mental-health

Do Babies and Small Children Feel and Remember Psychic Pain?

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You may find this hard to believe – but up until the 1990’s infants were routinely subjected to medical procedures including surgery without the benefit of anesthesia.

Pain research’s most famous infant, Jeffrey Lawson, was born prematurely in February 1985 and underwent open heart surgery shortly thereafter. (1) What made this particular surgery noteworthy was the fact that Jeffery was awake and conscious throughout the entire procedure. The anesthesiologist had administered only Pavulon, a paralytic that has no effect on pain. Only after Jeffrey died 5 weeks later did his mother, Jill, learn the truth about his surgery. Jeffrey had been too young to tolerate anesthesia, the anesthesiologist said, and anyway, “It had never been demonstrated to her that premature babies feel pain.” 1 This was not the case of a rogue anesthesiologist; textbooks at the time taught that the surgery Jeffrey underwent “could be safely accomplished with only oxygen and a paralytic”. (1)

Not until a research report from Anand and Hickey, “Pain and Its Effects in the Human Neonate and Fetus,” was published in the New England Journal of Medicine in 1987 did this practice finally begin to end.

Similar to the denial of infant physiological pain has been the denial of psychic pain, including the pain of separation from parents in infancy and childhood. Until the 1970s, infants and children who were hospitalized were actually denied visitation by their parents.

The need for parental love and care and the distress that children suffer without this, were considered unimportant in the physical recovery process for babies and children in the hospital – and the attachment needs of the young child went completely unrecognized in medical circles.

And even now, there are those who question whether trauma and/or loss occurring in the early months and years of life can be remembered. Many deny the importance of separations in the first weeks of life and some doubt whether separations or early trauma of other kinds are encoded in memory.

But this is what Susan Coates, a well known psychologist and the author of September 11: Trauma and Human Bonds (among other books) has to say:

It is now well documented that very young children show the same three basic categories of posttraumatic symptoms observed in adults: reexperiencing, numbing, and hyperarousal.(2) These three clusters of symptoms are the means by which posttraumatic disorders in adults are diagnosed. These clusters have consistently been shown to represent independent factors in the traumatic response process, and there are now over fifty published case reports documenting their presence in children under the age of four.(3)

She goes on to say:

Both Lenore Terr (1988) and TJ Gaensbauer (1995) report that children under the age of three, though unable to describe a trauma in words, enact it in play through motor behavior and somatic responses. Doing this requires a preverbal capacity to symbolically represent traumatic events in memory. Posttraumatic play in very young children is readily distinguishable from ordinary play. It is compulsively driven and it includes repetitive reenactment of the trauma. In addition, very young children show symptoms of reexperiencing the trauma that are highly reminiscent of what is seen in older children and adults: repeated nightmares, distress at exposure to reminders of the trauma, and episodes with features of flashbacks or dissociation.

What Coates is saying, in other words, is that babies, toddlers and young children who experience prolonged separations, or traumatic events, including medical procedures and hospital stays are affected by these events.

And if you have not read or heard about Susan Coates’ case of “Betsy”, you need to. This case involves a ten month old girl who was stabbed repeatedly by a psychotic man while sitting in her stroller in a park. Thanks to the fast action of her babysitter, a police officer and a surgical team, she survived. Her parents noticed no post traumatic symptoms, did not think she remembered the event, did not think it necessary to tell her about what happened and, in fact, were counseled not to do so.

One day, when she was three and playing in the kitchen sink with her father, she leaned against the counter and said “my line hurts”. When her father said, “Oh, you mean your special boo boo?” she said, “No” and made slashing motions with her hand. She said, “It was a very bad day”.

Clearly she had a memory of the traumatic event. And it was a somatic memory, that is, it was felt in her body and expressed through her physical action of replaying the stabbing motions of the man who attacked her. Her parents realized that she needed help to understand what had happened – and they took her to see Susan Coates for psychotherapy. Together, Betsy, her parents and Dr. Coates reconstructed what had happened and what it meant to Betsy.

So, not only do infants experience pain—and severe stress—when they are subjected to prolonged separation from parents or when they experience physical trauma such as catheterizations, lumbar punctures or other medical procedures without the benefit of anesthesia, but they are ALSO capable of forming symbolic representations and somatic – or bodily – memories of these experiences. In addition, we now know that their capacities for other kinds of memory are far more sophisticated than was thought even thirty years ago. And it is also true that these capacities include the rudiments of an episodic memory system even before the onset of language.

These two factors—the experience of pain and its memory—create necessary and sufficient conditions for traumatization and the development of PTSD – whether around trauma – or loss – in infants and children.

So, why is this important for parents to know?

It is important to recognize that early experiences of pain and separation may be important to your child and how she sees herself and the world. It is part of her life story and part of what has shaped her. And here we are not talking about separations of a few hours or a day, we are talking about long separations of weeks and months.

If a child has suffered an early and prolonged separation or a difficult medical experience, parents may be tempted to discount the possibility that this affected them or that they have any memory of what happened.

It is painful for parents to think otherwise. But it is important to acknowledge that these experiences do affect small children. It is important to talk with them about what happened in an age-appropriate way, and to empathize with how hard it may have been for them – even though they were very little at the time. It is important to be open to what the child has to say about it. And it is important to not make this a one-time conversation. It is important to talk about it with them from time to time and try to help them to understand what this experience might have been like for them and what it may have meant to them.

