how love shapes a baby's brain

In an important new book,¹ which it seems will revolutionise the way we think about the development of human personality and emotional life, Sue Gerhardt shows how the attachment relationship between mother and baby shapes the baby's brain and sets up its stress responses for later life

'IN essence, our early experiences form characteristic ways of relating to other people and of coping with the ebb and flow of emotions which are not only psychological predilections but also physiological patterns. They are the bones of emotional life, hidden and outside awareness – the invisible history of each individual. Like Freud, who saw himself as a kind of archaeologist of the person, I too find myself looking at people with an eye that scans for hidden structures. But unlike Freud who searched beneath the surface of the personality for the primal drives, the sexual and aggressive urges that he felt were the unseen motors of human life, I look instead for the unseen patterns of relationship that are woven into our body and brain in babyhood. These patterns orient our lives in a particular direction…There is something powerful about the earliest themes of our lives, which chaos theory may help to explain. It suggests that small differences at the beginning of a process can lead to hugely different outcomes. But this time of our lives is what neuroscientist Doug Watt has referred to as 'unrememorable and unforgettable'. We cannot consciously recall any of it, yet it is not forgotten because it is built into our organism and informs our expectations and behaviour.'

¹(from Why Love Matters – how affection shapes a baby's brain).

Sarah: How did you become interested in the development of babies' brains?

Sue: I did a Tavistock Clinic course which involved a two-year observation of a mother and baby. It seems innocuous – you go along every week and you spend an hour sitting with a mum and her baby. You don't speak much, you just observe. Then you go and write lots of notes and talk about it with other people. But just paying that much attention to what's going on for the baby opened up this whole world….just discovering that the minutiae was so loaded with meaning was absolutely fascinating.

Sarah: Were you looking for particular behaviour or expressions in the baby?

Sue: No, not really. The aim was just to observe the baby's state and how the mother responded. I visited two mothers and babies and with one of the pairs, I could feel a sort of avoidant attachment developing in the baby – the mother was depressed, didn't respond much and kept quite a distance from the baby. It was painful observing it that close up and not being able to do anything. What you're doing really is identifying with the baby which is a pretty novel experience. That just made me aware of what babyhood meant and then that whole experience and the thinking and reading around that linked up at some point later with Allan Schore's work.

Sarah: For people who are not familiar with Schore's work, could you outline the area of his research that you are particularly interested in?

Sue: Much of his work is about the effect of emotional experience on the prefrontal cortex of a baby's developing brain. Basically he's saying that positive emotional experience with a parent figure triggers off beta-endorphins and dopamine which are pleasurable energising biochemical reactions. They have a very specific action in the prefrontal cortex - the area, roughly speaking, behind our eyes - and as a result of those experiences, they facilitate connections and growth of that part of the brain. So the looks and smiles of a loving parent actually help the brain to grow. Schore suggests that these positive looks are the most vital stimulus to the growth of the social, emotionally intelligent brain. So if as babies we are cared for by a parent who loves us, this will help trigger the development of our social brain.

Sarah: And the prefrontal cortex is the part of the brain that plays a major part in managing our emotional lives?

Sue: Yes, it's the part of the brain that enables us to empathise and it also plays an important part in restraining our primitive emotional impulses.

What most people don't realise is that we are not born with the capacity to empathise – this part of the brain does not develop automatically. If a baby is neglected in its first year of life, the development of the prefrontal cortex will be greatly reduced.

One study found that murderers, for example, have smaller prefrontal cortexes, as have Romanian orphans who have had, what one imagines would be poor parenting experiences.

Sarah: Another area you talk about in your book as having great significance in the baby's developing brain is the stress response. Could you briefly explain this?

Sue: Yes. I was amazed when I started looking into this, how much evidence there is – mainly animal research – that very early experience shapes the stress response. There's more and more evidence that this is true for humans as well. We know that the stress response is set up very early on in life and if a baby's stress isn't being managed well it can get over-sensitive.

Sarah: How does this happen?

