is unsupported by research evidence and which is potentially harmful. It doesn’t work, it can do harm; doesn’t this tell us something important? Of course, the document doesn’t address either of these concerns.
One query: what about the physicians who do these physical exams? What do they think if and when they’re told that the exam is in preparation for psychotherapy? Pediatricians, if you’ve received such a request, did you think of discussing it with child protective services?
P.S.
A few additional points of interest: the Ohio therapists state that they may have parents hold their children for diagnostic purposes. Now, any behavior sample can contribute to a diagnosis, but it’s deceptive to suggest that observations of holding are in any way standardized, or that any systematic research has connected holding behaviors to one diagnostic category or another. This claim is not surprising, though, in light of the therapists’ use of the Randolph Attachment Disorder Questionnaire (RADQ), a poorly-developed and unstandardized test whose creator, Elizabeth Randolph (California psychology license revoked some years ago) states that it diagnoses “Attachment Disorder”, a disorder never described or used in any conventional work.
There are quite a few proponents of this unconventional form of treatment, in spite of the fact that HT, a type of physical restraint, has been associated with injuries and even deaths of children, and is remembered with terror by adults who were formerly subjected to it. (For more information on this point, see Attachment Therapy on Trial [Mercer, Sarner, & Rosa; Praeger, 2003]). What makes the subjects of today’s post a bit different is that they require a physical examination before accepting a child into their treatment program. Children aren’t treated unless there’s medical evidence that they can stand the treatment.
I will bet a large amount of money-- even the amount an unconventional practitioner recently sued me for unsuccessfully-- that nobody can find me a conventional psychotherapist who has this requirement for treating a child. (Asking for a general medical exam, to make sure there is no physical reason for mood or behavior problems, is not the same thing.)
The HT practitioners in question are at an Ohio counseling center (www.lake-cc.com). Here is what they say about the need for a preliminary physical examination: “… some attachment and bonding interventions evoke anger or anxiety responses similar to those found after exercise. … at times during the treatment process elevated emotional states are expected. If at any time a participant’s behavior creates a risk of physical harm to themselves or others, brief periods of physical holding (i.e., several minutes) to ensure safety may be indicated. In order to further ensure the safety and wellbeing of all participants in attachment therapy using holding interventions, we require participants to pass a physical exam from their medical provider (similar to those given for sports activities) prior to participation.” (Incidentally, these practitioners also state that they abide by the safety standards of ATTACh, the Association for Treatment and Training of Attachment in Children (www.attach.org), a group that has been stating that its members use only mild holding since shortly after the 2000 death of 10-year-old Candace Newmaker at the hands of holding therapists.)
Let’s examine the claims of the Ohio therapists under a strong light. “Anger or anxiety responses similar to those found after exercise.” What anger or anxiety responses are found after exercise and actually caused by exercise, as opposed to anger at getting a red card or anxiety that your ankle injury will sideline you for the season? As an every-other-day gym attender, and mother or grandmother of four sports enthusiasts, one whom lifts 500 pounds, I have never seen or heard of exercise-caused anger or exercise-caused anxiety. On the contrary, exercise is usually thought of as having a calming effect. Why would we contribute to the YMCA swim team if it made kids unnecessarily upset? Wouldn’t there be a nation-wide anti-youth-sports movement if there were any truth to this idea?
So what’s the point of making this claim, equating exercise and sports activities with the experience of being restrained? It would appear that the goal here is to “normalize” the use of physical restraint in child psychotherapy, to make it appear to be common and acceptable, just like Little League-- when in fact it is not only unconventional but has been established as a potentially harmful treatment as defined by the Emory University psychologist Scott Lilienfeld. By introducing the exercise concept early in their discussion of HT, these practitioners pave the way for their later statement requiring a physical examination, and they close the persuasive bracket by another reference to sports. The "logic" then becomes the following: childhood sports are normal and acceptable; childhood sports require a physical examination; HT requires a physical examination; therefore HT is, like childhood sports, normal and acceptable…. so don’t be alarmed at the idea that there might be some potential for harm in HT; there’s some risk in everything, even being on the swim team.
This is really quite a beautiful and expert use of persuasive techniques, and one almost has to admire the author of the document. Almost--- until it’s remembered that HT is a method whose effectiveness is unsupported by research evidence and which is potentially harmful. It doesn’t work, it can do harm; doesn’t this tell us something important? Of course, the document doesn’t address either of these concerns.
One query: what about the physicians who do these physical exams? What do they think if and when they’re told that the exam is in preparation for psychotherapy? Pediatricians, if you’ve received such a request, did you think of discussing it with child protective services?
P.S.
A few additional points of interest: the Ohio therapists state that they may have parents hold their children for diagnostic purposes. Now, any behavior sample can contribute to a diagnosis, but it’s deceptive to suggest that observations of holding are in any way standardized, or that any systematic research has connected holding behaviors to one diagnostic category or another. This claim is not surprising, though, in light of the therapists’ use of the Randolph Attachment Disorder Questionnaire (RADQ), a poorly-developed and unstandardized test whose creator, Elizabeth Randolph (California psychology license revoked some years ago) states that it diagnoses “Attachment Disorder”, a disorder never described or used in any conventional work.
Tuesday, June 14, 2011
Jean Talks! Podcast for Center for Inquiry
If you want to hear a podcast discussing myths, mistakes, and misunderstandings of child development, go to
http://www.pointofinquiry.org/jean_mercer_child_development_myths_and_misunderstandings/
where you'll also see the adorable cover of my critical-thinking-oriented book Child development: Myths & Misunderstandings (Sage, 2009).
I had fun being interviewed by Karen Stollznow... now I have to buckle down and do the promised revised version of this book.
If anyone has a new myth to suggest, I'd be interested to hear about it....
http://www.pointofinquiry.org/jean_mercer_child_development_myths_and_misunderstandings/
where you'll also see the adorable cover of my critical-thinking-oriented book Child development: Myths & Misunderstandings (Sage, 2009).
I had fun being interviewed by Karen Stollznow... now I have to buckle down and do the promised revised version of this book.
If anyone has a new myth to suggest, I'd be interested to hear about it....
Saturday, June 11, 2011
Eye Contact and Sign Language: A Comment from "Messy Mommy"
Blogger seems to be having difficulty in permitting me to respond to comments, so I'm going to use this method to call people's attention to a fascinating response I received to a recent post, http://childmyths.blogspot.com/2011/05/more-about-infants-and-eye-contact-gaze.html. "Messy Mommy" has written to describe issues that arose when her toddler was paying attention to gestures and not to faces.
Do read what she had to say if you're interested in this eye contact business.
If anyone has had other relevant experiences with their children, I would be very interested in hearing your stories.
Do read what she had to say if you're interested in this eye contact business.
If anyone has had other relevant experiences with their children, I would be very interested in hearing your stories.