We need to give children credit for being fully feeling individuals – from the moment they are born and throughout their development.

How To Help Children Feel Competent

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Today I am reviving and adding to an old post:

There seems to be a problem going on amongst middle and upper-middle-class parents which involves not just hovering and helicoptering but also downright coddling and intruding.

Children from 2 to 32 are being treated as incompetent people who can never do the simplest things — tasks their own parents — and certainly their grandparents did starting very early in life.

The thing is — children are more competent than we give them credit for — and they always have been.

By hovering and helicoptering we get in the way of their developing their own skills, and worse, we interfere with their ability to have experiences that teach them how to do what they need to do in life. As a result, we limit the development of their feelings of competence, confidence, and mastery.

In our parenting groups, I have observed that parents are feeling exhausted. And part of this is because they feel they have to help with everything. If a child doesn’t like what is for dinner, the parent feels like they have to provide something else. If a child wants the parent to help them with their homework each day, the parent feels they have to do this. If the child wants to look at a device during dinner, the parent feels they have to say yes to avoid a meltdown. And in the bathroom? Don’t get me started…


When a five or six or seven year old asks for help with wiping, the parent feels they have to go right in.

But the question parents must ask themselves from the time their children are two years old through adulthood is this: Am I actually helping my child become more competent and confident? Or am I expecting too little from them? Am I stepping in and doing too much for them? And if I am stepping in too often, why am I doing this?

Is it just easier to do things for our children rather than insisting they do them for themselves? Or is it too painful to watch children struggle — to watch children make mistakes and suffer the consequences — to watch children feel frustrated? Bored? Angry?

Or do we have expectations of ourselves as parents that are too high? If so, why? When did we cease to believe that experience was the best teacher? And when did we decide that we, as parents, are really the best teachers and that it is our job to help our children avoid difficult feelings such as frustration, failure, boredom, and anger?

Let’s look to the scientific literature for help.

In studies of what promotes feelings of competence amongst students, structure and support for their autonomy have been shown to be important. Students feel more competent when their teachers give them the opportunity to do work on their own, and when there are clear instructions as to what they should be doing.1

Students also feel more competent when they have the opportunity to help others, and to get support for themselves from peers.1

The attitude of the adults who are around kids is also pertinent as to what makes them feel competent. In a survey, students described teacher kindness, support for autonomy, relatedness, and non-controlling orientation as factors that contributed to their competence satisfaction. For instance, the students felt competent because their teachers had an approachable, helpful, and interactive teaching style and provided them with opportunities to interact with each other.1

Additionally, students mentioned that participation opportunities, respectful teacher-student interactions, and teachers who were responsive to their views, needs, and interests facilitated their competence satisfaction in class. This means that opportunities to give their opinions, to do hands-on work and to be met with a respectful attitude was helpful.

What’s more, students indicated that they feel more competent when teachers make expectations clear, and provide appropriate help when necessary.

Other research has looked at social and emotional competence and has found over and over again that children with better social skills and those who are able to manage their own feelings feel more competent — in addition to being more trusting, empathic and intellectually inquisitive.

So there is quite a bit of research, but often these studies are not translated into actual methods by which parents can learn how to promote competence in their children.3

So, how can parents apply the research findings to their own approach to parenting?

Well, first, we know that being attuned to our babies and children’s feelings and needs is crucial. From birth, we need to observe how they are feeling, and when they are upset, we need to be able to tell the difference between times when they need help calming down and when they are able to soothe themselves.

We must try to stay attuned to their feelings as they engage in difficult tasks (starting with tummy time and going all the way through writing high school papers) and only intervene when it is clear that they have become so frustrated that they cannot continue. We can be there and be available in case help is needed – but we should not jump in at the first sign of frustration.

Second, we must make our expectations of our children clear, but not try to control what and how they do things.

Third, being kind and respectful toward our children and their efforts to accomplish things helps them to internalize a kind and respectful attitude toward themselves.

Fourth, helping children to manage, recognize and understand their own feelings and talking with them about the feelings of others supports social and emotional competence.

Fifth, it is important to encourage independence and autonomy in our children while providing as much structure and support as we think they need.

So, for example, we can help a toddler learn how to pour her own orange juice — but we can suggest starting out doing this activity while standing on a stool and doing it in the sink. As she becomes more capable of pouring without spilling we can ask her if she has noticed how much better she’s gotten and invite her to pour her juice at the table.

Or, when a high schooler is having difficulty with writing a paper, rather than jumping in to read it over or to aid with the writing, we can start by helping them calm down and talk about what is making it so hard for them – before we take ANY action whatsoever.

In summary, helping a child or teen with a task by telling them how to do it or doing it for them is not actually the most effective way to help a child feel competent.

These days, we often feel we have to help our children before they may actually need it. And we may praise our children rather than pointing out the improvement the child has made and asking the child if they notice their improvement or whether they feel proud — of themselves.

In the end, we all want our children to feel competent and good about themselves. And we want them to feel this from the inside rather than waiting for praise from the adults around them or for A’s from their teachers. We want them not only to be competent, but we want them to feel competent.

