The needs of children

IN ONE OF THE LAST interviews of his life, British psychoanalyst John Bowlby was asked, "What do children need to grow up to be happy, secure?" He replied: "They need a mother figure who will care for them. She doesn't have to be on duty day in, day out.... The more help she gets, the better. But [mothers] should be responsible for their own children. They should be the principal caregiver. And if they are not the principal caregiver, then they must try and find someone else who will be. Someone who plays that major role through the child's childhood."(1)

Bowlby's distinguished work on the attachment needs of children underscores the critical importance of an infant's relationship with a caregiver who is responsive, nurturing, and more or less continually present. It also demonstrates that the nature of this early bond plays a crucial role throughout the child's life. When children suffer disruptions in these attachments, they become more vulnerable as adults to depression, anxiety, and relationship problems.(2)

WIRED FOR ATTACHMENT

Why are children born with such intense attachment needs? A large piece of the answer comes from evolutionary biology. In prehistoric times, infants who were kept in close proximity to their parents survived the ubiquitous threats of predation. The infant's nervous system, as we know it, is equipped with an automatic "alarm" to signal anxiety when separation from the primary caregiver is threatened. This inherited alarm is the outcome of the successful biological strategy of "attaching" infants to their primary caregivers.

The attachment behaviors of infants evolved by way of natural selection. Natural selection is the process through which individuals whose behaviors help them adapt to their environment leave more progeny and transmit their genetic traits. In other words, if an individual's genes predispose him toward behaviors that increase his chances of surviving and reproducing, those genes will gain representation in the next generation. Over the course of many generations, those genes will spread throughout the population.

Attachment is, in short, a residue of our psychobiological legacy. In our evolutionary past, attachment behaviors ensured optimal protection against environmental threats to survival, raising the probability that securely attached individuals would live long enough to reproduce. In this way, the predisposition to nurture children spread throughout the human gene pool. The anxiety and grief elicited by premature separation are characteristic not only of human infants but of all primate offspring. Attachment was selected by primates because it enhanced the likelihood of survival.

We humans are descended from 100,000 generations of huntergatherers, 500 generations of farmers, and 10 generations of industrial-age people. Even though the 10,000-year agricultural era seems like a long time, it is scarcely an instant in the unfolding of human evolution. The way we are today, physically and psychologically, is the result of forces of natural selection operative during the hunting and gathering phase of human existence. Every new baby comes into the world prepared for a Stone Age lifestyle.

To comprehend the needs our children bring with them into the world, we must look to contemporary hunting and gathering cultures. One such culture is the Kung San of northwest Botswana, whose mode of existence characterizes 98 to 99 percent of human and protohuman history.(3) The !Kung infant's needs are indulged without reservation. Nursing, which occurs on a demand basis, is more or less continual; and the child is carried in a sling at the mother's side. This ongoing contact between mother and infant ensures a fine-grained responsiveness to the child's needs. The mother learns to anticipate her child's waking, hunger, and defecation. During the first year, "the average amount of time elapsed...between the onset of an infant's fretting and the mother's nurturant response is about six seconds."(4)

In the sling, the child is stimulated by the mother's social world in all its variety. The child's awareness is animated by the mother's breast, her work, and older children--who frequently initiate brief, amiable interactions.

The dependency needs of the !Kung baby are gratified absolutely. The frequent nursing spells are "managed entirely by the infant," who determines the "time, setting, choice of breast, and length" of each one.(5) These sessions are punctuated with convivial and mutually enjoyable interactions ranging from touching to facial gesturing.

The !Kung mother has a kind of empathic resonance with her infant's needs and feeling states. When the child is not carried in the sling, "the mother may be amusing her--bouncing, singing, or talking." !Kung fathers are described as "indulgent, affectionate, and devoted."(6)

Separation from the mother and exploration of the surrounding environment are initiated by the child while the mother offers herself as a secure base to return to at any time. And indeed, the infant expects his mother to be there if he needs her. The mother's reliability and receptivity promote trust and emotional stability in her child. Indications are that attachment needs go far beyond physical survival--they underlie the sophisticated social skills needed for group life.