Monday, June 6, 2011
When Child Therapists Promote Coercive Tactics: A Deadly Trickle-Down
The front page of the New York Times today (June 6, 2011) carries a most disturbing story headlined “A Disabled Boy’s Death, and a Troubled System” (http://www.nytimes.com/2011/06/06/nyregion/boys-death-highlights-crisis-in-homes-for-disabled.html?_r=1&ref=dannyhakim). The article reports that “on a February afternoon in 2007, Jonathan, a skinny, autistic 13-year-old, was asphyxiated, slowly crushed to death in the back seat of a van by a state employee who had worked nearly 200 hours without a day off over 15 days. The employee, a ninth-grade dropout with a criminal conviction for selling marijuana, had been on duty during at least one previous episode of alleged abuse involving Jonathan. “I could be a good king or a bad king,” he told the dying boy beneath him, according to court documents. In the front seat of the van, the driver, another state worker…, watched through the rear-view mirror but said little.” The boy was in the face-down restraint position well-known to carry a risk of asphyxiation. When Jonathan stopped responding, the two staff members spent an hour driving around, talking and shopping, with his body in the back of the van.
The article goes on to describe how Jonathan had been losing weight at the state school where he was a resident, and a logbook about his treatment revealed that “the school was withholding food from Jonathan to punish him for taking off his shirt at inappropriate times”. Bruising and other injuries had been part of Jonathan’s school life as well as that of other residents.
Obviously, there was no single cause for this horrible event. Overwork , undertraining, and lack of supervision of staff are important reasons, as is the hiring of individuals with criminal records. But I believe there is another factor: methods proposed by a small number of child psychologists, therapists, and parent educators, which suggest that coercive and potentially dangerous techniques are acceptable ways of dealing with noncompliant children. Those methods are directed toward family use, but I question whether such recommendations do not “trickle down” to use in so-called special education facilities.
Some readers will recall that I have mentioned in earlier posts situations in which parents were advised to withhold food from children in order to force compliance. (I described one case in which the parents who withheld food and kept a child locked up both received prison sentences, but the therapist who advised them suffered no consequences.) Others as well as I have repeatedly discussed the continuing problem of recommendations for restraint of individuals in the prone (face-down) position, and the possibility of asphyxia when this advice is taken.
I would contend that these suggestions do more than put specific home-reared children and their families in danger. The existence of this advice, without response by comment or consequences from professional licensing boards or from national professional organizations, is a signal to those who care for the developmentally disabled. The signal says: withholding food and using dangerous types of restraint are good techniques for families to use; therefore, they are appropriate and acceptable for residential school staff too.
Recently, I spent 90 minutes listening to an audio presentation available at http://www.consequences.com/aggression/audio.html. This presentation was essentially a lengthy advertisement for a $900 weekend training in which parents would be taught methods of restraint declared to be safe by one of the presenters, a person who in his self-published work has recommended face-down restraint as a means of establishing compliance in children.
The weekend was described as providing contact with people to talk to, who would not turn the parents in to child protective services. It was also to include advice about establishing relationships with the police and with protective services staff so they would not take complaints of abuse seriously. Declaring that he didn’t understand “fancy psychotherapeutic stuff”, one of the presenters stated that he was “FBI trained” and that he would personally train and certify parents in restraint methods. The certification would give them credibility with authorities who might otherwise object to their treatment of children. The presenter suggested that single parents needed to recruit outsiders to help them with restraint, and that living in northern Virginia he arranges for Marines from Quantico to do this.
This presenter, and others with similar messages, break no laws when they give this type of advice and suggest ways to evade the attention of authorities who deal with child abuse. Even parents who follow the advice are unlikely to meet legal consequences unless, and until, a child is injured by their actions. As the Times article shows, when that kind of advice trickles down to the residential treatment center level, even harm to a child may receive only the mildest punishment. (In Jonathan’s case, the driver who watched the child being killed “had been fired from four different private providers of services to the developmentally disabled before the state hired him to care for the same vulnerable population”.)
I don’t propose legislation that would prohibit giving bad advice about parenting. There are too many possibilities for any law to cover. I do ask, however, why professional licensing boards and professional groups like the American Psychological Association appear to be indifferent to advice that can mislead parents and harm families, and that may encourage public attitudes that foster ill-treatment of the developmentally disabled. I understand and cherish the First Amendment, but I don’t believe that professional privileges include the right to mislead.
Incidentally, in the audio presentation mentioned above, one of the presenters says that in some states continuing professional education credits may be available for the advertised workshop. If anyone comes across CE units given for such a class, I would very much appreciate hearing from you about it.
The article goes on to describe how Jonathan had been losing weight at the state school where he was a resident, and a logbook about his treatment revealed that “the school was withholding food from Jonathan to punish him for taking off his shirt at inappropriate times”. Bruising and other injuries had been part of Jonathan’s school life as well as that of other residents.
Obviously, there was no single cause for this horrible event. Overwork , undertraining, and lack of supervision of staff are important reasons, as is the hiring of individuals with criminal records. But I believe there is another factor: methods proposed by a small number of child psychologists, therapists, and parent educators, which suggest that coercive and potentially dangerous techniques are acceptable ways of dealing with noncompliant children. Those methods are directed toward family use, but I question whether such recommendations do not “trickle down” to use in so-called special education facilities.
Some readers will recall that I have mentioned in earlier posts situations in which parents were advised to withhold food from children in order to force compliance. (I described one case in which the parents who withheld food and kept a child locked up both received prison sentences, but the therapist who advised them suffered no consequences.) Others as well as I have repeatedly discussed the continuing problem of recommendations for restraint of individuals in the prone (face-down) position, and the possibility of asphyxia when this advice is taken.
I would contend that these suggestions do more than put specific home-reared children and their families in danger. The existence of this advice, without response by comment or consequences from professional licensing boards or from national professional organizations, is a signal to those who care for the developmentally disabled. The signal says: withholding food and using dangerous types of restraint are good techniques for families to use; therefore, they are appropriate and acceptable for residential school staff too.
Recently, I spent 90 minutes listening to an audio presentation available at http://www.consequences.com/aggression/audio.html. This presentation was essentially a lengthy advertisement for a $900 weekend training in which parents would be taught methods of restraint declared to be safe by one of the presenters, a person who in his self-published work has recommended face-down restraint as a means of establishing compliance in children.
The weekend was described as providing contact with people to talk to, who would not turn the parents in to child protective services. It was also to include advice about establishing relationships with the police and with protective services staff so they would not take complaints of abuse seriously. Declaring that he didn’t understand “fancy psychotherapeutic stuff”, one of the presenters stated that he was “FBI trained” and that he would personally train and certify parents in restraint methods. The certification would give them credibility with authorities who might otherwise object to their treatment of children. The presenter suggested that single parents needed to recruit outsiders to help them with restraint, and that living in northern Virginia he arranges for Marines from Quantico to do this.
This presenter, and others with similar messages, break no laws when they give this type of advice and suggest ways to evade the attention of authorities who deal with child abuse. Even parents who follow the advice are unlikely to meet legal consequences unless, and until, a child is injured by their actions. As the Times article shows, when that kind of advice trickles down to the residential treatment center level, even harm to a child may receive only the mildest punishment. (In Jonathan’s case, the driver who watched the child being killed “had been fired from four different private providers of services to the developmentally disabled before the state hired him to care for the same vulnerable population”.)
