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 The Infants Need for Empathic Care
What is so special about empathic care? Why can't a conscientious parent serve an infant well by supplying a careful regime of temperature control, feeding, holding, stimulating, bathing, grooming, and diapering, without persistent positive attachments, attentive awareness, tenderness, and sensitive resonance characteristic of empathic care? Anna Freud addresses this question as she observes:
Except when asleep the infant will tolerate rarely to be left alone. On the other hand, for the outside observer this continued presence and care ... obscures to a large degree the true picture and extent of the infant's needs. It is ... [the mother's] task to remove tensions as fast as they occur, and to supply satisfactions before the need for them rises to a climax of despair. The well-cared-for baby therefore appears to the outside to "need little." But with the absence of the mother who performs this service, the observer could not fail to notice that the same infant does need a multitude of things done to it, and needs them practically from morning till night and gives the environment peace only when he is at peace himself, i.e., asleep [A. Freud, 1953, p. 161].
Actually, assiduous attention to the infant's life day by day is a prerequisite for the caregiver's awareness of what conditions are arousing the infant's distress or pleasure at any given moment.
The infant's dependence upon empathic care as a source for pleasure and as a protection from distress can be best illustrated by research and clinical observations pertaining to the infant's ever-changing needs for arousal stimulation and for tranquilizing comforting stimulation.
The Infant's Ever-Changing Needs for Tranquilizing Stimulation
An adult may erroneously surmise that an infant requires a quota of stimulation in order not to be deprived of sufficient arousal, and an absence from stimulation in order to be quieted and to rest. Often a parent may not be aware that the infant's needs for stimulation are not simply a matter of the presence or absence of stimulation but rather the presence or absence of certain different categories of stimulation. For example, overexcited, agitated, upset infants who need to be sedated require not an absence of stimulation but the presence of tranquilizing forms of stimulation. From the neurophysiological point of view, this formulation is summarized by Diamond and his colleagues as follows:
In the infant-mother dyad, the mother or her surrogate is more than a resource for the infant's basic needs for food, warmth, shelter, and cleansing, more even than a resource for love and social learning; she is also an important resource for stimulations which are an essential aid to the infant's still inadequate inhibitory capacities. At birth, the human organism is remarkably ill-equipped to cope with the variations and excitations of its new environment. It is a subcortical creature, which is in danger of going into shock through over-reacting to powerful or unexpected stimuli because it lacks the means for modulation of behavior which is made possible by development of cortical control. The role of the higher structures is played by the mother: she is the child's auxiliary cortex. She does this through various acts of tactile stimulation and handling which are included in the pattern of mothering, such as cuddling, stroking, shifting positions, and grooming. These serve to reduce over-reaction and to mobilize the infant's inhibitory capacity. The emotionally healthy mother performs these acts or their equivalents spontaneously. For example, the infant at birth responds to a sudden noise with a Moro [startle] reflex and startle reactions. The psychological component of the startle reaction is fright.... A responsive mother reacts smoothly and quickly to the stimulus of the loud noise by making gentle, physical contact with the infant, with the intent to diminish its reaction. When the reaction has already taken place, she will perform any one of a number of acts which help to relax the infant, such as rocking it, stroking it, uttering her soothing phrases or placing her hand on the infant's body [Diamond, Balvin, and Diamond, 1963, pp. 305-306].
Benjamin notes that especially during the third and fourth weeks of life, sensitivity to external stimulation increases to the point that infants tend to be overwhelmed unless a mothering person acts as a tension-reducing agent (Benjamin, 1961, pp. 1942; cited by Komer, 1964, p. 68). Also, Margaret Ribble concluded from her clinical observations of infant care that infants respond to certain rhythms and mild intensity of proprioceptive and tactile stimulation in the form of cradle rocking or auditory stimulation in the form of a lullaby in the first months of life in order to establish a satisfactory pattern of sleep (Ribble, 1965, pp. 47-48, 59). Such tranquilizing stimulation also is needed when an infant is excessively aroused, disturbed, or irritated.