References

1 Reymond, N. C., et al. (2022) Why students feel competent in the classroom: a qualitative analysis of students’ views. Frontiers in Psychology, Oct 13. https://pmc.ncbi.nlm.nih.gov/articles/PMC9612881/

2Housman, D.K. (2017) The importance of emotional competence and self-regulation from birth: a case for the evidence-based emotional cognitive social early learning approach. ICEP 11, 13. https://doi.org/10.1186/s40723-017-0038-6

https://ijccep.springeropen.com/articles/10.1186/s40723-017-0038-6

3 Miller, J. S., et al. (2018) Parenting for Competence and Parenting With Competence: Essential Connections Between Parenting and Social and Emotional Learning. School Community Journal, V. 28 (2) p. 28. https://files.eric.ed.gov/fulltext/EJ1201828.pdfMorereferences

What Now?

~ corinnemasur2331 ~ Leave a comment

As of Weds morning, there are many jubilant Americans and many devastated Americans. 

What can I say that will add anything at this point?

I myself am in a news blackout. That is what I need to do to continue to keep an even keel.

And, at this point everyone needs to find a way to keep themselves stable.

Whether you immerse yourself in the victory or you seek refuge in nature or poetry or music or Netflix or sleep. 

And we need to do this so that we can be available to those who need us – most  especially our children.

Whichever category you fit into, try to remember how you behave and how you speak about the election results in front of your children will influence and affect them.

This will be a confusing time for them.

They are hearing all sorts of things at school, from their friends, on social media and elsewhere. There is a great deal of emotion – elation, anger, sadness, dire predictions, threats, and promises – any of which may or may not be welcome.

So, if, as parents you are overjoyed at the win, if you are celebrating, remember, your kids are watching and you are sending a message about how to handle victory.

Or, if you as parents are upset, frightened, furious or disheartened, also, remember what message you are sending. 

Are your children thinking they can lord the win over their friends who wanted a different result? Are your children upset and afraid about what’s to come?

Children need to be reassured: this is what democracy looks like. There was an election, there was a winner and we must live with the results. 

Children also need to know that the adults in their lives will work to make sure there are other elections in 2 and in 4 years and we will have a choice again then.

They need to know that if we don’t like what happened this time, we can work to tip the scales back in a direction we like better in two years – and we can start to work on that as soon as we feel up to it.

AND parents need to try – no matter what – to reassure their children that they will keep them safe even if there are those who may talk about making changes to our system that we don’t agree with. 

Children need to know that in their house, values of kindness and fairness still apply. 

And if children are getting messages from other kids or teachers at school about who should have won or who did win, they need to know that you want to hear about it and talk about it with them.

However, if children observe parents doom scrolling, or panicking or feeling helpless or hopeless, they may feel that there is no one to help THEM with with their own anxieties.

So, here are some options:

– Whether you feel jubilant or hopeless, try to manage your own feelings in a way that will be tolerable to your children and teens.

– If your kids are anxious, if they are asking lots of questions or finding it hard to go to sleep at night, try to reassure them – especially your children twelve and under. Remind them that you are there for them and will work to keep them safe. Sit with them a little longer before it’s time to go to sleep. Read an extra book with them.

– Remind them that over the arc of history, there have been many heated political campaigns, many changes in government, and many scary and difficult events in this country – but that we are still here.

– Remind them that in this country there are still checks and balances and that the President does not have absolute power. Whether you want him to institute certain changes or you are afraid he will institute certain changes – it is not entirely within his power to do so. 

– Keep the news and political commentary off the screen until your younger kids go to bed

– And with your teenagers, keep the conversation open. Talk to them about how they feel, don’t hide what you feel, but also try not to  denigrate those on the other side of the political spectrum as you talk with them.

***Please comment on this post and tell us how you are feeling and WHAT you are doing – for yourself – and for your children***

In The Run-up to the Election, Who Cares About Children and Families, Anyway?

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A recent New Yorker article starts with the following:

“At the end of the summer, the U.S. Surgeon General, Vivek Murthy, issued an advisory on the mental health of the nation’s parents. Too many families, Murthy wrote, are beset by economic factors beyond their control, including the costs of health care, child care, elder care, housing, and groceries. Murthy cited alarming results from a survey by the American Psychological Association, conducted in 2023, in which forty-one per cent of parents said that “most days they are so stressed they cannot function,” forty-eight per cent said that “most days their stress is completely overwhelming,” and fifty per cent said that “when they are stressed, they can’t bring themselves to do anything.” 1

This is outrageous!

So many parents are so stressed!

We have to talk about this.

And it is also time to fully acknowledge how little support there is for families in this country.

Unlike other developed nations, we have little to no governmental support for the care of our young children. Parents are not subsidized to stay home to care for infants and young pre-school aged children – and at the very same time, the survival of most families AND the survival of our economy require both parents to work in most families. 

But, as the article says, “insufficient or erratic child care is a major disruptor of parents’ work schedules”1 and “In eleven states and the District of Columbia, child care costs at least twice as much as typical monthly rent or mortgage payments, and two-thirds of parents nationwide report spending twenty per cent or more of their take-home pay on child care. For sole parents, this share rises to thirty-five per cent.”1

The Build Back Better bill, proposed by President Biden included funding for child care and early childhood education. 

And yet, even knowing how important childcare is to family well being, the Build Back Better agenda did NOT receive widespread bipartisan support, and the provisions for daycare were completely cut from the final bill which was passed, called The Inflation Reduction Act. 2

The Democrats’ plans included universal pre-kindergarten, lower child care costs, paid family and sick leave and the enhanced child tax credit, among other provisions, but all of these were ultimately eliminated during negotiations between Democrats and Republicans. Those cuts became the ninth time in just two and a half years where proposed legislation aimed at helping women and families have been removed, according to a CNN analysis of data from the Congressional Budget Office and Congressional Research Reports.

