The myth of normal, p.14
The Myth of Normal, page 14
Pondering this information sent me back to my mother’s diary. Nothing to do with war or Nazis this time—just a woman of twenty-four trying to love her baby within the constraints of cultural norms, including medical advice that ran counter to her parenting instincts. According to accepted practice of the time, the doctor prescribed that I be fed on a strict schedule. Being a physician’s dutiful daughter, my mom feared to disobey. Still in the hospital, with me a couple of weeks old, my mother writes:
Now you are really giving me what for. For a change, you howled from half past midnight until 2:00 A.M. when the nurse came in and suggested I suckle you at least a little, so you finally slept. My greedy son, I definitely must warn you that we cannot make this a habit. In fact, soon we’ll have to give up the 7:00 A.M. feeding. Believe me, my precious little son, my heart is rent in two as I hear you whimper your bitter complaints, but you are old enough of a fellow by now to realize that, pardon me, nighttime is for sleeping, not for eating.
There was my mom, following doctor’s orders and so, for ninety long minutes, enduring my desperate vocalizations and her own emotional distress, coping as best she could via the dry wit that would be her signature until her death in 2001.
Revisiting this material now, versed in the neurobiology of parent-child attachment, I see a young woman in whose brain the instinctual CARE system described by Panksepp is at odds with the cultural mindset. Succumbing to the unnatural dictates of medical authority, her mother’s heart aches.
And what of the infant in these now yellowed pages? What does he experience? Some three decades later, in 1975, Jean Liedloff warned her readers in The Continuum Concept about “the current fashion to let the baby cry until its heart is broken and it gives up, goes numb, and becomes a ‘good baby.’” And indeed, I became a very good baby. Even as a four- or five-year-old I would lie in my bed before dawn, stoically enduring the stabbing pain of a middle-ear infection, whimpering quietly to myself so as not to disturb my sleeping parents.
Though it no doubt runs diametrically counter to most parents’ intentions, a child whose cries are not responded to, who is not fed, not held close to a parent’s warm body when in distress, learns a clear if wordless lesson: that his needs will not be met, that he must constantly strive to find rest and peace, that he is not lovable as he is. By taxing my brain’s PANIC/GRIEF system, my poor mother’s non-responsiveness also helped wire my brain for those chronic tendencies of mine that express the overactivation of that system: anxiety and depression. “When our brains are undercared for,” writes Darcia Narvaez, “they become more stress-reactive and subject to dominance by our survival systems—fear, panic, rage.” Don’t I know it.
“The question,” Gordon Neufeld said to me, “becomes, What are the irreducible needs of the child?” By “irreducible” he means a need that the child cannot do without if she is to reach her Nature-endowed potential; one that, if not met, will incur negative consequences. As he told the European Parliament, “It is true maturation, not schooling, learning or genetics that is key to becoming fully human and humane.” We cannot teach maturity; nor can we cajole, entice, or coerce a child into it. What is required of us is to ensure the developmental conditions that satisfy the child’s nonnegotiable needs; from there, Nature more or less takes care of the rest. There are four irreducible needs for human maturation, in Dr. Neufeld’s astute formulation. These four needs are both simultaneous and build one on the other, in pyramidal fashion. I invite you, the reader, to consider how well our culture satisfies them for our children, or fails to.[*]
1. The attachment relationship: children’s deep sense of contact and connection with those responsible for them.
Observe how my own neural expectation for such contact, instilled in infant me by eons of evolution, was frustrated within the first days and weeks of my life. Keep in mind that what matters is the child’s sense of attachment; it has nothing to do with whether or how much the parents love the child or feel connected to her. Many young and well-meaning parents, myself and my wife included, have made the error of gauging the relationship by how they are feeling, how much attachment they are experiencing. Yet what makes the biggest difference is not what is sent so much as what is received by the child. It takes relatively mature and/or well-supported parents to be able to tune into the child’s emotional needs as distinct from their own.
2. A sense of attachment security that allows the child to rest from the work of earning his right to be who he is and as he is.
Once foundational security is established, the young one can relax comfortably. This is the condition Dr. Neufeld identifies as “rest,” one in which the child does not have to strive for attachment with the parent nor work to maintain the right equilibrium of contact. This state is the soil in which the roots of healthy development can firmly take hold. From there we can reliably expect emotional, social, and intellectual growth to follow.
Despite my mother’s love for me, I was essentially put to work from the moment I was born—no rest for the innocent. Contrary to her anxious half-joke that, before I was three weeks of age, I ought to be “old enough of a fellow by now to realize that . . . nighttime is for sleeping, not for eating,” I was years away from being physiologically able to “realize” anything—much less that my needs were up for barter.
3. Permission to feel one’s emotions, especially grief, anger, sadness, and pain—in other words, the safety to remain vulnerable.
“Since emotion is the engine of maturation, when children lose their tender feelings, they become stuck in their immaturity,” Neufeld explains. For the emotions to remain accessible, the environment must allow them to be safely experienced—meaning the child’s expression of feelings cannot threaten the attachment relationship with the parents.