I don’t propose legislation that would prohibit giving bad advice about parenting. There are too many possibilities for any law to cover. I do ask, however, why professional licensing boards and professional groups like the American Psychological Association appear to be indifferent to advice that can mislead parents and harm families, and that may encourage public attitudes that foster ill-treatment of the developmentally disabled. I understand and cherish the First Amendment, but I don’t believe that professional privileges include the right to mislead.
Incidentally, in the audio presentation mentioned above, one of the presenters says that in some states continuing professional education credits may be available for the advertised workshop. If anyone comes across CE units given for such a class, I would very much appreciate hearing from you about it.
Saturday, June 4, 2011
Does Individualized Treatment Mean Systematic Research is Impossible?
In a recent e-mail discussion, someone mentioned to me her belief that it was not really relevant that some psychotherapies for children are not supported by clear research evidence and thus can’t properly be called “evidence-based”. She reasoned that because psychological treatments have to be tailored to individual cases, it is impossible to control how the treatment is done, and real experimental research like that done in physical medicine cannot be managed. Therefore, she argued, we should not demand that psychotherapies be supported by evidence from randomized trials.
That correspondent was talking about a treatment called Dyadic Developmental Psychotherapy, which has not earned the “evidence-based” category, but she was certainly not the only person to make that argument, nor is DDP the only treatment that has been discussed in this way. Several weeks ago, when I was present at a workshop on Sensory Integration treatment, I took the opportunity to ask the presenter privately where she stood on the idea that Sensory Integration lacks the support of research evidence. She cheerfully agreed that it had very little support, and followed up her statement with the argument that individualization of treatments means that it will never be possible to evaluate SI and provide clear research evidence supporting its effectiveness--- so, we should choose to use SI or similar methods simply on the basis of therapists’ judgments about what seems to “work”.
These are not irrational arguments, but I think they are wrong. Obviously, research on any treatment of human beings is going to involve many more complicated factors than, say, studying which kind of fertilizer gives the best crop for a particular kind of bean. With more factors, it becomes increasingly harder to define and interpret outcomes. Nevertheless, by following rules of research design, it’s possible to work out ways of deciding whether a treatment is more effective than another choice (whether it’s a different treatment, no treatment at all, being on a waiting list for the desired treatment, or whatever it may be). Applying those rules gives a better assessment of the treatment than can be given by the judgment of a therapist who is very much involved in the therapy, or the judgment of parents who may have their own reasons for enthusiasm or hostility toward a particular psychotherapy for their children, or for that matter the judgment of the treated children themselves.
Here’s the thing: in most situations where either a child or and adult is going to receive psychological treatment, somebody is going to make a decision about what the treatment will be. That “somebody” may be a parent or a teacher or a judge or a psychologist or a social worker. Without research evidence, none of those people have anything but their own experience or other people’s opinions to go on, and even very experienced therapists can hardly have treated more than a few hundred of certain kinds of problems in their professional lifetimes. Their opinions may be better ways of making choices than flipping a coin, but they can’t be nearly as good decision guides as systematic research, and I’ll tell you why.
1. Individual teachers or therapists can only have a limited number of past observations to go on, but systematic research approaches can bring together information about hundreds of similar cases. The great advantage of having all those cases is that the individual differences between children and their situations are likely to average out and “disappear” arithmetically from measurements of the children’s conditions. In addition, when you work with small numbers of children, it’s much more likely that individual differences will affect the results, and even that the children you are looking at are by accident a different sort of people than the rest of the population. (This is like the old sock drawer problem: if you have a drawer full of socks, half of them white and half black, and you pull out only three, it could easily happen that all three are the same color. But when you pull out a dozen socks, chances are that you will get something closer to half black and half white, and with two dozen that’s even more likely. Similarly, if half of the children will get “better” with a treatment, and the other half will get ”worse”, it could easily happen that a small number of children could by accident all be of the “getting better” type.)
2. Individual therapists or parents may not be in a good position to compare children in treatment to children with similar problems who are not being treated. Without that kind of comparison, it’s impossible to know whether changes in the treated children are caused by the treatment, or whether they change just because they are getting older, or whether their problems are of a temporary kind to begin with. The rules of systematic research direct us to begin a study by establishing a comparison group of people who are similar in age, sex, socioeconomic status, etc., etc. to the people who will be treated, but who will receive a different treatment, or possibly no treatment at all. Simply comparing the children’s conditions before and after treatment is just not good enough, because it gives us no idea whatever why any improvement has occurred, and improvement can take place for a thousand reasons-- even the parents’ changed behavior because they have confidence in a therapist.
3. Individual therapists, parents, or teachers, however careful they may try to be, can find it impossible to be objective about the effects of a treatment. This is not an insult, or even a criticism, but just the statement that all of us human beings easily think or remember things the way that makes most sense to us or that suggests that we’re right about something. Well-designed research does not let this kind of subjectivity get in the way, because it makes sure that children are evaluated by people who do not know what kind of treatment they are getting, and that the data collected are also analyzed “blind” by people who don’t know the children.
4. Individuals may be very much tempted to make decisions about treatments on the basis of other individuals’ experiences-- testimonials, for example. But those individual experiences are very likely to be seriously biased in ways that systematic research is not. What testimonial ever said, “Oh, it was okay, I guess”, or for that matter, “It was ghastly-- what a waste of time and money”? Decisions based on individual experience are likely to pay close attention to positive statements and ignore neutral or negative experiences. On the contrary, the job of systematic research is to try hard to find negative information that will lead to the rejection of a treatment unless it is far more than balanced by positive findings.
All these are reasons why choices about treatment are better based on systematic research than on individual experiences. All choices are likely to be based on some information rather than by random decisions, so it only makes sense to choose treatments based on systematic research evidence when that is possible (and, by the way, it usually is possible, as there are well-supported psychotherapies for parents and children).
One other thought, however. I don’t mean to say that individual experiences are worthless, and in fact there is one situation where they may be enormously valuable in the assessment of a treatment. This is the case when a therapy is actually potentially harmful under some circumstances. We can assume that even potentially harmful therapies don’t hurt every client, because it would rapidly become obvious if they did. However, if they harmed only one person in a thousand, it would be important to know this. Chance factors might mean that no individual in a systematic study would be hurt. We would be likely to find out about problems only from family members or from a therapist who observed an adverse event. Let’s hope that if such discoveries are made, the observers will find some way to make their findings publicly known.
That correspondent was talking about a treatment called Dyadic Developmental Psychotherapy, which has not earned the “evidence-based” category, but she was certainly not the only person to make that argument, nor is DDP the only treatment that has been discussed in this way. Several weeks ago, when I was present at a workshop on Sensory Integration treatment, I took the opportunity to ask the presenter privately where she stood on the idea that Sensory Integration lacks the support of research evidence. She cheerfully agreed that it had very little support, and followed up her statement with the argument that individualization of treatments means that it will never be possible to evaluate SI and provide clear research evidence supporting its effectiveness--- so, we should choose to use SI or similar methods simply on the basis of therapists’ judgments about what seems to “work”.