Paid family leave alone has been trimmed down or dropped five different times since March 2020, and universal pre-kindergarten, paid family leave and an expanded child tax credit were all left out of the Inflation Reduction Act.

Now we have a presidential candidate who is introducing a six-thousand-dollar tax credit for parents of newborns, and a cap on child-care expenditures at seven per cent of a family’s income. She has also signalled her commitment to pro-family economic policy in choosing Tim Walz, the governor of Minnesota, as her running mate. As Governor, Walz has made school breakfast and lunch free in Minnesota and has made public higher education free for low-income students, he has added more than two billion dollars to Minnesota’s K-12 school budget, expanded the state’s child tax credit, and enshrined paid family and medical leave.

If instituted on a nationwide basis, these policies would do a LOT to decrease family stress – 

and yet the presidential race is still neck in neck. 

Obviously, many fathers and mothers are not putting help for families at the top of their priority list when choosing who to vote for.

It’s obviously time that we name the problem loud and clear: children and families are not considered important in our country. 

To many, “it’s the economy, stupid” which is important. 

But let’s connect the dots: the workers of today, parents, need to be less stressed to do their jobs. And the workers of tomorrow, children, need to be well cared for in order to be the healthy community members and the creative and productive workers the economy needs.

If this is the only argument that will get through to some people, let’s make it!

As Winter suggests in her New Yorker article, a coherent, constructive debate about how to help working parents—about how our politics and institutions can foster a care economy that exists, in one form or another, in virtually every other developed nation on Earth—is needed. 

Let’s start talking!

References and Citations

1 https://www.newyorker.com/news/the-lede/the-real-and-perceived-pressures-of-american-parenthood?

2 CNN

https://www.nationalaffairs.com/publications/detail/the-uncomfortable-t…

https://www.nichd.nih.gov/sites/default/files/publications/pubs/documen…

https://www.psychologytoday.com/us/blog/insight-therapy/202002/the-deal…

How to Talk With Your Children About the Upcoming Election

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This is an updated version of a post written for the election two cycles ago.

As we approach the presidential election, it’s a good time to talk to your kids about winning and losing.

The subjects of sportsmanship, humility and grace come to mind – as well as braggadocio, sore losing and bitterness.

Whatever side of the electoral battle you are on, you and your children will be having strong feelings.

So what do we say to our children? And at what age are they ready to have this conversation?

Well, really children of any age, starting around 3 know about winning and losing – and they can talk about the feelings that come when they experience each. Of course, depending on your child’s age, you will speak about this differently.

But the place to start is to remind your child – whatever age they are – that how your family feels at this moment about who you want for President is not the way that everyone feels. Some people are for one candidate and some people are for the other. This is a time to talk about values and WHY you prefer the candidate you prefer, what values and policies they represent, and why you are in favor of these.

This is the time to talk about the history of our country and what democracy is all about – and this includes the fact that in our country we allow the people (represented by the electoral college) to choose the president and that we are honor bound to stick with this decision.

HOWEVER – and this is where the more nuanced part of the discussion comes in – it is important, whatever you or your child feel, to help your child to be aware that when other people feel differently than we do, that it is important to treat them and their feelings with respect.

Good sportsmanship is something that kids who play on teams should be learning. You can provide this as an example: after a game, your team shakes hands with the other team to indicate that you both played a good game and that there are no hard feelings left over from the competition.

The losers can feel upset but still lose graciously. This is a concept that can be introduced to a 3 year old and also to a 16 year old.

And the winners can feel happy and joyous – but they can also behave graciously by telling their competitors that they played well. Children can be reminded that bragging about winning is not the way to go, even though inside it feels so good to win.

You can tell your children the story of “burying the hatchet”: when Native American tribes had disputes or wars with each other, when they were over, the two formerly opposing sides literally buried a hatchet in the ground to symbolize the end of the disagreement.

This is a way to handle winning and losing an election too. After someone has won or lost, it is time to bury the hatchet, to accept the defeat or the victory and to move back to getting along.

It is also time to continue to cling to the values you hold dear and to not give up on them.

I fervently hope that both we and our children can do this both before and after the upcoming election.

***************

Mombrain: Myth or Real?

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This is the seventh post in a series on The Transition to Motherhood.

In her book, Matrescence, Lucy Jones discusses the idea that society — and women themselves — often feel that childbirth and caring for young children diminish their memory and cognitive capacity. While they are pregnant and after they give birth, women often complain of not being able to remember anything, being scatterbrained, or feeling stupid.

But when looking at the research, Jones found the opposite!

In fact, it seems that having a baby concentrates the mind. Brain structure and the neurochemistry of the brain actually change during and after pregnancy in order to aid the mother to tune into her baby and her baby’s needs. It may be that some of the old things the mother used to think about are less the focus of her attention after her baby arrives and she may feel less capable of concentrating on them — but this is far different from being “stupid.”

In fact, Bridget Callahan, a researcher at UCLA, found evidence of enhanced learning, memory, and cognitive capacity after childbirth (Callahan, et al, 2022).

