Dave: The birth of the baby represents a quantum jump in intimacy and the complexity of living. There is a deep mutuality in the relationship between a parent and an infant. A baby is a salve for the mother’s deepest wounds, for example, her sense of loneliness and meaninglessness. But as the baby grows, and the need for mother declines, the pain returns, and the small garden of paradise becomes the world-as-before.

When the mother’s “I” is not secure, it puts pressure on the baby, who by simply “being” provides a feeling of being healed, a sense of wholeness and adequacy, a decrease in pain. When the imagesmother is anxious, the baby’s upset demands she care for him, and when she is caring for him, her pain is better. This dynamic is present in virtually all mother-child connections and manifests itself in myriad ways. It is not inherently pathological, it just is. It becomes pathologic when it can’t be outgrown. If the mother has been wounded in the past or present in a historically notable or symbolic way, it may contribute to pathology in the child.

This does not signify a moral problem. It is not about being good or bad. However, it may look like a moral problem, because of the confusion created by parental guilt and disappointment in self or spouse. It becomes a psychological problem when the baby grows and the mother’s anxiety goes up, she unconsciously demands the baby remain a baby. It is not an intentional problem, it is a problem that is the result of emotional hunger, pain and a search for more health.

The situation is more likely to develop when the father is not emotionally engaged with his spouse or with the baby. When the father is an emotional presence in the family, when he loves the mother, if the baby is cared for and loved by the father, the mother is not so desperate for the baby to remain a baby. However, in our way of thinking, the child experiences the father’s lack of involvement and the mother’s resultant dependency as a corruption of the family function, and loses faith in the family’s ability to help him grow up. This type of relationship pattern results in what I characterize as “defiance” (which can take the form of depression, ADHD, anorexia or somatization)” as a way to preserve the “I.” The child grows up and the child’s growing threatens the mother’s emotional security.

Case Illustration

Brian is twelve, a spectacular basketball player and a popular seventh grader. He is the middle of three children and is viewed as having attention deficit disorder because of minor acts of defiance at home and school combined with anxiety symptoms. The pediatrician prescribed Ritalin, but it made his anxiety worse and interfered with his sleep. After the medication was stopped, the sleep problem persisted. He became afraid of being anxious. A psychiatrist suggested Paxil, but the family refused, fearing it, too, might make him worse. At that point the pediatrician referred Brian and his family to me for therapy.

Unknown-2Father, a hard-headed successful general surgeon made the phone call. I insisted on the whole family attending, but doctor/father, was against “counseling” for unclear reasons. He said the family could come but he wouldn’t. I told him I wouldn’t start without him. He was too important. My fantasy was that like many successful men he feared therapy because it would expose him to uncertainty and behind that his unacknowledged hunger for intimacy.When the situation intensified, father called back and grudgingly agreed to come in. At the first session, I interviewed them about the family in the present and the symbolic past. On the surface they were a healthy, attractive and satisfied family. Brian was clearly the family star except for his tendency toward “mouthiness” and his anxiety, an incongruous blend.

In the first interview, the following crucial dynamics came to light. When Brian was born, His mother’s brother was ill with leukemia. When Brian was four months old, Mother went to live with her mother to help her care for her brother. Her brother died when Brian was ten months old. Mother had breast-fed Brian during this period. She admitted baby Brian “saved her life,” held her together emotionally, while she was caring for her dying brother. Breast-feeding calmed her and restored order to her world, which was disorganized by her isolation and the haunting presence of death. During that period Father was in the early years of practice and because of his own emotional underside was unable to offer solace. He seemed to have little capacity for emotional warmth. This is likely related to why he was reluctant to bring the family.

During the first interview, Mother relived the pain of the past with her brother and son, yet she was radiant and relieved as she spoke of it. My impression was that reliving those sad, but sweetly intimate moments was deeply comforting to her.

At this point in the family life she was a newly certified teacher who was just beginning to work after 17 years of mothering. She was anxious about leaving the home to re-enter the outside world. Her anxiety reactivated the old relationship program between herself and Brian. Father was a nice person, but emotionally impaired, he could not appreciate her distress and tended to dismiss her. His non-subjective nature added to the wife’s anxiety and thus to Brian’s. Father was a non-subjective physical presence, but he was too realistic.

This is a description of a normal family. I am giving a sense of covert distress in a normal family and its contribution to a young man’s symptoms of distress. Hopefully, you can see how the images-6baby was a healing presence in the mother’s life. Then later, his attention deficit disorder can be characterized as attentiveness to the family’s emotional field which made it difficult to pay attention to more mundane matters like social studies. Likewise, when mother was disturbed, the family anxiety would go up, Brian’s anxiety would increase. Her caring for him, made her feel better and thus he felt better. In the meantime, father’s ambivalence about himself, his self-loathing, masked by professional competence was reactivated.

This illustration gives a picture of the underlying dynamics of defiance. In this case, defiance was manifested in Brian’s “mouthiness”. The vignette illustrates how Brian was programmed by his infant experience to respond to his mother’s emotional pain. His symptoms restore the mother and restore the bond between them. The therapeutic process is helpful by identifying the relational pattern and giving the process value. Father did become a patient, he learned how to use his relationship to me to question himself. He even became curious about himself and about the realm of human experience. He discovered a previously unknown part of himself. Father commented that he was amused by these changes in himself. Brian’s symptoms faded out.

 

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