These are not irrational arguments, but I think they are wrong. Obviously, research on any treatment of human beings is going to involve many more complicated factors than, say, studying which kind of fertilizer gives the best crop for a particular kind of bean. With more factors, it becomes increasingly harder to define and interpret outcomes. Nevertheless, by following rules of research design, it’s possible to work out ways of deciding whether a treatment is more effective than another choice (whether it’s a different treatment, no treatment at all, being on a waiting list for the desired treatment, or whatever it may be). Applying those rules gives a better assessment of the treatment than can be given by the judgment of a therapist who is very much involved in the therapy, or the judgment of parents who may have their own reasons for enthusiasm or hostility toward a particular psychotherapy for their children, or for that matter the judgment of the treated children themselves.
Here’s the thing: in most situations where either a child or and adult is going to receive psychological treatment, somebody is going to make a decision about what the treatment will be. That “somebody” may be a parent or a teacher or a judge or a psychologist or a social worker. Without research evidence, none of those people have anything but their own experience or other people’s opinions to go on, and even very experienced therapists can hardly have treated more than a few hundred of certain kinds of problems in their professional lifetimes. Their opinions may be better ways of making choices than flipping a coin, but they can’t be nearly as good decision guides as systematic research, and I’ll tell you why.
1. Individual teachers or therapists can only have a limited number of past observations to go on, but systematic research approaches can bring together information about hundreds of similar cases. The great advantage of having all those cases is that the individual differences between children and their situations are likely to average out and “disappear” arithmetically from measurements of the children’s conditions. In addition, when you work with small numbers of children, it’s much more likely that individual differences will affect the results, and even that the children you are looking at are by accident a different sort of people than the rest of the population. (This is like the old sock drawer problem: if you have a drawer full of socks, half of them white and half black, and you pull out only three, it could easily happen that all three are the same color. But when you pull out a dozen socks, chances are that you will get something closer to half black and half white, and with two dozen that’s even more likely. Similarly, if half of the children will get “better” with a treatment, and the other half will get ”worse”, it could easily happen that a small number of children could by accident all be of the “getting better” type.)
2. Individual therapists or parents may not be in a good position to compare children in treatment to children with similar problems who are not being treated. Without that kind of comparison, it’s impossible to know whether changes in the treated children are caused by the treatment, or whether they change just because they are getting older, or whether their problems are of a temporary kind to begin with. The rules of systematic research direct us to begin a study by establishing a comparison group of people who are similar in age, sex, socioeconomic status, etc., etc. to the people who will be treated, but who will receive a different treatment, or possibly no treatment at all. Simply comparing the children’s conditions before and after treatment is just not good enough, because it gives us no idea whatever why any improvement has occurred, and improvement can take place for a thousand reasons-- even the parents’ changed behavior because they have confidence in a therapist.
3. Individual therapists, parents, or teachers, however careful they may try to be, can find it impossible to be objective about the effects of a treatment. This is not an insult, or even a criticism, but just the statement that all of us human beings easily think or remember things the way that makes most sense to us or that suggests that we’re right about something. Well-designed research does not let this kind of subjectivity get in the way, because it makes sure that children are evaluated by people who do not know what kind of treatment they are getting, and that the data collected are also analyzed “blind” by people who don’t know the children.
4. Individuals may be very much tempted to make decisions about treatments on the basis of other individuals’ experiences-- testimonials, for example. But those individual experiences are very likely to be seriously biased in ways that systematic research is not. What testimonial ever said, “Oh, it was okay, I guess”, or for that matter, “It was ghastly-- what a waste of time and money”? Decisions based on individual experience are likely to pay close attention to positive statements and ignore neutral or negative experiences. On the contrary, the job of systematic research is to try hard to find negative information that will lead to the rejection of a treatment unless it is far more than balanced by positive findings.
All these are reasons why choices about treatment are better based on systematic research than on individual experiences. All choices are likely to be based on some information rather than by random decisions, so it only makes sense to choose treatments based on systematic research evidence when that is possible (and, by the way, it usually is possible, as there are well-supported psychotherapies for parents and children).
One other thought, however. I don’t mean to say that individual experiences are worthless, and in fact there is one situation where they may be enormously valuable in the assessment of a treatment. This is the case when a therapy is actually potentially harmful under some circumstances. We can assume that even potentially harmful therapies don’t hurt every client, because it would rapidly become obvious if they did. However, if they harmed only one person in a thousand, it would be important to know this. Chance factors might mean that no individual in a systematic study would be hurt. We would be likely to find out about problems only from family members or from a therapist who observed an adverse event. Let’s hope that if such discoveries are made, the observers will find some way to make their findings publicly known.
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
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.
.
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.
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.
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).
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.
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.
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.
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.
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.
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.
Tuesday, April 19, 2011
Why Should We Worry About Maternal Depression?
It seems as if I’ve had a lot of discussions of maternal depression lately-- both the perinatal mood disorders of birth mothers and post-adoption depression. When these topics come up, there are a lot of different responses. Some deny that there could be post-adoption depression, because they’re convinced that the hormones of pregnancy cause perinatal mood disorders (although if this were the case, it’s not too clear why all women don’t have the same problems). Others feel that the women are just suffering from “buyer’s remorse” and could do perfectly well if they just pulled their socks up. Still others feel that such mood disorders are excuses given by people who don’t like the hard work of early motherhood.
In most cases, people focus on the mother as the significant person, the one who’s influenced by depression. They forget the fact that the impact of maternal depression on a baby’s development can be quite negative. They also forget that this is an issue that has significance not just for mothers but for all major caregivers. Depression in nannies, day care providers, or grandmothers who “watch” the child while the mother works all have the potential for interfering with optimum development. (You notice I don’t say “normal development”. Things have to get pretty bad before development gets below the bottom of the normal range-- but long before that there may be a deviation from a baby’s best developmental trajectory, the one that will result in the best developmental outcome.)
So, what do depressed mothers and caregivers do that’s so different from what better-functioning people manage?
Imagine your own experiences with depression-- whether they involved an afternoon of low interest in life, or a long, serious problem with thoughts of suicide. Think how you feel when you’re depressed, what you feel like doing, and how you respond to other people. You’ll probably realize that you feel not only sad, but slow, tired, unresponsive, hard to please, pessimistic, and perhaps guilty or even worthless. You’d like people either to leave you alone completely or to nurture you without thought of themselves. You don’t want to talk or listen to others, you don’t want to make eye contact, you don’t smile or show expression in your posture or gestures.
Then, imagine how you feel when you’re with someone else who is depressed (and you aren’t). You may feel and act sympathetic at first, but that might not last long in the face of their negative mood. You interpret the other person’s mood as anger or hostility or rejection, and soon you respond to that perceived mood by being angry yourself. You don’t want to be with that person, and if you have to be (you live together, for instance), you may end up picking a fight just to get some acknowledgement of your existence.
Now, I don’t want to act as if I think babies have the same interpretations of other people’s behavior as adults do. I’m positive they do not. But when you consider how you feel when you’re depressed, and how you react to other depressed people, I think you can catch something of the flavor of a baby’s reaction to a depressed caregiver. In addition to that “flavor”, though, it might be good to consider some things depressed caregivers do or don’t do, and how those things relate to a baby’s needs.