Of course, this makes sense, because new mothers need to expand their ability to tune in to their babies, to learn what helps and doesn’t help their babies to feel comfortable, and to learn how to solve the many problems of everyday childcare.

In fact, in reviewing the literature, researchers Erika Barba-Müller et al found that there are structural and functional changes in the woman’s brain both during pregnancy and following delivery which stimulate her to progress from being an individual with self directed needs to being responsible for her baby. These changes are highly adaptive and aid in the woman’s transition to motherhood.

Similarly, in a review of the literature, Winnie Orchard found that there is evidence that the brains of pregnant women become more flexible, efficient, and responsive.

Minor difficulties in word finding and short-term memory often make women feel less competent during pregnancy and early motherhood — but this is not all that is going on.

Referring to Orchard again, Lucy Jones says that the lifetime impact of motherhood on cognition and the brain may be positive and that the cognitive load of adapting and adjusting to one or more growing children may help the brain to be resilient.

Think about it: So many people have started doing the daily word puzzles put out by the New York Times — as well as doing all sorts of gaming apps on their phones — in order to preserve and enhance their cognition. But these do not provide even a portion of the challenge that comes up in a day for the parent of a newborn or child of any age!

For a first-time mother — and her partner — the day they come home from the hospital is often a terrifying day. Suddenly, they realize that it is up to them to figure out how to care for their new baby and to keep them alive. Soon it is clear that caring for a newborn requires a completely new set of skills. And there is a great deal of trial and error. Every day new problems need to be solved. So much has to be learned — not just about babies in general — but about this particular baby, her sensitivities, and her preferences. And then, just as the parents are getting the hang of it, the baby starts a new sleep pattern, develops new feeding preferences, or enters a new developmental stage. And learning how to deal with these things requires a great deal more problem-solving.

So as for “Mom Brain” — yes, there is such a thing, but it is not what we often think it is. The Mom Brain is a more flexible, more competent, more resilient brain than the non-mom brain.

References

Barba-Müller, et al (2019). Brain plasticity in pregnancy and the postpartum period: links to maternal caregiving and mental health. Arch Womens Ment Health. 2019; 22(2): 289–299. Published online 2018 Jul 14. doi: 10.1007/s00737-018-0889-z

Callaghan, B. et al., (2022) “Evidence for cognitive plasticity during pregnancy via enhanced learning and memory”, Memory 30(5) , p. 519-536.

Jones, Lucy (2023). Matrescence.

Orchard, E. R., et al., (2022) “The maternal brain is more flexible and responsive at rest: Effective connectivity of the parental caregiving network in postpartum mothers”, bioRxiv

The Transition to Motherhood: Pregnancy

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Part 5 in a series

In her book, Matresence, Lucy Jones says that pregnancy is a metamorphosis. Like a caterpillar that becomes a butterfly, the woman’s previous identity must melt away in order for her new identity and concept of self to emerge.

And during her own first pregnancy, Jones found this process very disturbing. She says, unlike other stages of life for which there are parties and ceremonies to mark the transition of one stage of life to another, during pregnancy, for which there are no ceremonies in our culture which celebrate the mother, the woman can feel profoundly awkward and alone.

Jones talks about how, during adolescence, she felt similarly awkward. She felt like she didn’t know what was going to happen next or how to be; she felt unsettled by the changes in her body.

But, she says, she had friends going through the same thing and films and articles and music which addressed the strangeness and alienation of adolescence, so she didn’t feel completely alone.

But as she went through her pregnancy, she did not feel accompanied. Part of this may have been because she, herself, did not understand what was happening to her mind, her body, or her self — and therefore she could not really talk about it with others.

She says that missing from pregnancy books or health apps was information about how pregnancy affects a woman’s mind – and her actual brain. She quotes Rosemary Balsam from the Western New England Psychoanalytic Society as calling this the “vanished pregnant body.”

She suggests that the very idea of the pregnant woman, of being two people in one, may make other people uncomfortable.

For example, there’s the the story of the runner, Allyson Felix. Felix was an Olympic medalist and many time US National Champion when she became pregnant. One of her sponsors, Nike, cut her pay by 70% and refused to offer her reasonable pay protection during her postpartum period. Felix reports being told “runners should just run” – in other words, women runners should not be pregnant.

Clearly having a premier spokesperson be pregnant was uncomfortable for Nike. And Jones talks about how it was uncomfortable for her – as it is for so many women — and not just because of the bodily changes, but also because of the emotional disequilibrium she felt and because of the changes in the way she perceived others as seeing her.

Experiencing this was hard for Jones because she felt external pressure to “pretend that pregnancy was a less dramatic and drastic event” than what she felt it to be.

And it is a dramatic and drastic event. For all women.

Thank goodness for Lucy Jones for saying so and letting us all heave a sigh of relief. We didn’t have to say it. But she did.

Toward the end of her pregnancy, Jones describes bowing out of work and not feeling guilty. She realized this was not typical of her — but she felt that she wanted to be at home and she didn’t mind being alone. She says that she felt “calm and placid, pleasantly vague, like nothing could touch me”.

Later she found out that this is normal — that there are physiological changes that accompany each of the many stages of pregnancy and that at the end of pregnancy, the reactivity to stress hormones is dampened. No wonder she didn’t feel the normal pressure to work and perform and please her boss. And luckily for her, she had the ability to step away.