For reasons we have already begun to glimpse, many children in our culture are shut off from their authentic feelings.[*] And how would they not be, given the conformist expectations of society, amplified through parenting advice liberally dispensed by behaviorist “experts”? Consider the prescription of psychologist and mega-bestselling author Jordan Peterson: “An angry child should sit by himself until he calms down. Then he should be allowed to return to normal life. That means the child wins—instead of his anger. The rule is ‘Come be with us as soon as you can behave properly.’ This is a very good deal for child, parent and society.”[10]
Is it, though? Notice the assumption: anger in a young child is neither normal nor acceptable. Contra her inborn need for unconditional warmth, any positive response to the child is to be distinctly conditional. She is not to be accepted for who she is, only for how she is. Here’s the problem: even if the parent wins the behavior-modification game, the child loses. We have instilled in her the anxiety of being rejected if her emotional self were to surface. This exacts a heavy toll on both physical and mental health. While the expression of an emotion can be inhibited, or even its conscious experience blocked, the emotion itself is energy that cannot be obliterated. By banishing feelings from awareness, we merely send them underground, a locked cellar of emotions that will continue to haunt many lives.
I know for myself that the early hardening of my heart to my own pain shielded me not only from grief but also from joy. Rediscovering joy—or better yet, discovering it newly—remains part of my life’s journey to this day.
4. The experience of free play in order to mature.
Rather than a frivolous, childish activity to “grow out of,” play is a requirement for the healthy development of all mammalian species. Jaak Panksepp coined a name for the neural system governing true recreation, to go with PANIC/GRIEF and CARE. “The PLAY system,” he wrote, “may be especially important in the epigenetic development and maturation of the neocortex.” A lack of secure infant bonding and a lack of early play, he asserted, can be contributory factors in the genesis of conditions such as ADHD, as well as of adult irritability and aggression.[11] Authentic play—agenda-free, interactive, engaging joy and imagination, and, rarer than ever these days, person-to-person—is easily compromised when children are under conditions of stress or deprivation. (Nor is it compatible with being distracted and mesmerized by digital technology, a vexing issue we will revisit in chapter 13.)
If the overall goal of development is to foster in children a felt sense of being alive in a nurturing world—“how it feels to be human,” in Raffi’s wonderful phrase—then we have utterly lost the plot. It takes a culture in good running order, with societal structures that take their cue from Nature’s dictates, to support parents in ensuring the child’s irreducible needs. How and why so many of our children’s needs are going unmet will be the subject of our next chapters.
Chapter 10
Trouble at the Threshold: Before We Come into the World
My Tristram’s misfortunes began nine months before he ever came into the world.
—Walter Shandy, in The Life and Opinions of Tristram Shandy, Gentleman (1759), by Laurence Sterne
Dear little son/daughter, I feel you kicking inside me. I am terribly sad and discouraged and frightened now but I love you and will protect and nourish you with all the love in the world. This adrenaline you feel is not meant for you nor flows because of you. One day I’ll tell you about your gestation and I hope that if you carry with you ambivalent or painful memories, when I tell you the truth you will be able to heal. Dear little child: your Daddy will love you, too, when he gets to know you. He can’t feel you moving inside him as I do inside me.
So wrote my wife when we were expecting our unexpected third child. It was a difficult period for us, and especially for Rae. She was stressed, unhappy, and anxious; what should have been a period of joy and mutual preparation felt like a lonely slog. I, the Daddy in the story, was in my mid-forties, outwardly a successful physician and columnist. Yet who was I within myself and within the four-walled world of our home? A depressed, anxious, psychologically underdeveloped man, years away from addressing his core wounds; a man whose family bore the burden of his dysfunctional, erratic, and emotionally hostile behaviors; a man whose workaholism took the form at home of physical and emotional absence, even negligence; a man addicted to his own internal drama, not knowing how to be responsible for his actions and mind states or their impacts on his family, least of all his child-to-be.
Gestation Self-Portrait, Rae Maté, 1988, mixed media. Rae created this painting during the first half of the pregnancy depicted in this chapter.
Rae’s diarized correspondence with the baby growing inside her showed how much she intuitively understood, long before I did, about human development and about the dynamics that so often distort its natural course in this culture. In our chapter on trauma, I pointed out that prior to becoming creators of our environment, we are its creations. Before we develop the capacity to take part in constructing our universe, the world fashions us. By what medium? At the beginning, through the bodies and minds and circumstances of our parents, who themselves are molded by the state of the world around them and by the histories of preceding generations. In this way, our own bodyminds are products of the larger culture from the start, a life course that begins with conception.
Before proceeding further, a necessary caution. Many readers will feel some alarm at the phrase “begins with conception,” which has been heavily politicized in the ongoing cultural/religious debate over abortion rights. It is easy to see how a science-based recognition of the needs of the unborn can become political fodder for an anti-choice/“pro-life” view. All the more reason that I be extremely clear about what I do and don’t mean. As a physician, I am well aware of the suffering imposed when women’s right to choose is denied. There is no argument in this chapter, or anywhere in this book, for denying the right of autonomy when it comes to making such life decisions.