1.Depressed caregivers don’t talk much.
Babies need to hear speech from the earliest months. Initially, hearing speech helps babies learn which noises adults make as part of speech, and which are not part of speech. To understand a language, you have to learn that particular sounds determine the meaning of speech, and others, like humming, coughing, or saying “ummm” do not. Different languages have different proportions of certain speech sounds and sometimes don’t use a particular sound at all. Babies who hear little speech are delayed in their understanding of the way their native language works and which sounds they need to pay attention to in order to understand.
2.Depressed caregivers make the “still face” often.
By a few months of age, certainly by 4-6 months, babies have normally learned to expect adult facial expressions to change in response to baby communications. When an adult makes the “still face”-- gazing blankly and unresponsively as if he or she can’t see the baby-- it’s very disturbing to the baby, who will begin to cry quite soon, will avert his or her gaze and become disorganized, sometimes hiccupping or spitting up. Adults can make still faces under perfectly normal situations like trying to remember where the car keys are or trying to talk to the plumber on the phone while the baby makes a bid for attention. Ordinarily, though, the non-depressed adult quickly comes back and re-engages with the baby, repairing their temporarily troubled communication. Depressed caregivers, on the contrary, may not only do the still face more often, but may lack the energy or interest to help the baby later understand that everything is okay and resolve the disorganization and anxiety the baby feels.
3.Depressed caregivers do only the basics.
Fatigue and slowing of responses are part of depression and interfere with normal infant care routines. Ordinarily, caregivers do a lot more than just the physical jobs of caring for a baby. The non-depressed caregiver who is changing a diaper talks to the baby in an interesting, voice that catches the baby’s attention. She plays with the baby at the same time, making eye contact, smiling, tickling or blowing on the tummy, perhaps giving the baby a toy to hold (not entirely play, of course, this is a good strategy for keeping the little hands out of the dirty diaper). When feeding the baby, she talks and jokes, perhaps pretending to eat some of the food herself (for some reason, this is a wow with the high-chair set), or helping the baby pick up some finger food. The depressed caregiver goes through these routines without any of the usual grace notes, doing the minimum and missing out the actions that pique the baby’s interest and foster communication, as well as those that encourage learning.
4.Depressed caregivers may not be very careful or attentive.
When babies can roll over, or pull to stand in their cribs, or later on crawl and so on, caregivers need “eyes in the back of their heads” to ensure safety. Even so, most babies experience a few scary tumbles as their caregivers fail to anticipate their doing something for the first time. The depressed caregiver moves slowly and has trouble paying attention to more than the troubles in her own thoughts and feelings. She may be so preoccupied that the baby might as well be at the top of the stairs or in the bathtub alone. Paradoxically, the depressed caregiver’s sense of guilt or worthlessness may concern her so much that she fails to prevent accidents and thus really does become guilty.
These are only a few of the caregiving problems that can be associated with depression. It may well be that the best thing we could do to foster good early development would be to attend to and treat the depression of mothers and other infant caregivers, so they can do the optimum job of bringing up young children.
In most cases, people focus on the mother as the significant person, the one who’s influenced by depression. They forget the fact that the impact of maternal depression on a baby’s development can be quite negative. They also forget that this is an issue that has significance not just for mothers but for all major caregivers. Depression in nannies, day care providers, or grandmothers who “watch” the child while the mother works all have the potential for interfering with optimum development. (You notice I don’t say “normal development”. Things have to get pretty bad before development gets below the bottom of the normal range-- but long before that there may be a deviation from a baby’s best developmental trajectory, the one that will result in the best developmental outcome.)
So, what do depressed mothers and caregivers do that’s so different from what better-functioning people manage?
Imagine your own experiences with depression-- whether they involved an afternoon of low interest in life, or a long, serious problem with thoughts of suicide. Think how you feel when you’re depressed, what you feel like doing, and how you respond to other people. You’ll probably realize that you feel not only sad, but slow, tired, unresponsive, hard to please, pessimistic, and perhaps guilty or even worthless. You’d like people either to leave you alone completely or to nurture you without thought of themselves. You don’t want to talk or listen to others, you don’t want to make eye contact, you don’t smile or show expression in your posture or gestures.
Then, imagine how you feel when you’re with someone else who is depressed (and you aren’t). You may feel and act sympathetic at first, but that might not last long in the face of their negative mood. You interpret the other person’s mood as anger or hostility or rejection, and soon you respond to that perceived mood by being angry yourself. You don’t want to be with that person, and if you have to be (you live together, for instance), you may end up picking a fight just to get some acknowledgement of your existence.
Now, I don’t want to act as if I think babies have the same interpretations of other people’s behavior as adults do. I’m positive they do not. But when you consider how you feel when you’re depressed, and how you react to other depressed people, I think you can catch something of the flavor of a baby’s reaction to a depressed caregiver. In addition to that “flavor”, though, it might be good to consider some things depressed caregivers do or don’t do, and how those things relate to a baby’s needs.
1.Depressed caregivers don’t talk much.
Babies need to hear speech from the earliest months. Initially, hearing speech helps babies learn which noises adults make as part of speech, and which are not part of speech. To understand a language, you have to learn that particular sounds determine the meaning of speech, and others, like humming, coughing, or saying “ummm” do not. Different languages have different proportions of certain speech sounds and sometimes don’t use a particular sound at all. Babies who hear little speech are delayed in their understanding of the way their native language works and which sounds they need to pay attention to in order to understand.
2.Depressed caregivers make the “still face” often.
By a few months of age, certainly by 4-6 months, babies have normally learned to expect adult facial expressions to change in response to baby communications. When an adult makes the “still face”-- gazing blankly and unresponsively as if he or she can’t see the baby-- it’s very disturbing to the baby, who will begin to cry quite soon, will avert his or her gaze and become disorganized, sometimes hiccupping or spitting up. Adults can make still faces under perfectly normal situations like trying to remember where the car keys are or trying to talk to the plumber on the phone while the baby makes a bid for attention. Ordinarily, though, the non-depressed adult quickly comes back and re-engages with the baby, repairing their temporarily troubled communication. Depressed caregivers, on the contrary, may not only do the still face more often, but may lack the energy or interest to help the baby later understand that everything is okay and resolve the disorganization and anxiety the baby feels.
3.Depressed caregivers do only the basics.
Fatigue and slowing of responses are part of depression and interfere with normal infant care routines. Ordinarily, caregivers do a lot more than just the physical jobs of caring for a baby. The non-depressed caregiver who is changing a diaper talks to the baby in an interesting, voice that catches the baby’s attention. She plays with the baby at the same time, making eye contact, smiling, tickling or blowing on the tummy, perhaps giving the baby a toy to hold (not entirely play, of course, this is a good strategy for keeping the little hands out of the dirty diaper). When feeding the baby, she talks and jokes, perhaps pretending to eat some of the food herself (for some reason, this is a wow with the high-chair set), or helping the baby pick up some finger food. The depressed caregiver goes through these routines without any of the usual grace notes, doing the minimum and missing out the actions that pique the baby’s interest and foster communication, as well as those that encourage learning.