The infant also controls the process of relinquishing this intense attachment to the mother. Gradually, as the child develops and internalizes the empathic functions of the mother, he becomes more psychologically independent of her. At his own pace, the young child spends more and more time with other children. All the while, his need for security is honored through the mother's reliable, responsive presence.

According to anthropologist Marjorie Shostak, "!Kung parents are aware that the tremendous outpouring of love given each child in the first few years of life produces children who are typically secure and capable of handling... emotional stress. The extremely close relationship with their mothers seems to give children strength: the child has the mother's almost exclusive attention for an average of forty-four months, thirty-six of these with unlimited access to the food and comfort afforded by nursing."(7)

Comparisons of !Kung children with youngsters living in industrialized nations reveal that the !Kung are much more independent. Those under the age of five will venture farther away from their mothers, demand less nurturing, and engage in more interactions with other children. A 14-year-old !Kung boy is capable of driving a lion away from an antelope carcass with a stick and carrying the meat home to his parents. A young !Kung woman is capable of going out into the desert to birth her baby without assistance and, after cutting the cord, bringing her newborn back to the village. These people are not lacking in self-confidence or resourcefulness.(8)

Research by Mary Ainsworth confirms that the indulgence of early dependency needs leads to independence. Maternal responsiveness and close bodily contact are associated with the unfolding of self-reliance. The reduced anxiety levels that result when attachment needs are met--a phenomenon she refers to as the "secure base effect"--enable the child to explore the environment.(9)

The daily nursing and sleeping practices of the !Kung further illustrate nature's plan. There are two types of mammals: those that "nest" their young and those that remain in continuous proximity to their young. Mammals that raise their young in nests produce milk with a high protein and fat content, and feed their offspring at widely spaced intervals. Mammals that carry their young produce milk with a low protein and fat content, and feed their young more or less continuously. Humans, like all higher primates, have the milk composition and suckling characteristics of "carrier" species. !Kung mothers, in keeping with this biological reality, nurse their infants about four times an hour.(10)

In the !Kung culture, as in all nonindustrial societies, mother and infant sleep in direct physical contact. This is the pattern selected in all higher primates because it maximizes the chances of offspring surviving to maturity.

Industrial societies depart from this arrangement. Here, infants often sleep in a room apart from their mothers,(11) either alone or with siblings too young to nurture them. Some researchers view the "syndromes" of bedtime protest and nightwaking--phenomena that are almost universally exhibited by our infants and toddlers--as mere artifacts of our sleeping arrangements.(12) When mothers and infants stay together, bedtime protests do not arise and nightwaking, which does, is not a "problem."

The !Kung are like a window on our evolutionary past, through which we can see what kind of infant care nature expects from us. Significantly, their gratification of infantile dependency needs has not been surpassed by any other human population.(13)

THE VALUE OF BEING CARRIED

Is it really necessary to have such a fine-tuned responsiveness to the needs of infants? For example, do human infants "need" to be carried around so much? The best answer to this question comes from the annals of neurology and neuropsychology.

The cerebellum is a unique part of the brain. It is the only part in which the number of cells continues to increase long after birth. Optimal development of the cerebellum is stimulated by motion. Hence, being rocked or carried is not just soothing; it is essential for complete brain growth.

The cerebellum regulates the smooth coordination of muscles. It is also involved in emotional behavior. In fact, it is implicated in the modulation of pleasurable and unpleasurable states. Infants who are not rocked and cuddled are at risk for incomplete development of the brain pathways that mediate pleasure. Adults who have difficulty experiencing pleasurable states are more easily frustrated, more prone to violence, and probably more vulnerable to drug or alcohol addiction.

Neurologist Richard Restak, whose research led to many of these findings, states that "physical holding and carrying of the infant turns out to be the most important factor responsible for the infant's normal mental and social development [italics added]."(14) And, as brain researchers are demonstrating with increasing frequency, the effects of such development extend well beyond infancy. Early experience impacts in enduring ways on neural and neuroendocrine functions underlying emotional behaviors.