The biology and neurobiological literature supports Jones. When she reports that she felt that her brain was changing during her pregnancies, she was right. In one study by Niu et all (2024), ten pregnant women were followed over the course of their pregnancies. Changes in brain structure were charted. Reductions in gray matter volume were found over the course of pregnancy. In other words — the pregnant woman’s brain actually shrinks! Their conclusion? There are profound neurobiological changes during pregnancy.

Moreover, in a review of the literature, Esel (2010) found evidence that the brains of pregnant women and women with children are very different from the brains of women who have not had children who are within the same age range. Moreover, Esel found ample evidence of neurobiological and hormonal influences on women and their feelings and behavior. She says that maternal behavior develops over the course of a woman’s life, including during pregnancy. This happens through the development of special neural networks, which are cooperatively developed by genetic, environmental, and hormonal factors.

In fact, the biology is fascinating. Esel points out the importance of hormonal influences in preparing women for motherhood. She says that estrogen, prolactin, and oxytocin stimulate maternal behavior after birth — and that the stimulation of the vagina during birth initiates the release of oxytocin, so important for the initiation of maternal behavior as well as milk production. She also discusses the finding that women are prepared to become mothers from their own birth. She says that early exposure to estrogen during the perinatal period in their own early lives may be responsible for women’s greater interest in and facility with social relationships over that of men. She suggests that this capacity primes women to be interested in and to relate to their infants once they become mothers. Then, during pregnancy the capacity for relating to their own infants is further primed by the high levels of progesterone and estrogen which are secreted. Furthermore, she says that the hormonal exposure of the brain during pregnancy plays an important role in the development of maternal neural networks and systems.

In the same vein Esel says that in humans, the ability to establish social relationships is inversely related to levels of fetal testosterone both in females and males — so in other words, men, from birth, are less primed to establish social relationships.

No wonder women feel different when they are pregnant — and no wonder they feel a shift in both body and identity. The hormonal influences on their brains, their bodies, their feelings and their behavior are powerful.

I look forward to reading the rest of Jones’s book to find out more about the research on the physiological and psychological changes that come about during pregnancy. I know too little about this.

In fact, most of us know too little about this.

Scientists are looking at aspects of the woman’s experience during pregnancy in a way that they might not have considered doing years ago, even though we have needed this information for a long time. But perhaps, as Jones suggests, science waited until there were enough women in the field to make this a priority.

References

Esel, Ertugrul (2010). Neurobiology of Motherhood. Turkish Journal of Psychiatry. https://www.turkpsikiyatri.com/Data/UnpublishedArticles/3uydyp.pdf

Jones, Lucy. Matrescence.

Yanbin Niu, Benjamin N. Conrad, M. Catalina Camacho, Sanjana Ravi, Hannah A. Piersiak, Lauren G. Bailes, Whitney Barnett, Mary Kate Manhard, David A. Cole, Ellen Wright Clayton, Sarah S. Osmundson, Seth A. Smith, Autumn Kujawa, Kathryn L. Humphreys (2024). Neurobiological Changes Across Pregnancy: A Longitudinal Investigation, bioRxiv, The Preprint Server for Biology doi: https://doi.org/10.1101/2024.03.08.584178

A Deeper Dive into the Transition to Motherhood

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More on matrescence – part 4 in a series

Posted July 20, 2024

Let’s take a deeper dive into the transition to motherhood in this, the fourth post in a series on this subject.

In the Introduction to her beautiful book, Matrescence, Lucy Jones says, “Pregnancy, then birth, and then – big time – early motherhood, simply did not match up with the cultural, social, and philosophical narratives I had grown up with…I started to realize that that my mind had been colonized by inadequate ideas about womanhood, about motherhood, about value, even love… A sense that I had been fundamentally misinformed about the female body and maternal experience set in fast” (p. 9, 10).

She describes how, during her pregnancy she noticed changes in herself which she had no language to describe – but she noticed that her “consciousness felt different: restructured or rewired” (p. 10).

She says, “I thought the baby would grow inside my body, …that I would still be the same person. But that didn’t seem to be the case” (p. 10).

I think that many if not most women feel all of these things. But do they have the language to speak about them? Or do they feel permitted to speak about them?

I suspect not.

Jones talks about how ill prepared she was for motherhood – how she had never changed a diaper and knew nothing about what it took to raise and take care of another human.

And I think many women feel this way – especially with their first babies.

Jones speaks about her guilt if she tried to do anything just for herself during those first months of motherhood.

She also writes about the idea that women are supposed to have a built in maternal instinct and how this works against the acknowledgement that motherhood absolutely requires the acquisition of knowledge and skills about babies, children and mothering.

And in saying this, I think Jones puts her finger squarely on the shame and embarrassment many mothers feel when they don’t know what the right thing is to do for their baby – whether it is something as simple as whether to put them down for a nap or something as complex and important as when to call the pediatrician.

As she says, “this is a set up in which mothers (are) destined to fail” (p. 11).

She says, “I thought early motherhood would be gentle, beatific, pacific, tranquil, bathed in a soft light. But actually it was hard core, edgy, gnarly” (p. 14).

Finally, we have someone who tells the truth about motherhood.

We have needed a Lucy Jones for a long time.

Women feel that they are not allowed to talk about the utter fatigue, boredom, tedium, panic and downright hardship of childcare. Yes, the difficulty of juggling work and child care is talked about. And the under valuation of parenting work is mentioned now and then. But as a society? We do not have much of a discussion around many of these issues – and we certainly have not made changing any of them a priority – in our own minds, with our partners and friends, or at the ballot box.

