In an American hospital in Mississippi in 2009, a judge signed an order removing a newborn baby girl named Ruby from her mother with no explanation. The baby was put into foster care with an American couple who practiced law before this very judge.
The mother, Cirila Baltazar Cruz[1], an Indigenous Chatino woman from a remote mountain village in the state of Oaxaca, Mexico, had walked to the United States out of economic necessity. With the help of the Southern Poverty Law Center (SPLC) she filed suit against the hospital for having violated her civil right to family unity. She was reunited with her baby after one year.
In 2014, the SPLC was preparing the case to go to court and asked me to evaluate the psychological impact on Cirila of the initial traumatic separation from her infant as well as the complexity of their reunion one year later and to explain to the court why it mattered.
I learned that the day Cirila was denied access to her baby, she was told to leave the hospital and spend the night in the Salvation Army homeless shelter next door and that if she complied with these instructions, she would see her baby in the morning.
Cirila spent a cold and terrified night at the shelter. When she arrived at the hospital the next morning, her baby was not there. Hospital staff would not talk to her. They gave her a phone number to call. Cirila described it this way: “No one answered that phone. They treated me like I was a crazy person, like I couldn’t think or talk. They said I would get my baby back if I went to that place, that shelter. But they lied to me.”
—
In my evaluation, the most telling measure I gave Cirila was the Adult Attachment Projective. The AAP measures adult attachment status at the representational level. It also provides information about defensive processes that can be used to either integrate or segregate attachment distress. In my report, I described the neuropsychological results (that Cirila was intact neurologically) as well as the results of the depression, anxiety and trauma measures (she endorsed significant symptoms of all three).
The lawyers at the SPLC understood this and felt the court would as well. Then the lawyers read this excerpt from my AAP findings to me over the phone:
While [Cirila] is categorized as being unresolved in regard to attachment on the AAP, it is important to highlight a less studied aspect of attachment theory because her protocol indicates both high levels of traumatization AND a capacity for adaptively integrating attachment distress.
and said:
“Could you explain what things like attachment, attachment distress and defensive processes mean in layman’s terms. You know, just a couple of sentences in a footnote.”
And that is where infant mental health consulting is at its most powerful, being able (in perhaps more than “a couple of sentences” but less than a textbook) to articulate these complex, critically important truths about babies’ and their caregivers and make a difference.
—-
During the evaluation, Cirila and I probably spent about 7 hours together doing formal evaluations and another seven informally, just moving around the hotel and at meals. From observing Ruby (5 at the time) I learned that she is shy, curious, bright eyed and easily used her mother as a secure base from which to explore new things.
I wanted to connect with Cirila before I left to acknowledge her grace and courage while revisiting these traumatic events. We tried talking directly in Spanish a little, but were mostly going through our Chatino interpreter, when Cirila said, “But doctor, what I really want to know is how to feel less dead inside.”
Instantly, the burden of the trauma she carries, and the hope of her resilient mothering lodged in the pit of stomach. My eyes filled while my brain formed a treatment plan:
You need to see an infant mental health clinician probably twice a week to process the trauma. Work on practicing mind/body techniques to re-regulate when that trauma gets triggered. Maybe do a group. A medication consult could be useful….
In as long as it took those thoughts to form, the impossibility of this kind of treatment in an isolated village on the Sierra Sur of Oaxaca became crystal clear.
So, I talked about breathing. How breath is something that is always available to us, and that taking some time every day to breath slowly, on purpose could help. We practiced breathing together for a bit. In for 3, hold for 3, out for 3.
I talked about breathing in her courage and her mother love and breathing out the sadness. Breathing in Ruby’s beautiful, smart, resilient self and breathing out the fury. Breathing in what feels good in whatever right now she finds herself and breathing out what hurts.
She looked at me and said directly in Spanish, “Eso sí puedo”. That I can do.
[1] In October of 2015, five months after the case was won, Dr. Boyatt received permission from Cirila Baltazar Cruz and the SPLC lawyers to write and speak about this case.
Authors
Boyatt, Jessica, Psy.D.
Cambridge, MA, USA
jboyatt@gmail.com
