Introduction
Each year the Australian Association for Infant Mental Health (South Australian Branch), in partnership with Healthy Development Adelaide (an initiative of the University of Adelaide which plays a key role in linking research, service delivery and policy development in South Australia concerning the physical, emotional and social needs of infants, children and adolescents), hosts a public event during Infant Mental Health Awareness Week to promote the understanding of infant mental health. This year’s theme was “Bonding before Birth”.
The following hybrid, de-identified vignettes, based on clinical work, were presented in this context. They speak to some of the challenges encountered in supporting early relational health from the very beginning of life.
One
A personal reflection:
There’s barely a dry eye in the room. We, a sizable cohort of professionals, have just watched a two-minute video of an infant just born, wet and messy. He looks intently, hungry for his mother, his seeking primary and naked. He finds her face, and then he finds her eyes. The mother takes him in, with the warmth of her skin, the tone of her voice, and the softness of her face. The music is evocative. My tears come, quick and unbidden. What is it? The music, the primal longing, the exquisite intimacy, my heart’s recognition of my beginnings, as an infant, as mother? And perhaps a knowing that we cannot fly solo.
There are times I find it excruciating to be with infants – skin too thin, heads too wobbly, nerves too tender, cheeks too soft, smell too animal. So much vulnerability, dependence, voicelessness, and so many hazards. Sometimes it’s difficult to counter the ordinary blindness of my adult mind and stay open, knowing that every infant is in there, aware and feeling, fully alive, a sponge from the earliest beginning.
So easily do infants slip from our collective sight.
Two
The infant was named Lila. She was delicate and beautiful, like a perfect black-haired doll. Her daddy smiled at her and cradled her close. Lila was mostly quiet, she slept and suckled and didn’t cause a fuss. At first, she was planned and wanted, but as she grew, things changed. Lila failed to thrive in the womb of her mother’s mind. She couldn’t be thought about, except as an intrusion, a moving cancer, foreign and unlovable. When Lila kicked, her mother punched at her belly.
It was as if the hapless infant, growing inside, had broken a seal, and a mess of ambivalence, of feelings and memories, known and unknown, poured into the pregnancy. Lila’s parents, Maly and Sann, had left Cambodia, barely one generation on from the horror of genocide. They sought prosperity and a new life, and with the best of intentions, fled from their history, leaving their first-born child behind, in the care of Maly’s grandmother.
By the time she came for treatment, Maly was depressed and consumed with guilt. She idealized her first pregnancy and hated this one. Though soon she confided that following her first baby’s birth, the child she now longed for, Maly had planned to kill both her infant and herself. Maly’s grandmother stepped in, as she had stepped in when Maly’s mother fled in the wake of violence. Maly’s mother never returned.
Maly had tried to help herself, she read books on self-development, and she attempted to meditate, to calm her feelings, to cleanse her mind.
With her pregnancy advancing, she sought outside help. In therapy, Marly recognized, back inside her own tender beginnings, the impact of grief, abandonment, and trauma. Yet Lila remained in the shadows. It was her first child who occupied Maly’s inner world; she poured her efforts into retrieving the son she’d abandoned.
When Lila was born, Maly tried to love her. She knew her baby needed her. She smiled woodenly and offered her breast, then passed her to Sann for care. They travelled to Cambodia and claimed Lila’s brother, their small family reunited at last. Marly thought it best if they divided the parenting, one child each.
And what of Lila? Her calm demeanour and her seeming compliance were puzzling. She was strangely at ease. Had she learned already not to cause a fuss, had Sann’s attentions largely shielded her? Lila could not help but feel her mother, the messengers of her body, the vibration of her cells, the conflicted soup in which she grew.
A crisis came when Sann wasn’t there. Lila wouldn’t stop crying and Marly struck her. A notification followed. Then, with a coordinated effort, workers got together; those who knew Marly and Lila already, child protection, and a Cambodian support worker joined the care team. With steady support now in place, Marly joined her community. Cocooned by cultural familiarity and soothing relationships, Marly slowly claimed Lila, her second-born child.
Three
Sarah hovers, and for the umpteenth time, feels reassured. Holding her breath, she checks Jamie; the minuscule movement of his nostrils, the rise and fall of his chest, the flicker of his eyelids, the hue of his skin. She won’t be reassured for long. From the outside, her moves barely register, but behind her smile, she remains on standby, a heartbeat from panic. Sarah never lets go.
Not once, but many times, Sarah suffered loss. A series of miscarriages, for which no clear cause was found, each one more anguished than the last. Such a private grief. Yet Sarah was determined, and with growing hope, she carried a daughter, well into the last trimester. Inexplicably, Sarah’s baby died.