There is still pressure to put on a good face as a mother, to treat the work we do as joyous and to present that point of view to anyone other than our closest and most trusted friends and fellow parents.

Jones calls this “cultural apathy”. And she says that many women feel that they themselves are to blame for the extent of their troubles as new mothers. However, the fact is that a majority of women feel anxious after having a baby, at least 45% report feeling low, and at least 35% describe themselves as depressed. One in five mothers do not tell anyone about their feelings and over half report not feeling supported by their families. Almost half say they feel like they have to handle everything alone.

But there is hope. Jones writes about a burgeoning field of neurobiology that is looking at the changes in the brains of pregnant women and those who care for young infants. And she quotes Alexandra Sacks, a psychiatrist interested in this subject, as saying that simply by talking about the difficulties inherent in transitioning to motherhood, many women will feel relief.

And this is why, Jones says, she wrote her book: as an invitation to start talking about the process of becoming and being a mother.

And this is why I am writing this series.

Stay tuned for more.

References

Jones, Lucy. Matrescence

Matresence: The Transition to Motherhood – Isolation and Identity Shift

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A while back I wrote a post on matrescense, or the transition to motherhood, which seems to have struck a chord. This post is the second in a series on this subject.

To give some background, matrescence is a terms that was coined in the 1970’s by medical anthropologist, Dana Rafael, in her book, Being Female: Reproduction, Power and Change. More recently, the term was brought back to our attnetion by Aurelie Athan, a reproductive psychologist at Columbia University.

Athan notes that Rafael “pointed out that in many cultures, the birth of a new baby is announced by saying, “a woman has given birth.” Athan’s point is that the focus is on the mother and what she has done. And that emphasis is important. The mother is given credit for what she has accomplished. This is symbolic of the meaning the culture gives to the event and how it is handled. In cultures other than our own, mothers are often more supported after the birth of a baby, and more taken care of.

For example, in South Korea, it is common for mothers to go to a retreat for the first 21 days after they give birth. There, fresh meals are delivered three times a day, they can receive massages and facials and attend childcare classes, and there are nurses available to watch over the baby if the mother needs a rest.

There is a special soup to drink, traditional in South Korea during the postpartum period, lactation consultants and exercise routines to help with recovery, and body realignment to help new mothers get back in touch with their bodies.

In South Korea, eight out of ten mothers go to such a spa after giving birth.

This is the kind of thing that mothers in the United States can only dream about.

Here, mothers are often isolated in their own apartments or homes after their babies are born. During their leave from work, they often struggle with feelings of loneliness and anxiety. And this is especially true for first time moms who are not entirely sure what they are doing.

For example, a New York Times article profiled Alicia Robbins. When she had her first two children, she, like almost every woman who has birthed a child before her in this country, felt overwhelmed upon leaving the hospital. Never mind that she herself is an obstetrician and gynecologist. She said, having a child “was way harder than I expected. I kept wondering if it was OK that breastfeeding was so difficult or that I felt anxious. I kept asking myself, ‘Is this really my new normal?’”

Her mother came to help her, “but she kind of froze,” Dr. Robbins said. “I love her, God bless her, but we had fights over things like whether you need to sterilize the breast pump for three hours.”

In this country, as Aurelie Athan says, we talk about the baby, not the mother. We pay attention to the infant, give gifts to the infant, visit the infant….and we don’t talk so much about what the mother has accomplished and what we can do for her.

But the process of becoming a mother is something that we, in our culture, need to pay more attention to. As Daniel Stern said in his two books, The Motherhood Constellation and Becoming a Mother, giving birth to a new identity may be as hard, or even harder than the act of giving birth to the actual baby.

Becoming a mother changes who a woman feels herself to be. It expands her identity — but, as with many changes, this expansion can be fraught with uncertainty and anxiety. Who am I now? Do I know how to be a mother? Am I doing the right thing? What kind of mother do I want to be? Can I ever get back to doing the things I used to like to do? And if I do, will I be neglecting my baby? Can I still work? How much should I work? Can I still be good at my job?

The questions are endless.

Additionally, becoming a mother changes a woman’s identity as a partner. And this is not always easy. Sometimes a woman wonders if she still has room in her emotional repertoire for her partner. Sometimes the partner is jealous of the time a woman spends with her baby. Sometimes a woman feels she can only share her body with one person at a time and she feels resentful of other demands being made on her or torn about who that person should be — the baby or the partner? Often, a mother and her partner differ on how they each feel caring for the child should be handled. Conflicts come up over sleep training or how much of a schedule the baby really needs. And the energy for talking through these conflicts can be in short supply. Women often feel they carry more of the mental load for making doctor’s appointments, reading up on child development, and thinking about what the baby needs.

This identity shift is especially difficult, as a new mother needs her partner for support, and any resentment, difference of opinion, or outright conflict can get in the way of feeling supported.

The identity shift a woman faces after giving birth is hard. Like shedding a skin that no longer fits, the woman must say goodbye to aspects of herself and ways of being and doing that were part of her previous self, and she must grow into her new role as she works out what that will be.

Just knowing that all women experience this, that having a hard time with this shift is normal, and that it can be named and learned about — and even, in some cases, talked about with other mothers — can be helpful to new mothers.