The first few years of life figure prominently in the development of such psychosocial traits as trust, empathy, optimism, and affection. How do children internalize these qualities? The answers are embedded in the body of knowledge known as self psychology.

THE NEED FOR SELF-ESTEEM

In the sixties and seventies, Heinz Kohut revolutionized psychoanalytic theory by challenging the classic Freudian drive model of the personality. Kohut devised a new model based on the assumption that we are relational creatures governed not by drives but by self-esteem regulation. According to this new model, the ability to regulate self-esteem derives from early relationships with mother and father. If a child's psychological needs are understood and responded to, then normal development will occur--that is, the functions of the empathic mother and father will become internalized, creating resilience to the vicissitudes of life. If, on the other hand, the child is chronically traumatized, the early troubling experiences will become internalized as expectations that will interfere with the child's capacity to form intimate relationships later in life.

In either case, internalization occurs because the parent is experienced as an extension of the infant's self, as a "selfobject." The infant, in other words, has no sense of the parent as a separate, distinct person; the primary caretaker is experienced as an integral part of a field of archaic needs. Selfobject needs include feeding, soothing, being held, being understood, being secure, being wanted, and being competent. Selfobjects are, in effect, precursory forms of not-yet-existing psychological structures.(15)

Therough consistent responsiveness, the parent affirms the self of the child as a center of initiative. The parent's responsiveness helps the infant achieve a sense of agency, a feeling that her motivations and goals are her own. The sensitive parent facilitates this experience of competence in the world by tuning in to the child and facilitating her goal-directed behaviors. The parent's responsiveness gives the child a feeling of optimism about her ability to communicate and satisfy her needs, a feeling of trust in her caregiver, and a feeling of confidence in her capacity for assertion and exploration.

The parent's responses to the child's archaic needs, according to self psychology, have a critical effect on the child's psychological development. When the parent repeatedly fails to respond to a particular selfobject demand, the child will feel anger, shame, guilt, or fear. The prematurely separated child, for example, may begin to deny his relational needs and internalize mistrust and anger instead of affection and empathy. To preserve contact with the selfobject, however, he will begin to screen out the distress signals and avoid feeling the shame, guilt, or anxiety.

How does the brain respond to chronic selfobject failures? With a diminished capacity to organize and understand what is happening. In effect, the brain fails to organize perceptions accurately and to communicate reliably. As a result, several practitioners, including myself, believe that emotional trauma alone can induce "functional brain damage."(16)

According to psychiatrist Harry Stack Sullivan, the brain makes a trade-off--giving up attention to attachment needs in return for lessened anxiety.(17) Indeed, for a child whose attachment needs are chronically frustrated, anxiety and depression will diminish when attention to the needs diminishes. The cost, however, is exorbitant: loss of the ability to trust, loss of the capacity for intimacy, and a diminished ability to empathize with oneself and others.

If a child is chronically traumatized, his selfobject needs will remain relatively archaic. These primitive needs will then be transferred onto his later relationships. The vulnerable, fragile self will in all likelihood place inappropriate demands on friends or a spouse.

Under optimal conditions, the child's needs are tamed and become integrated into the maturing personality. Productive interactions between self and selfobject ultimately foster the growth of healthy self-esteem and the capacity to perceive and adapt to new situations because the child gradually internalizes the functions of the parents, which become transformed into a healthy sense of self and flexible expectations of self and others.

Selfobject needs, like attachment needs, require for their fulfillment a fine-grained responsiveness from primary caretakers. From the point of view of attachment theory, this type of responsiveness ensures continued proximity and reduces the anxiety children feel in response to separation or threats of separation. From the point of view of self psychology, sensitive attunement leads to healthy self-esteem and the ability to function well in the world.