It has never been more vital that we speak about human development and its womb-to-tomb trajectory. It is also a highly delicate matter. For one thing, looking squarely at anything involving harm to children is difficult, often painful. Worse, when these topics arise, mothers and fathers might get the impression they are being judged, castigated, or impugned, which is doubly unfortunate: first, because in this culture too many parents—and I speak as one myself, three times over—already shoulder crippling guilt, already feel defensive; second, because blame is neither helpful nor remotely justified. We are all doing our best. My contention—really, the thrust of this whole book—is that our best deserves to be better, and can be if we incorporate the growing body of knowledge now available to us. I aim only to shed light on dynamics our entire culture needs to understand. This and the next chapter begin at our very beginnings, tracing our culture’s failure to follow the developmental templates of gestation and birth as laid down by evolution.
The child’s “ambivalent or painful memories” that Rae foresaw in her pregnancy journal are no poetic invention. Intrauterine experiences may not be accessible to conscious recall, but they can live on as a different kind of memory: emotional and neurological imprints embedded in the cells and nervous system of the human organism. The psychiatrist Thomas Verny calls this process “bodywide memory.” A pioneer in recognizing the long-term influence of the intrauterine period on emotional health, Verny published his groundbreaking The Secret Life of the Unborn Child in 1982. In his sequel to that book, he wrote, “Before the event of birth, before we have even had a glimmer of sight or sound in the womb, we record the experience and history of our lives in our cells.”[1]
In recent decades, a deluge of fresh information has underscored the crucial importance of women’s physical environment, health, and emotional balance during pregnancy to the optimal development of the infant. Meanwhile, our era has also brought substantial increases in the number of children, adolescents, and young people facing depression and anxiety and other mental health challenges. Genetics on their own cannot begin to account for such abrupt shifts. If we are serious about reversing trends like these, it is critical that we connect the dots by looking to the environment. “Environment does not begin at birth; environment begins as soon as you have an environment,” the neuroscientist Robert Sapolsky has said. “As soon as you’re a fetus, you are subject to whatever information is coming through Mom’s circulation, hormone levels, and nutrients.”[2]
A very early factor is the stresses pregnant women are under—emotional, economic, personal, professional, and social. As the physician and psychoanalyst Ursula Volz-Boers points out, “Intrauterine life is not a paradise as some people try to make us believe. We are the receiver of all the happiness and of all the anxieties and difficulties of our parents.”[3] But of course, even the earliest factor has its own earlier factors: namely, the intolerable pressures contemporary society places on the rearing milieu, the family, and on the developing young—and, as epigenetics teaches us, on the very activation of DNA itself. We need to consider to what extent our culture, including employment and the health care and insurance systems, supports or undermines women’s capacity to hold their unborn infants’ needs as a high social priority.
How many women are asked during prenatal checkups about their mental and emotional states, what stresses at home or on the job they may be experiencing? How many future physicians are even taught to pose such questions? How many spouses are helped to understand their responsibility to protect their expectant partners from undue stress and travail? How many businesses make provisions for their pregnant employees’ relief? That last question has an especially dismal answer: women frequently report a pregnancy-hostile work milieu, especially in lower-paid jobs. But even in supportive workplaces, women are often burdened by the pressure they have absorbed and put on themselves to perform, advance, even excel in a competence-mad society. Work rarely “stays at work.”
As Rae intuited, the baby feels the mother’s stress directly. “By listening intently to movements and heartbeats, researchers are finding that the fetuses of mothers who are stressed or depressed respond differently from those of emotionally healthy women,” the New York Times reported as far back as 2004. “After birth, studies indicate, these infants have a significantly increased risk of developing learning and behavioral problems and may themselves be more vulnerable to depression or anxiety as they age.” Essential neurotransmitters such as serotonin and dopamine that later play key roles in mood regulation, impulse control, attention, motivation, and the modulation of aggression—and are implicated in the very learning, behavioral, and mood difficulties the article mentions—are affected by prenatal stress on the mother. Babies of moms stressed in pregnancy have lower levels of these brain chemicals and higher levels of the stress hormone cortisol. Not surprisingly, the same study showed that these newborns also had less developed learning skills, they were less responsive to social stimulation, and they were less able to calm themselves when agitated.[4]
Beyond brain substance levels, there is evidence suggesting that maternal mind states during pregnancy and postpartum shape the very structure of the infant’s developing brain. In one study, nursing professor Dr. Nicole Letourneau, Canada research chair in parent-infant mental health at the University of Calgary, and her colleagues found that the child’s gray matter, the cerebral cortex, was thinner on MRI scanning of the brains of preschool children whose mothers had suffered depression in the middle three months of pregnancy. As they point out, their brain-scan findings may presage later problems such as depression, anxiety, impaired impulse control, and attention difficulties in the child.[5] Postpartum depression had similar effects, indicating that there are certain critical periods in development, both before birth and after, during which the young human is particularly vulnerable to the environment. Such findings align with those of multiple other studies, which point to maternal-stress impacts on such brain structures as, for instance, the fear- and emotion-processing amygdala[6] and on neurological conditions such as autism.[7]