4.Depressed caregivers may not be very careful or attentive.
When babies can roll over, or pull to stand in their cribs, or later on crawl and so on, caregivers need “eyes in the back of their heads” to ensure safety. Even so, most babies experience a few scary tumbles as their caregivers fail to anticipate their doing something for the first time. The depressed caregiver moves slowly and has trouble paying attention to more than the troubles in her own thoughts and feelings. She may be so preoccupied that the baby might as well be at the top of the stairs or in the bathtub alone. Paradoxically, the depressed caregiver’s sense of guilt or worthlessness may concern her so much that she fails to prevent accidents and thus really does become guilty.
These are only a few of the caregiving problems that can be associated with depression. It may well be that the best thing we could do to foster good early development would be to attend to and treat the depression of mothers and other infant caregivers, so they can do the optimum job of bringing up young children.
Sunday, April 10, 2011
Breastfeeding: Test Your Knowledge-- True or False?
The important human function of breastfeeding is the subject of many myths and misunderstandings. A fascinating meld of biological and behavioral events, it’s worth the attention of everyone interested in early development, even those who will not be participating at the adult end. Test your knowledge of breastfeeding by reading these “true or false?” questions.
1. Breastfeeding helps the baby resist infectious diseases. True or false?
Very true! Although babies are born with a supply of antibodies they got from their mothers’ immune systems, those antibodies can only protect against diseases the mother had already been exposed to, not exposure to new diseases after the birth. In addition, those antibodies will have diminished by the time the baby is about 8 months old, a point at which infants do not yet do a good job of making their own antibodies. The nursing mother acts as an “auxiliary immune system” to her infant. She supplies more of the antibodies she already had, and if the nursing pair are exposed to a new disease, the mother’s efficient immune system goes to work to produce antibodies and pass them on to the baby in her milk. What if the baby is exposed to something, and the mother not exposed to it? Don’t worry, she will be exposed quickly, because the physical intimacy of nursing (and other infant care) means she will come into contact with the baby’s mucus, urine, and feces.
Do note that the baby can still use this kind of help toward the end of the first year. Babies who live in clean conditions, with modern food supplies and access to modern medicine, are less affected by a lack of breastfeeding, but those living in primitive conditions may die of infections that could have been prevented by breastfeeding.
2.Nursing mothers need to eat a lot more than usual. True or false?
It depends on the conditions. If the mother was well nourished during the pregnancy, she has laid down extra fat and extra calcium in her bones, and these will be used to support lactation, so she needs little if any extra food. If the mother is living at a subsistence level, she will need extra calories to compensate for those consumed by the baby. An ounce of human milk has about 20 calories on the average, so you can do the math, considering the amount of milk consumed by babies of different sizes and ages.
The nursing mother does need to drink a lot more fluid than when she is not breastfeeding. Every ounce of fluid the baby takes needs to be replaced. Many nursing mothers automatically go to drink a glass of water before they pick up the baby to nurse, or have a cup of tea while breastfeeding. Traditionally, nursing mothers drank dark beers like porter, which supplied extra fluid and a hefty dose of B vitamins, and gave everyone a nice nap too-- nowadays we tend to frown on this, and certainly this practice would have its dangers if it occurred more than once in a while .
3. You can’t breastfeed a baby once he or she gets teeth. True or false?
False. Babies can easily be taught not to bite the nipple, if the mother is vigilant (and believe me, after one bite she WILL be vigilant). Biting and sucking take different jaw movements, and an attentive mother can see when a sucking baby re-adjusts its jaw position in preparation for a chomp. The mother then gently inserts her finger between the baby’s jaws, toward the back of the mouth. This breaks the suction, so the baby cannot get any milk, and if he or she bites down, there’s not much satisfaction, because those itchy teething gums are in the front. Within 24 hours, the baby will have learned that although you can bite lots of things, you can’t bite that nipple-- it just doesn’t work.
Nursing mothers really have to teach biting babies not to bite, or their nipples can actually be damaged, and the baby will have to be weaned from the breast.
4. Nursing babies don’t like the milk that’s flavored by strong-tasting foods their mothers have eaten. True or false?
This is mainly false, with some possible individual exceptions. The taste researchers Menella and Beauchamp fed a group of nursing mothers an all-garlic-flavored lunch, waited a couple of hours, and then timed how long the babies nursed. When they compared this to nursing time after a bland lunch, they found that the babies actually nursed longer when the milk had a garlic flavor.
There may be some individual differences, with particular babies possibly disliking certain flavors. One important point is that when a nursing mother has had a mild breast infection, the milk on that side seems to be a little saltier than usual, and babies may not care for it-- to the mother’s frustration, as frequent thorough nursing is a help in clearing up these problems.
1. Breastfeeding helps the baby resist infectious diseases. True or false?
Very true! Although babies are born with a supply of antibodies they got from their mothers’ immune systems, those antibodies can only protect against diseases the mother had already been exposed to, not exposure to new diseases after the birth. In addition, those antibodies will have diminished by the time the baby is about 8 months old, a point at which infants do not yet do a good job of making their own antibodies. The nursing mother acts as an “auxiliary immune system” to her infant. She supplies more of the antibodies she already had, and if the nursing pair are exposed to a new disease, the mother’s efficient immune system goes to work to produce antibodies and pass them on to the baby in her milk. What if the baby is exposed to something, and the mother not exposed to it? Don’t worry, she will be exposed quickly, because the physical intimacy of nursing (and other infant care) means she will come into contact with the baby’s mucus, urine, and feces.
Do note that the baby can still use this kind of help toward the end of the first year. Babies who live in clean conditions, with modern food supplies and access to modern medicine, are less affected by a lack of breastfeeding, but those living in primitive conditions may die of infections that could have been prevented by breastfeeding.
2.Nursing mothers need to eat a lot more than usual. True or false?
It depends on the conditions. If the mother was well nourished during the pregnancy, she has laid down extra fat and extra calcium in her bones, and these will be used to support lactation, so she needs little if any extra food. If the mother is living at a subsistence level, she will need extra calories to compensate for those consumed by the baby. An ounce of human milk has about 20 calories on the average, so you can do the math, considering the amount of milk consumed by babies of different sizes and ages.
The nursing mother does need to drink a lot more fluid than when she is not breastfeeding. Every ounce of fluid the baby takes needs to be replaced. Many nursing mothers automatically go to drink a glass of water before they pick up the baby to nurse, or have a cup of tea while breastfeeding. Traditionally, nursing mothers drank dark beers like porter, which supplied extra fluid and a hefty dose of B vitamins, and gave everyone a nice nap too-- nowadays we tend to frown on this, and certainly this practice would have its dangers if it occurred more than once in a while .