How does an infant cope with an unempathic parent? British psychoanalyst Donald Winnicott noted that infants comply and adapt. The strategy used to adapt to a parent's pathology he termed the "false self organization." If a mother, for example, is insufficiently responsive, her child is forced to tune in to her at the expense of his own aliveness. Living as a false self means not knowing who one is. The false self, tentative and insecure, is an obedient mask covering an inner core of depression and emptiness.

In contrast, the true self is spontaneous, authentic, and idiosyncratic. Only the true self can feel real and be creative. The true self evolves through a mother's responsiveness and attunement to the leading edge of her child's development.(18)

Winnicott once said, "There is no such thing as a baby." By this, he no doubt meant that the baby is an indivisible part of a larger psychobiological mother-child unit. Indeed, the child learns confidence through the mother's guiding help, trust through her reliability, and empathy through her sensitive attunement. In this way, mother is midwife to her child's discovery of his own way of being in the world.

Studies of mothers and babies clearly indicate "that the infant does not become social through learning or conditioning, or through an adaptation to reality, but that the infant is programmed to be social."(19) Bowlby viewed our predisposition for attachment as an archaic heritage, genetically encoded and designed to unfold at birth in an automatic, powerful way. Our need for this relational matrix, however, is not only biological; it is also a psychosocial precondition for becoming fully human.

RELATIONAL BY DESIGN

For a child to develop the capacity to care for herself and empathize with others, to experience herself and others as real and worthwhile, she must have an empathically responsive mother. Children who have been sensitively cared for internalize the capacity to project themselves into the life situation of others. They become able to imagine how they would feel in another's shoes. Children who lack an empathic relationship with at least one primary caretaker are at risk for a deficient sense of right and wrong.(20) Although they may not become full-blown criminals, they may become what Dr. Elliot Barker calls "partial psychopaths"--individuals who because of early failures of attachment, treat others like objects and manipulate them for personal purposes.(21)

As a clinician, I have seen significant attachment deficiencies in adults diagnosed with depression, anxiety, and narcissistic or borderline personality disorders. Sadness, helplessness, anger, and clinging dependency are as symptomatic of these conditions as they are of the behavior of children in distress because of attachment problems. Indeed, characteristic infantile responses to loss and separation are prototypical of adult responses.

Studies confirm the existence of attachment deficiencies in the backgrounds of people with agoraphobia, depression, alcoholism, antisocial personality disorder, and borderline personality disorder. Furthermore, research demonstrates that the quality of attachment in an individual's earliest relationship is strongly predictive of the individual's later behaviors. The quality of relatedness at 12 months of age is a reliable predictor of frustratability, persistence, cooperativeness, and task enthusiasm at 24 months of age;(22) social competence in preschoolers;(23) psychopathology in boys at age six,(24) and self-esteem, empathy, and classroom deportment.(25)

The social adaptation of university students living on their own for the first time is directly related to the quality of their early relationships. Those who had secure attachments during their first year of life adjust well, whereas those who had less secure attachments are at risk for low self-esteem, poor social relatedness, and emotional vulnerability to stress.(26) In other words, insecurely attached children, lacking the opportunity to internalize a benevolent selfobject, reach adulthood without an empathic buffer against the vicissitudes of life. These findings strongly suggest that the quality of the mother-infant relationship is a lifespan issue.

It is also a societal issue. Lack of a nurturant relational matrix increases the likelihood of disrupted relationships later in life, for the intimate relationships of adulthood evoke the fateful expectations internalized in earliest childhood. In the final analysis, the farther we stray from meeting children's attachment needs, the more likely we may be to produce a population skewed toward depression, anxiety, and relationship disorders.

The demands of infancy only seem unreasonable when we do not see them in the context of nature's design. Infants--whether they are born into a hunter-gatherer culture or into our modern industrial one--need a warm, nurturing, and more or less continuous relationship with their mothers. Those whose needs are gratified in a loving, psychologically responsive environment have the opportunity to internalize the empathy and affection of their parents. These children will grow up to be happy and secure.