Sue: Babies rely on their carers to soothe their distress and regulate them. If a carer ignores a baby's distress for too long, his or her cortisol levels will go up and can get stuck, as it were, in the high position. This then influences how we deal with stress later in life.

Sarah: If being left to cry for long periods of time is a factor in creating high cortisol levels then we must have whole generations of people with high stress responses...

Sue: Well, stress isn't just about crying but a more complex thing of not being responded to when you need a response. But I do agree that maybe the way that people in the 1920s and 1930s left their babies to cry outside in their prams because fresh air was supposed to be good for their lungs did contribute to the stiff upper lip approach that was common in those days, or, in attachment terms, the avoidant character who has learnt to suppress reactions and feelings.

Sarah: So is there any evidence that therapy can help change established neural pathways or rebuild the brain in any way for people who have had very poor early parenting experiences?

Sue: We don't know yet if therapy has an effect on specific parts of the brain but it would be fascinating to have more research on it. I imagine that what we are doing as therapists is very slowly building up connections in the prefrontal cortex and other relevant parts of the brain, particularly when clients are emotionally aroused and we are helping them to think.

Sarah: Can you tell us about the therapy organisation you co-founded for mothers and babies?

Sue: Yes, about seven years ago, after doing the baby observation course, I decided to set up OXPIP (Oxford Parent and Infant Project), primarily to provide psychotherapy or counselling for parents with babies. My aim was to do it a non-pathologising sort of way where anybody could use it, whether middle-class, working-class, referred by somebody or self-referred. It's now absolutely flourishing – we've got a whole load of dedicated people involved: nine part-time clinicians and some trustees who have spent hours of their lives on it. We're still struggling financially – for the last three years we've had a community fund grant which we've just heard is not going to be renewed. So as far as funding is concerned it's difficult to know where to turn, but the service itself is really working well.

Sarah: So are most people referred by their health visitors who notice problems between new mothers and their babies?

Sue: Yes, or people are self-referred. What we're doing with people is therapy but I think parent-infant therapy is pretty different from normal one-to-one therapy. It's not such a tight frame and you have to be much more flexible. The way I understand it now is that these parents who are having problems with early parenting have difficulty regulating their own states, their own emotions, probably because of their own early experiences. They then find it very difficult to regulate their baby.

Our aim is to help the baby but we have to get the parent into a better state first so they can approach things from a different angle. Very often we spend a lot of time focusing on the mother and her state of mind and her history before we can get to the baby because she can't really think about the baby until she is relatively OK. Sometimes we also bring fathers into it and sometimes if we can help the couple to get on better they can regulate each other better. But ideally we're working on the relationship so we'd use techniques that you wouldn't use in ordinary therapy such as an observational approach: for example, we might sit and look at the baby together. Or we might video them and then play it back and talk about what the baby's expressions and gestures mean. It's much more proactive than normal therapy.

Sarah: And presumably you see plenty of positive results in the mothers and babies?

Sue: Yes, to give an example from my book: I worked with one mother – a successful professional – who came to see me in a very agitated and anxious state when she had her first baby. She was an older mother and desperately wanted to get it right, but she was having trouble breastfeeding and the tension between her and her baby was palpable. The baby had a flat, dull expression and turned away when her mother came near. The mother resented her baby so much that she confessed that whenever she passed an upstairs window she had fantasies of throwing the baby out. But in a very short space of time we improved this situation considerably as the mother learnt to follow her baby's lead and let her baby tell her what she needed. She soon started to relax and before long the positive mutual feedback increased to the point where mother came in to see me, adoring her baby, whilst the baby smiled back at her.'

Sarah: You say that your aim with your book was to bring all this important scientific understanding about babies to a much wider audience which, judging by the media's response to it, you've been very successful in doing. What are your hopes for the future?

Sue: I think that until now psychotherapists haven't seen working with babies as something they could do but I hope that in the future, as our understanding of the importance of this stage of life increases, that will change. And I hope that one day they'll be an OXPIP-type counselling and psychotherapy service in every town, accessible for all mothers and babies who might need it.

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