Donald Winnicott, a hugely eminent English paediatrician, psychiatrist and psychoanalyst, believed that sanity is the result of a good-enough environment at the beginning of life. John Bowlby, a pioneering English psychologist, psychotherapist and psychiatrist, famous for his work in child development and ground breaking work in attachment theory, also saw the key to psychological security as the early attachment bond.


Attachment behavior is basically behavior that has proximity to an attachment figure which has a predictable outcome and whose evolutionary function is to protect the infant from danger. Although the traditional explanation that this infantile attachment was based entirely on the provision of food, the classic experiments of Harry and Margaret Harlow in the 1970s using rhesus monkeys showed that this was not the case. The conclusion is therefore that, yes, primate babies need food, but primarily they crave warmth and comfort.


From the very beginning of life, a baby needs complete care, both physical and emotional. The handling of an infant is very important. Through adequate handling, the infant comes to accept the body as part of the self, and to feel that the self dwells in and throughout the body. The boundaries of the body provide the limiting membrane between what is “me” and what is “not-me” and this boundary is important in the attainment of integration, health and indeed sanity. The influence of other people is at its most powerful in early life. The self is viewed as developing through this intersubjective process. Early cumulative trauma can lead to mental ill health, personality disorders and psychological breakdown. Importantly, it is not necessarily just the horrors of abuse that cause lasting damage but often, the more seemingly unimportant or even unconscious ways of relating can be very damaging. For example, a lack of attuned mirroring and marking of affective states, not seeing the child as a separate and important human being, not entering into and acknowledging their world and not being affectionate and responsive enough, can leave the child with an inner life that is experienced as barren and unknoweable. These feelings of alienation and isolation can become fundamental to a sense of self that feels empty or fragmented. It can also lead to the inability to develop sustaining and nurturing relationships with others. Furthermore, the early damage caused may not be immediately known. It can often be a trigger later in life, such as leaving home, the death of a parent or having a new baby which can result in unexpected feelings of mental ill health including depression or anxiety.


A critical experiment (albeit seemingly a little unethical!) reveals just how important the mothers subtle way of relating (i.e her facial expressions) is to the baby. In the ‘still face situation’ the mother, after interacting normally with the baby, suddenly adopts a mask like still face (this particular mother only does this once and only for two minutes). Time and time again, the experiment reveals the baby attempting to move mother out of this posture (by smiling, pointing, screaming, crying) but when unsuccessful is dramatically distressed and ultimately becomes emotionally detached. The mother and baby dyad is all about timing, tracking and matching of vocal expressions, facial expressions and gaze.


When we understand clearly what this healthy attached way of relating is about we can think about what needs to be done. Mothers of securely attached children are able to negotiate with the child his/her demands for care and attention as well as his/her needs to become increasingly dependent as opposed to being either intrusive or distant or ineffectual when providing assistance and support. Constant repetition of insensitive responses or non-supportive communications may lead to insecurity. These might include: invalidation of the child’s subjective experience, threats, unproductive criticisms, intrusiveness and mind reading, double-binding, counter-stimulating comments, constant blaming, dismissive or hard-hearted responses and over-reactive responses. Basically, an inability to respect the child’s sense of initiative, rejection, neglect, inability to play together, pushing for achievement, role reversal and inconsistency can all be damaging for the child in the present and in the future. These concepts of secure and insecure attachment not only relate to what is going on in the mother-child relationship, but also (and more fundamentally) to the internal working models or representations that the child builds of this relationship.

In a nutshell, healthy infants need love, safety and protection from fear. Furthermore, as they grow, and as Bowlby tirelessly points out, we also need to start taking more seriously what children say about their own feelings and needs, their fears and their version of life as they experience it. Bernie Siegel directly correlates the amount of love kids receive to long term mental health and happiness. As he so eloquently and succinctly put it in a recent lecture I was listening to, ‘parenting is the most significant public health issue on the planet.’

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