NOTES

(1.)V. Hunter, "John Bowlby: An Interview," The Psychoanalytic Review 78, no. 2 (1991): 167.

(2.)J. Bowlby, The Making and Breaking of Affectional Bonds (London, England: Tavistock Publications, 1984), pp. 45, 81.

(3.)R.B. Lee and I. DeVore, eds., Man the Hunter (Chicago: Aldine, 1968).

(4.)M. Konner, The Tangled Wing: Biological Constraints on the Human Spirit (New York: Holt, Rinehart and Winston, 1982), ch. 13 and p. 303.

(5.)Ibid., p. 303.

(6.)M. Shostak, NISA: The Life and Words of a !Kung Woman (New York: Vintage Books, 1981), p. 45.

(7.)Ibid., p. 48.

(8.)See Note 4, p. 313.

(9.)M. D. S. Ainsworth, "Attachments across the Life Span," Bulletin of the New York Academy of Medicine 61 (1985): 792.

(10.)See Note 4, p. 308.

(11.)Here and elsewhere, I refer to the primary caretaker as the mother, with the understanding that fathers can also play this role.

(12.)See Note 4, pp. 309--310.

(13.)M. M. West and M. J. Konner, "The Role of the Father: An Anthropological Perspective," in M. E. Lamb, ed., The Role of the Father in Child Development (New York: John Wiley and Sons, 1976), p. 193.

(14.)R. Restak, The Brain (New York: Doubleday, 1979), p. 122.

(15.)H. Kohut, The Restoration of the Self (New York: International Universities Press, 1977).

(16.)M. F. Basch, Doing Psychotherapy (New York: Basic Books, 1980), p. 20; and B. van der Kolk, "Post-Traumatic Stress Disorder," Harvard Medical School Mental Health Letter 1, no. 5 (1984): 4--6.

(17.)H. S. Sullivan, The Interpersonal Theory of Psychiatry (New York: W. W. Norton, 1953).

(18.)D. Winnicott, "Ego Distortion in Terms of True and False Self" (1960), in D. Winnicott, The Maturational Processes and the Facilitating Environment: Studies in the Theory of Emotional Development (London, England: The Hogarth Press and the Institute of Pychoanalysis, 1965).

(19.)S. Mitchell, Relational Concepts in Psychoanalysis (Cambridge, MA: Harvard University Press, 1988), p. 24.

(20.)K. Magid and C. McKelvey, High Risk (New York: Bantam, 1988).

(21.)E. Barker, MD, in Empathic Parenting 11, no. 4 (Autumn 1988): 10.

(22.)M. Main, "Sicherheit und Wissen," in K. E. Grossman, ed., Entwicklung der Lernfahigkeit in der Sozialen Umwelt (Munich, Germany: Kinder Verlag, 1977); and L. Matas et al., "Continuity of Adaptation in the Second Year: The Relationship between Quality of Attachment and Later Competence," Child Development 49 (1978): 547--556.

(23.)A. F. Lieberman, "Preschoolers' Competence with a Peer: Relations with Attachment and Peer Experience," Child Development 48 (1977): 1277--1287; M. A. Easterbrook and M. E. Lamb, "The Relationship between Quality of Infant-Mother Attachment and Infant Competence in Initial Encounters with Peers," Child Development 50 (1979): 380--387; and E. Waters et al., "Attachment, Positive Affect and Competence in the Peer Group: Two Studies of Construct Validation," Child Development 51 (1980): 208--216.

(24.)D. Stern, The Interpersonal World of the Infant (New York: Basic Books, 1985), p. 187.

(25.)Ibid.

(26.)H. I. Kaplan and B. J. Sadock, Synopsis of Psychiatry (Philadelphia: Williams and Wilkins, 1991), p. 108.

For more information on attachment parenting, see the following articles in past issues of Mothering: "The Critical Importance of Mothering," no. 47; "The Importance of the In-Arms Phase," no. 50; "Childhood and Ritual in Bali" and "Normal Neurotics Like Us," no. 61; and "Who's in Control?" no. 73.

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