3. You can’t breastfeed a baby once he or she gets teeth. True or false?
False. Babies can easily be taught not to bite the nipple, if the mother is vigilant (and believe me, after one bite she WILL be vigilant). Biting and sucking take different jaw movements, and an attentive mother can see when a sucking baby re-adjusts its jaw position in preparation for a chomp. The mother then gently inserts her finger between the baby’s jaws, toward the back of the mouth. This breaks the suction, so the baby cannot get any milk, and if he or she bites down, there’s not much satisfaction, because those itchy teething gums are in the front. Within 24 hours, the baby will have learned that although you can bite lots of things, you can’t bite that nipple-- it just doesn’t work.
Nursing mothers really have to teach biting babies not to bite, or their nipples can actually be damaged, and the baby will have to be weaned from the breast.
4. Nursing babies don’t like the milk that’s flavored by strong-tasting foods their mothers have eaten. True or false?
This is mainly false, with some possible individual exceptions. The taste researchers Menella and Beauchamp fed a group of nursing mothers an all-garlic-flavored lunch, waited a couple of hours, and then timed how long the babies nursed. When they compared this to nursing time after a bland lunch, they found that the babies actually nursed longer when the milk had a garlic flavor.
There may be some individual differences, with particular babies possibly disliking certain flavors. One important point is that when a nursing mother has had a mild breast infection, the milk on that side seems to be a little saltier than usual, and babies may not care for it-- to the mother’s frustration, as frequent thorough nursing is a help in clearing up these problems.
Tuesday, April 5, 2011
A Survivor of Holding Therapy Tells His Story
Please go to http://anyachaika.wordpress.com/2011.04/05/a-first-hand-account-of-holding-therapy-in-the-uk and read one boy's experience of holding therapy and other disturbing treatment. The author of this piece is a young man now and is preparing to fight against the use of "fringe" mental health treatments in the United Kingdom.
Saturday, April 2, 2011
Rats and Mice and Such Small Deer: Can They Help Us Learn About Human Infants?
Over at http://marginalperspectives.blogspot.com there’s a discussion going on about research on other species. Reference has been made to a research article: Graham,Y.P., Heim, C., Goodman,S.H., Miller, A.H., & Nemeroff,C.B. (1999). The effects of neonatal stress on brain development: Implications for psychopathology. Development and Psychopathology, 11, 545-565. (And yes, if that name rings a bell, this is the same Nemeroff who had to leave Emory because of failure to report his income from a drug company--- http://www.emorywheel.com/detail.php?n=27732). At marginalperspectives, people are talking about whether information obtained by observing rats can be generalized to human infants. They’re most concerned about the effects of separation from the mother, as evidenced by rat experiments (I mean experiments using rats as subjects, not experiments performed by rats).
The Graham et al paper reports, among many other things, that undesirable brain changes occur in young rats who are separated from their mothers, even though in one situation somewhat older pups could see the mothers through a transparent burrow. The marginalperspectives group suggest that this means that similar effects occur in human babies who are separated from their mothers, as, for example, in a hospital nursery, or of course in adoption.
The Graham group notes the large developmental differences between the central nervous system maturity of newborn rats and humans, noting that a human at 24 weeks gestational age (still 16 weeks preterm) is equivalent in maturity to a newborn rat pup. This in itself points up for us differences between the species. In addition, though, we need to look at differences in rat and human experience of separation. When rat pups are experimentally removed from their mothers in this kind of study, they are NOT given substitute maternal care. Separation from the mother means separation from care. When human infants are separated from their birthmothers in medical situations or in adoption and fostering, they are given substitute care. The only parallel involving substitute care for rats lies in the situation described by Graham et al, in which additional handling by human beings is beneficial for rat pups’ brain and behavioral development.
The Graham article does not allow easy generalization of these points from rat pups to human infants. To try to do this is to confound the variables of maternal-like care and of the mother herself. We can’t logically jump from the experiences of rat pups in experimental separation to those of human infants who are fostered or adopted, nannied, nursed, baby-sat, or picked up by their daddies or big brothers or sisters.
Let me point out, by the way, that not only are humans developmentally and neurologically different from rats, and that rat pups are more mature than humans at birth-- rat mothers also behave differently from human mothers. As an old-fashioned psychologist, dating back to the days when every psych student worked with pigeons or rats or both as part of their studies, I know a lot about this (including how to pick the little guys up without getting bitten).
Rat mothers have much different jobs from human mothers/caregivers. It doesn’t matter if they’re depressed or anxious, because they needn’t talk or communicate with gestures like eye movement. They don’t need to pick up a baby and help it latch on to the nipple, or to maintain their marital relationships during the trying first months of motherhood. Here’s what they do: if a baby gets out of the nest, they retrieve it and put it back in so it doesn’t get cold. They lick the babies all over, thus stimulating urination and defecation, and you guessed it, they lick that up too. If a baby is very sick or dies, they eat it (and of course they started their maternal care by eating off the amniotic sacs and placenta, occasionally eating a baby while they were at it). When the babies start to grow fur, the mother gets a lot less interested. (By the way, the pups at birth are just pink bare skin, so transparent that you can actually see the milk in their stomachs after they nurse-- a sight that would probably be comforting to worried nursing mothers if humans had it too!)
Studying other species can give us some good ideas about how humans might develop, but until we test the ideas in humans themselves, we can’t safely conclude that the facts about one species tell us the facts about another. Does anyone remember Thalidomide, the tranquilizer that caused severe birth defects in Europe? It was thoroughly tested with animal models. It wasn’t teratogenic in those cases. But it surely was in humans. It was a bad idea to generalize too quickly across species about that drug, and that should tell us something about generalizing across species about social and emotional development.
The Graham et al paper reports, among many other things, that undesirable brain changes occur in young rats who are separated from their mothers, even though in one situation somewhat older pups could see the mothers through a transparent burrow. The marginalperspectives group suggest that this means that similar effects occur in human babies who are separated from their mothers, as, for example, in a hospital nursery, or of course in adoption.
The Graham group notes the large developmental differences between the central nervous system maturity of newborn rats and humans, noting that a human at 24 weeks gestational age (still 16 weeks preterm) is equivalent in maturity to a newborn rat pup. This in itself points up for us differences between the species. In addition, though, we need to look at differences in rat and human experience of separation. When rat pups are experimentally removed from their mothers in this kind of study, they are NOT given substitute maternal care. Separation from the mother means separation from care. When human infants are separated from their birthmothers in medical situations or in adoption and fostering, they are given substitute care. The only parallel involving substitute care for rats lies in the situation described by Graham et al, in which additional handling by human beings is beneficial for rat pups’ brain and behavioral development.
The Graham article does not allow easy generalization of these points from rat pups to human infants. To try to do this is to confound the variables of maternal-like care and of the mother herself. We can’t logically jump from the experiences of rat pups in experimental separation to those of human infants who are fostered or adopted, nannied, nursed, baby-sat, or picked up by their daddies or big brothers or sisters.
Let me point out, by the way, that not only are humans developmentally and neurologically different from rats, and that rat pups are more mature than humans at birth-- rat mothers also behave differently from human mothers. As an old-fashioned psychologist, dating back to the days when every psych student worked with pigeons or rats or both as part of their studies, I know a lot about this (including how to pick the little guys up without getting bitten).