In general, tranquilizing stimulation is gentle, soft, and tender and is characterized by:
(1) diminishing intensity such as is afforded by a mother talking or singing more and more quietly to her infant until the infant drifts off to sleep;
(2) diminishing rhythm rates; for example, patting, rocking, and talking to the infant at a rate initially matching the infant's own movements and then becoming slower and slower as the infant's excitement gradually subsides (Bowlby, 1969, pp. 293-294);
(3) deep pressure, gently and diffusely applied;
(4) gradualness of change temporally and/or spatially; for example, gradual changes in intensity of stimulation, gradual changes in rate of stimulation, gradual changes in configuration of stimulation (in contrast to changes that are highly demarcated and sudden). Whereas suddenly demarcated temporal and spatial change provides a basis for sharpness and roughness, spatial and temporal gradualness and diffuseness combined with reduced intensity provides for tranquility and sleep (Wolff, 1966, p. 44).2
On the other hand, as the months go by, an infant requires an increasing degree of arousal stimulation as a source for stimulation of consciousness, alert wakefulness, and the development of the infant's sensorimotor, emotional, and cognitive capacities.
The Infant's Ever-Changing Needs for Arousal Stimulation
Stimulation which arouses states of alertness and excitement involves:
(1) increases in the intensity of tactile, visual, auditory, or proprioceptive stimulation;
(2) suddenness in temporal change in tactile, visual, auditory, or proprioceptive stimulation as occurs during playful movements;
(3) suddenness in spatial change, for example, provided by sudden changes in visual and tactile forms and shapes;
(4) an increasing speed of tactile, auditory, and/or proprioceptive stimulation as occurs during playful hugs, tickling, and laughter. If arousal stimulation becomes too intense, then comforting, tranquilizing stimulation is required in order to moderate mounting distress.
Within a given range, an infant's need for arousal and tranquilizing stimulation actually varies from one time of day to another and even from moment to moment (Brazelton, 1969, p. 50). For example, after a long day, an infant may become tired and irritable, at which time he or she requires tranquilizing stimulation in the form of tender comforting to reduce inner states of irritation and to induce a state of tranquility and sleep. On the other hand, an hour or so after waking, a healthy active baby is not ready for tranquilizing sleep-inducing forms of stimulation but rather for playful arousal stimulation which reinforces the activation of wakeful muscular activity and cognitive receptivity (Stern, 1974, pp. 404, 405, 406). At any given time, one should be able to plot degrees of pleasure as a function of arousal and tranquilizing stimulation. Within a given range of arousal stimulation at any given time, the infant experiences reactions of pleasure and reward, whereas at intensities above and/or below this range, the infant displays discomfort and distress (Stern, 1974, p. 41 1). Likewise, within a given range of tranquilizing stimulation at any given time, the infant experiences reactions of pleasure and reward, whereas at intensities below or above this range, the infant displays signs of discomfort and distress. Bouncing and tickling an infant who needs to sleep leaves the infant in a state of helpless frustration. So would sleep-inducing monotonous rocking of an infant who is ready to expend an abundance of healthy energy. Thus, the parental ego is allotted the difficult task of distributing to the infant mild forms of arousal stimulation at certain times and mild forms of tranquilizing stimulation at other times, to fit the infant's constantly changing requirements. These, then, are some of the reasons why the infant's need for stimulation as a source for pleasure and a protection from distress is not a matter of how much stimulation in general should be offered but what kind of stimulation at what time. A critical question then arises as to whether the caregiver can respond appropriately to the infant's expression of its needs.
In brief, these examples pertaining to an infant's everchanging needs for various types of stimulation draw attention to the conclusion that no simple fixed prescription can tell an adult how to fulfill an infant's needs from moment to moment and how to relieve the infant's ever-changing conditions of distress. These examples therefore suggest why, throughout its waking hours, an infant requires the benefits of all aspects of empathic care (persisting, positive, tactile, visual, and auditory attachment; attention; tenderness; and empathic, resonant, emotional awareness) if it is to be consistently protected from mounting distress and if its rewarding states of pleasure are to be facilitated and maintained... |