I recommend that anyone suffering from this transition reach out — whether to friends, other new mothers, more experienced mothers, or even to a therapist who can discuss these issues openly.

After my last post, one such mother reached out to me and said that she felt less alone just knowing that what she was feeling was not unique to her.

****************************

For more good discussion of this subject, see the references section below and watch this blog for part 3 of this series.

To find a therapist, visit the Psychology Today Therapy Directory.

References

Jones, Lucy. Matresence

Rafael, Dana. Being Female: Reproduction, Power and Change

Stern, Daniel. Becoming a Mother

Stern, Daniel, The Motherhood Constellation

Today, As We Think About the Victims of the Massive Bombing Campaign in Ukraine, a Post on War and Children

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Because of the news of a massive bombing campaign including the bombing of a Ukrainian Hospital today, I would like to post on war on children.

This is an excerpt from my book, How Children Grieve: What Adults Miss and What They Can Do to Help:

One psychiatrist said of both the children and the adults in the Ukraine, “(They) aren’t just grieving a person; (they) are grieving (their) entire existence.”[i]

And, as the United Nation International Children’s Fund (UNICEF) says:

            “In war, children suffer the most”.

As I write, children are dying and losing loved ones every single day in multiple locations around the world, including Ukraine, Gaza, Israel, Russia, Sudan, Somalia, Libya, Myanmar, Yemen, Congo and numerous other countries. These children are suffering in ways that are quite simply horrific and completely incompatible with normal development.

In fact, globally, one in four children, or over 400 million children live in a country affected by armed conflict, terrorism, or disaster.[ii] And armed conflict can last throughout a child’s entire life, such as in Liberia where civil war caused widespread trauma from 1989 to 2004.[iii]

The effects of war are innumerable. They extend far beyond the trauma that is experienced by the loss of loved ones and the witnessing and being the victim of violence. In wartime, children, teens and adults may all experience a brutal shattering of parts of their inner worlds. Their minds may become black holes of horror and despair and their mental functioning can be intruded upon and assaulted by destructive forces. [iv]

Moreover, they experience all the secondary losses of war including the loss of home and community due to fighting and bombardment. They include all the losses embedded in the experiences of evacuation and immigration including the loss of contact with friends, and the division of families. They include all the difficulties associated with adapting to one or more new living arrangements. And they include the loss of food security, the loss of the provision of proper public health measures and the loss of general health care including mental health care.

The World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) estimated that approximately 20 million children and adolescents have been displaced from their country of origin as refugees in the year 2023.[v]

And we must remember that the numbers of children living through war and experiencing displacement are even larger than this because there are many kinds of war—including not only armed conflicts between nations – but also drug wars, gang wars, and more localized street fighting caused by conditions of poverty and social inequality – and these too cause people to suffer and to flee.

In the Ukraine alone, as of March 2022, half of all Ukrainian refugees were children.[vi] And this number does not even include all of the children who have been kidnapped and forced to adapt to life in Russia.  Again, this is a LOT of children who have lost their homes, friends, neighborhoods, schools and so much more.

The past two decades have marked increasing interest in the psychological impact of war on children. Many researchers have studied this subject, it is well documented that exposure to adverse childhood events (including violence and war trauma) leads to a higher-than-average incidence of acute stress disorder, posttraumatic stress disorder (PTSD) and physiological and mental illness).

The most important thing we know about the effect of war on children is that even above and beyond the exposure to risk and violence, the most traumatizing event for children is the threat of separation from one or both parents or actual separation from them. Given the intense attachment of children to their parents, this is the worst consequence of war for children and leads to the most suffering. [vii]

We also know that the most common mental health effects of exposure to war for children are elevated symptoms traumatic stress, depressive disorders, anxiety disorders and post-traumatic stress disorder (PTSD).

There is so much more to say about the effect of war on children. See this site for more in the coming weeks.

[i] Fleming, LaKeisha, How the War in the Ukraine is Affecting the Mental Health of Survivors.

https://www.verywellmind.com/ukrainian-mental-health-during-the-war-5225389

[ii] Gudrun Østby, Siri Aas Rustad, and Andreas Forø Tollefsen, “Children Affected by Armed Conflict, 1990–2019,” Conflict Trends 6.

[iii] Betancourt. T. S., et al., “The Intergenerational Impact of War on Mental Health and Psychosocial Wellbeing: Lessons from the Longitudinal Study of War-Affected Youth in Sierra Leone,” Conflict and Health 14, no. 62 (2020), https://doi.org/10.1186/s13031-020-00308-7.

[iv] Roth, Merav, Ten simple guidelines on initial therapeutic intervention with acute trauma following October 7, 2023. In Psychoanalysis in a Holy Land, Abramovitch, Cusin, Leo, Roth, Alaltiello and Volkan. Pgs. 135 – 162. Frenis Zero Press: Italy.

[v][v]

[vi] United Nations Children’s Fund (UNICEF). Two Million

Refugee Children Flee War in Ukraine in Search of Safety

Across Borders. UNICEF. Available from: https://www.unicef.

org/press‐releases/two‐million-refugee-children-flee‐war‐ukraine‐

search‐safety‐across‐borders.

[vii] Masten AS, Best KM, Garmezy N (1990). Resilience and development: Contributions from the study of children who overcome adversity. Dev Psychopathol 2: 425–444.