Rat mothers have much different jobs from human mothers/caregivers. It doesn’t matter if they’re depressed or anxious, because they needn’t talk or communicate with gestures like eye movement. They don’t need to pick up a baby and help it latch on to the nipple, or to maintain their marital relationships during the trying first months of motherhood. Here’s what they do: if a baby gets out of the nest, they retrieve it and put it back in so it doesn’t get cold. They lick the babies all over, thus stimulating urination and defecation, and you guessed it, they lick that up too. If a baby is very sick or dies, they eat it (and of course they started their maternal care by eating off the amniotic sacs and placenta, occasionally eating a baby while they were at it). When the babies start to grow fur, the mother gets a lot less interested. (By the way, the pups at birth are just pink bare skin, so transparent that you can actually see the milk in their stomachs after they nurse-- a sight that would probably be comforting to worried nursing mothers if humans had it too!)
Studying other species can give us some good ideas about how humans might develop, but until we test the ideas in humans themselves, we can’t safely conclude that the facts about one species tell us the facts about another. Does anyone remember Thalidomide, the tranquilizer that caused severe birth defects in Europe? It was thoroughly tested with animal models. It wasn’t teratogenic in those cases. But it surely was in humans. It was a bad idea to generalize too quickly across species about that drug, and that should tell us something about generalizing across species about social and emotional development.
Do Animals Have Babysitters? An Important Aspect of Human Child Care
A recent book by the anthropologist Sarah Hrdy (“Mothers and Others: The Evolutionary Origins of Mutual Understanding”, Harvard University Press, 2009), describes some important differences between the great apes and human beings in hunter-gatherer groups. Apes and humans are noticeably different in their reproductive and infant-care behaviors, and Hrdy proposes that these differences are important for our understanding of human development. Among the great apes, females give birth only every 6 to 8 years. Hunter-gatherer women usually give birth every 3 or 4 years. Yet apes mature more quickly than humans, so the ape big brother or big sister is almost an adult by the time the next infant is born, while the human child is still very much in need of adult care when the next baby comes. The mother ape invests many years’ work in bringing one offspring near to maturity before taking on the next, but the human may have several children who simultaneously require a great deal of adult nurturance and supervision. Human children particularly need the kind of personal attention that fosters language development, or they will not grow up to be functioning members of their group.
How is this apparently paradoxical situation to be understood? Sarah Hrdy suggests that one very big difference between humans and great apes lies in the number of caregivers each infant has. Ape mothers do not like other apes to so much as touch their young infants. Although other apes play with and help the juvenile apes as they get older, the mother is pretty much on her own in early infant care. Not so with human beings, however. Human mothers allow and even encourage familiar adults to be in contact with their babies. Those adults can and do provide important aspects of care-- not just feeding and cleaning, but the social interactions, gestures, and sounds that contribute to development of communication and speech. In the evolutionary development of our species, Hrdy believes, there were advantages for babies who were good at engaging with adults and getting cared for. Skill at understanding what other people felt and intended would also be advantageous. Those babies would be more likely to survive, grow to maturity, and reproduce, passing on their genetic material and the behavior traits associated with it. Those useful traits would be more important for humans, who might depend on many adults for care, than for apes who initially were cared for by their mothers alone.
It’s interesting to speculate on whether attachment-- the strong preference of humans for staying near familiar people at times of threat-- would also have emerged from having a mother who would tolerate other caregivers for her baby. A toddler who was very engaging might be likely to approach and communicate with strangers, who might then take the baby away-- unless internal attachment processes made it less likely that the child would approach completely unfamiliar people. A baby who was jealously guarded by its mother, as occurs among the great apes, would not need attachment processes to keep it near the family; the mother would do this job. Although attachment is often thought of as the “invisible playpen” that would have kept our ancestors’ babies out of danger from fire and wild animals, we see another important dimension when we realize that the babies’ ability to get attention from adults might have put them in danger of kidnapping or death from enemy humans. If they could crawl or toddle, but did not have the emotional attachment that would warn them away from strangers, they might not live to grow up; when they became mobile, the emergence of attachment and stranger anxiety would keep them safer.
Although social interaction, communication, and forms of attachment occur in species other than our own, it’s not necessarily correct to assume that any of those behaviors is the same in every species. I recently received a journal reviewer’s comment that referred to attachment as “transspecific” (occurring across species). Although that is true, it’s less correct to assume that attachment is “panspecific” (occurring in all species in the same way). Some behaviors of human and animal babies seem so parallel that we tend to think of them as identical when they may not be so. But no human baby exists without adult caregivers, and few animal babies can. That means that in order to understand parallels between humans and animals, we may need to look at adult caregiving behavior as well as at the babies’ own actions. Humans use babysitters, animals don’t--- and many other differences may follow from those facts.
How is this apparently paradoxical situation to be understood? Sarah Hrdy suggests that one very big difference between humans and great apes lies in the number of caregivers each infant has. Ape mothers do not like other apes to so much as touch their young infants. Although other apes play with and help the juvenile apes as they get older, the mother is pretty much on her own in early infant care. Not so with human beings, however. Human mothers allow and even encourage familiar adults to be in contact with their babies. Those adults can and do provide important aspects of care-- not just feeding and cleaning, but the social interactions, gestures, and sounds that contribute to development of communication and speech. In the evolutionary development of our species, Hrdy believes, there were advantages for babies who were good at engaging with adults and getting cared for. Skill at understanding what other people felt and intended would also be advantageous. Those babies would be more likely to survive, grow to maturity, and reproduce, passing on their genetic material and the behavior traits associated with it. Those useful traits would be more important for humans, who might depend on many adults for care, than for apes who initially were cared for by their mothers alone.
It’s interesting to speculate on whether attachment-- the strong preference of humans for staying near familiar people at times of threat-- would also have emerged from having a mother who would tolerate other caregivers for her baby. A toddler who was very engaging might be likely to approach and communicate with strangers, who might then take the baby away-- unless internal attachment processes made it less likely that the child would approach completely unfamiliar people. A baby who was jealously guarded by its mother, as occurs among the great apes, would not need attachment processes to keep it near the family; the mother would do this job. Although attachment is often thought of as the “invisible playpen” that would have kept our ancestors’ babies out of danger from fire and wild animals, we see another important dimension when we realize that the babies’ ability to get attention from adults might have put them in danger of kidnapping or death from enemy humans. If they could crawl or toddle, but did not have the emotional attachment that would warn them away from strangers, they might not live to grow up; when they became mobile, the emergence of attachment and stranger anxiety would keep them safer.
Although social interaction, communication, and forms of attachment occur in species other than our own, it’s not necessarily correct to assume that any of those behaviors is the same in every species. I recently received a journal reviewer’s comment that referred to attachment as “transspecific” (occurring across species). Although that is true, it’s less correct to assume that attachment is “panspecific” (occurring in all species in the same way). Some behaviors of human and animal babies seem so parallel that we tend to think of them as identical when they may not be so. But no human baby exists without adult caregivers, and few animal babies can. That means that in order to understand parallels between humans and animals, we may need to look at adult caregiving behavior as well as at the babies’ own actions. Humans use babysitters, animals don’t--- and many other differences may follow from those facts.
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