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 Empathic Care:
A Definition of "CARE"
Leopold Weil, MD
(1) enduring, positive pleasurable contacts with the infant;
(2) watchful attention and awareness of conditions affecting the infant's activities and emotions; and
(3) tenderness (Benedek, 1956, p. 272; Josselyn, 1956, p. 268).
The following clinical and experimental findings reported in the psychological literature pertain to these forms of behavior which provide an essential setting for the operation of empathic care.
I
Persisting, Pleasurable Contacts with the, Infant as Components of Maternal Affectional Types of Care
Among humans as well as among other mammals, maternal affectional types of emotional behavior can be differentiated from other well-known types of emotional reactions.
Aggression involves contacts of ever-increasing force and power, including destructive force; fear involves unpleasurable, negative contacts of avoidance; sexual emotions involve mounting positive, pleasurable contacts over a limited, circumscribed period of time, with a "high" of orgastic pleasurable excitement followed by a sudden reduction in excitement. On the other hand, maternal affectional contacts involve tender, positive, pleasurable contacts which evenly and continuously persist to afford the infant tranquility, comfort, and protection.
Among mammals, specific components of maternal behavior are regulated by the physiological processes within the limbic emotional-instinctual systems in the core of the brain. The ejection of milk has been found to be regulated by neural tracts leading from the hypothalamic core of the limbic brain to the posterior pituitary gland (Cross and Harris, 1952, p. 148). Furthermore, relatively small lesions higher within the limbic instinctual brain interfere seriously with grooming, litter survival, nest building and repair, as well as with protection of the young by retrieval from harmful conditions such as excessive heat. Signifigantly, such grooming, nesting, and nursing, as primary activities associated with the maternal instincts, all foster close and persisting, tender, pleasurable contacts between mother and infant. Some examples of these conclusions are presented by DeVore (1963, pp. 310-311) and by Jay (1963, pp. 286-288). Likewise, Harlow concludes that among the Rhesus monkeys, "contact clinging [rewarding for the infant as well as for the mother] is the primary variable that binds mother to infant and infant to mother" (Harlow, Harlow, and Hansen, 1963, p. 268)*
II
Watchfulness, Attention, and Awareness as Components of Maternal Affectional Types of Care
Such pleasurable contacts between caregiver and infant reward the reinforcement of the maintenance and repetition of such contacts and provide an important source for the caregiver's heightened close attention in relation to the infant. Pleasurable maintenance of auditory contacts with the infant promotes careful listening, while pleasurable maintenance of visual contacts promotes careful watchfulness. Such contacts are in a position to help contribute to the caregiver's awareness of what conditions are impinging upon the infant's being and awareness of what concomitant reactions the infant is displaying. By prolonged visual and auditory contacts, as well as prolonged tactile contacts maintained by the caregiver's concomitant feelings of pleasure and reward, the caregiver gains a better chance of learning what a cry at a certain time of day may indicate and what changes the infant may be needing.
The importance of pleasure/reward reinforcement of a caregiver's attention and awareness of an infant's reactions to environmental stimulus conditions has been emphasized by Robert Emde. Emde notes that a cardinal principle of infant care, and, subsequently, a cardinal principle of therapy, involves the concept of "Be there" (Emde, 1980a, pp. 87-88), meaning be available, be an available listener, be interested, and tune in to the infant's feelings. Mary Ainsworth has stressed this same conclusion that -
[The caring] mother must be reasonably accessible to the baby's communications before she can be sensitive to them. Accessibility is a necessary condition for sensitive awareness .... An inattentive "ignoring" mother is, of course, often unable to interpret correctly the baby's signals when they breakthrough her obliviousness, for she has been unaware of the prodromal signs and of the temporal context of the behavior [Ainsworth, Bell, and Stayton, 1974, p. 1281.
III
Tenderness as a Component of Maternal Affectional Types of Care
Tenderness (gentleness, placidity) is also a conspicuous characteristic of maternal affectional behavior among animals, whether the tenderness pertains to the behavior of a powerful tigress who gently picks up her cubs with her sharp teeth, or the behavior of a mother bird who quietly and peacefully nestles close to her young to keep them warm and protected from the elements.
The relation of soft, tender, gentle contacts on the one hand and caring attention and awareness on the other, becomes understandable in terms of the knowledge that attention to delicate cues requires a quiet, peaceful approach, much as an appreciation of fine music requires concerted peaceful attention upon the part of the listener. States of wild excitement provide a basis for aggressive attack or sexual interaction, but such excitement would interrupt sensitive awareness of the emotional responses of a fragile infant. The caregiver's tenderness counters a tendency to be abrupt and impulsive. It helps prevent states of overarousal and thus provides a basis for comforting the infant. The relation of tenderness to tranquilizing forms of stimulation is considered in the next section of this chapter....
* From his experimental studies with primates, Harlow has concluded that a mother's experiences during her own infancy will be one factor as to whether she will express a positive, persisting pleasurable contact with her infants (Harlow, Harlow, and Hansen, 1963, pp. 275-276). An abused female infant becomes an abusive mother and, conversely, a female infant who has been warmly, closely, tenderly held during its period of helplessness will be likely to grow up to become a mother who contacts her own infants warmly, closely, and tenderly. The possibility arises that when a helpless female infant has received persisting positive, pleasurable contacts from her mother, the warm persisting, pleasurable emotions associated with her infancy may be retriggered when later in life she herself becomes a mother. |
