Nature is full of heart-melting examples of mother-baby relationships, especially, in birds and mammals. However, a parent’s tenderness for their children is not always spontaneous from the very first moment. In fact, raising a child can sometimes be a very demanding and exhausting task. Parents can struggle with what they think is correct, what others say, and what they experienced in their childhood (as discussed in a previous ITM blog), especially when they are parents for the first time.
Sadly, some parents suffer parenting difficulties alone, for fear of being judged as “bad parents”. As Perinatal Psychiatrist, Ian Brockington, says, “Anger and hatred are less obviously a concern for psychological medicine than depression and anxiety”, nevertheless, when not overcome; they can have damaging consequences for both parents and children (indeed, the importance of sensitive parenting is a topic often discussed on ITM's column 'The Perinatal Journey') .
As a clinical psychiatrist, I have found that many of the behavioural problems and affective disorders seen in children and teenagers can be traced back to when parent-child bonding began. Thus, the early emotional environment between the family contributes to shaping the way children are. To help children, it is often necessary to help parents with parenting when it takes on pathological overtones.
Mother-baby relationship
By way of definition, bonding is the emotional connection between caregiver and child, and attachment is the adaptive response of the child to the caregiver.
After childbirth, developing a relationship with the newborn is the most important psychological task for the mother, but it is not a one-way process. Brockington explains in the book ‘Motherhood and Mental Health’, that “the infant plays an important part because his behaviour has a powerful effect on his mother’s emotions, for good or ill. Newborn infants are attracted to humans and show a preference for those involved in their care”. Thus, babies exhibit behaviours which influence the mother and other caregivers, for example, crying, smiling, following, clinging and sucking (to read more about 'Baby language' see ITM's previous blog).
Factors from across the mothers’ lifetime, from childhood to after childbirth influence bonding. These include the mother’s childhood experiences, her expectations of motherhood, whether and how the pregnancy was planned; her familial/social support, marital relationship, and professional and work conditions. After childbirth, the family and spouse’s support are also critical.
As was discussed in a recent Inspire The Mind Article, fathers can have a profound impact on the bonding between mother and infant, long before and after birth. The father usually plays a significant role in supporting the mother-baby dyad and the rest of the family. Indeed, sensitive fathering, through play, and verbal and behavioural stimulation, can buffer the effects of maternal depression or mother-baby impaired bonding on offspring.
Bonding disorders
Bonding disorders consist of a syndrome with three main features – aversion to the infant, a desire to escape from the burden of childcare, and (in severe cases) a wish for the disappearance of the infant, by theft or death. Fortunately, the prognosis is good. A study carried out at a mother-child day clinic reported a rate of almost 90% of recovery from mother-child bonding disorder.
Brockington explains that for a long time, traditionally, the mother's love has been considered a ubiquitous reality, an ideal for many women; however, this is so far from the reality of mental health disorders in mothers. This social idealisation has led many women (and fathers) to suffer their difficulties in silence during the perinatal period, due to fear of being stigmatised or judged. It is supposed that a newborn baby's smell, soft skin, babbling and gurgling, and beautiful smile would awaken the deep magic of legends and the joy parents expect. But this expectation is not always reality. In the UK, according to the National Childbirth Trust, around a third (32%) of UK mothers experience difficulties bonding with their babies. Another study reported that the frequency of bonding disorders was found to be 24% among healthy postpartum mothers as against 45.2% in mothers with psychiatric disorders. However, the frequency of mild disorders of bonding was relatively lower at 5.6% among healthy mothers and 6.5% among mothers with psychiatric disorders.
The History of Bonding Disorders
Bonding disorders have existed for a long time, but they have only been described since the early 20th Century. Oppenheim (1919) wrote on Misopädie (aversion to children), one of the earliest articles on this subject. Similarly, in 1845, Rothamel described the death of a child from starvation, indicating entrenched hatred and rejection.
Curiously, even in unexpected cases, when parents are very well prepared for a wanted baby’s arrival, impaired bonding can occur. For instance, in the example Brockington provided in the foreword of his book “Bonding disorders. Emotional Rejection of the Infant”. Both parents were doctors and well aware of the challenges a newborn brings. Despite their preparation, far from feeling excitement and joy for their first baby, the father stated that the birth: “opened a chasm, a raw jagged hole of emptiness, bewilderment, alienation, hate and pain. There was no love. My wife felt only anger, resentment, wild mood swings and dark, dark thoughts. There was also fear. Fear of what she might do. She looked for help…” After meeting a perinatal psychiatrist and receiving help, she got much better. Some years later, they said, “We are now ten years down the line. The experience is still raw in our hearts and the knowledge of what has and could have been is still one that fills us with horror… It would seem the last taboo left in our world is still intact. We see it every day and yet we still refuse to accept that the concept of a universal and undying mother’s love is not in every circumstance universal at all. Please open your eyes... Diagnose it and help to treat it”
One crucial step forward in the field of bonding disorders would be for them to be recognised in key mental health diagnostic manuals (ICD-11 and DSM-5), sometimes referred to as 'psychiatry's bibles', which are used to guide the diagnosis of mental disorders. This would improve recognition of these disorders, guiding standardised care for patients and influencing research endeavours. Greater knowledge by specialists and the general population about bonding disorders could reduce stigma and allow parents suffering in silence to gain easier access to specialised help services.