The baby’s father grieved in his own way and tried to understand. He offered gruff sympathy, but not enough. “It’s not your body that fails”, Sarah said. “You don’t get it, you don’t bleed”. He retreated into work and stayed long hours, swallowed by a culture of manly silence.
Later, and pregnant with Jamie, Sarah lived in turmoil, veering wildly between extremes. As the weeks advanced the anxiety turned crippling and Sarah couldn’t go on at home. She was admitted to the hospital. Another death was out of the question.
Jamie was born by caesarean section, earlier in weeks than the sister before him. Pronounced well on arrival, his progress then faltered, and for many weeks, Jamie and Sarah required lots of care. Though their bond was intense, Sarah couldn’t trust herself. Upon his first proper breastfeed, Jamie choked and turned blue.
Jamie is now three and eating is a struggle. He shows signs of developmental delay and co-sleeps with his mum. In therapy, Sarah revisits her history of extreme neglect and extreme abuse. She suffers from nightmares, of babies lost and dead. Jamie’s father still hovers in the background.
Four
Jenny watches her baby for a different reason, watches and attends and responds. She can’t afford to miss a beat. She looks for signs of rejection, signs that she’s messing up. She says she can’t bear it when Grace fusses; if she cries, it’s even worse. Jenny has to fix the problem, quick quick, so that Grace doesn’t go on to develop the mental health issues that Jenny’s partner says that she, Jenny has.
Before Grace was born, Jenny fretted. She worried that she’d fall apart afterwards, as she had the first time, into a blithering mess of paralysing indecisiveness. Grace’s big sister has just turned four. Jenny feared her baby would pick her for incompetent, go on to reject her and then have to parent herself, as Jenny had been required to do.
At a young age, her struggling teenage parents left Jenny on the veranda with her bag packed. She was asked to take sides. Do you want to live with your mum or your dad? In the end, she lived with neither, and by the age of sixteen had rented a flat and was earning her keep and parenting her younger brother.
Jenny is good at delight and Grace is delightful. It’s delicious to witness the smiles and little gestures and conversation back and forth. Grace gurgles and blossoms. Jenny is learning to be with herself, to soothe her fright. And on a good day, when no one’s been sick and she’s managed to get out for a walk, Jenny glimpses that she is a good enough mum and her children are fine; she does not have to justify her every move. Jenny allows herself to say “No”, and they each survive it. Jenny has begun to imagine thriving.
Conclusion and Practice Reflective Questions
Sue Gerhardt, a psychoanalytic psychotherapist who for decades has provided psychotherapeutic help to parents and babies says that,
There is something powerful about the earliest themes of our lives ….(yet our beginnings are) what neuroscientist Doug Watt (2001) has referred to as ‘unrememberable and unforgettable’. We cannot consciously recall any of it, yet it is not forgotten because it is built into our organism and informs our expectations and behaviour. (Gerhardt, 2015, p. 30)
As clinicians working in this challenging space and with this in mind, I invite you to reflect on your responses to each of these stories.
- Where did they take you?
- How did you feel in relation to each of these parents and babies?
- Where did your sympathies lie? And,
- Were there moments where the baby slipped from your mind?
Holding your reflections in mind while drawing on chaos theory, Sue Gerhardt (2015) suggests that “small differences at the beginning of a process can lead to hugely different outcomes (p.30).” To this end, I now invite you to bridge your responses and reflections to the transformational process of connecting with the experiences of the babies and their families, that many of us meet with in our day-to-day practices:
- Was there a parent and baby/family to whom you particularly responded and how do you understand your response?
- How would you use this information in building a therapeutic connection with this particular dyad/family?
- Is this an aspect of practice that you would take to reflective supervision and how might you frame your supervision question?
In conclusion, our work in early intervention with infants and their families holds the potential for profound intergenerational change, for our clients and also ourselves.
References
Gerhardt, S. (2015). Why Love Matters: how affection shapes a baby’s brain. Routledge (2nd Edition)
Watt, D. (2001). Emotion and Consciousness: implications of affective neuroscience for extended reticular thalamic activating system theories of consciousness. www.phil.vt.edu/ASSC/watt/default html.
Authors
Heather Warne (Adelaide, Australia)
Heather Warne is a mental health occupational therapist and psychotherapist. From 2013 to 2020 she worked as an infant mental health specialist with the Infant Therapeutic Reunification Service at the Women’s and Children’s Hospital in Adelaide, South Australia. The program was a joint initiative between Health and The Department of Child Protection, providing assessment and therapeutic services for infants who had been harmed or were at risk of harm, and their parents. Heather now works in private practice. She is interested in storytelling as an agent of change and in creative and therapeutic writing for health and well-being.
