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Book Forum: Love   |    
Why Love Matters: How Affection Shapes a Baby’s Brain
WILLIAM T. McKINNEY, M.D.
Am J Psychiatry 2004;161:2338-2339. doi:10.1176/appi.ajp.161.12.2338
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By Sue Gerhardt. New York, Brunner-Routledge, 2004, 246 pp., $69.95; $17.95 (paper).

Given the title of this very interesting and readable book, one cannot help but be drawn to it in the way one is drawn to the infants and young children that are its subject matter. The author identifies herself as a psychoanalytic psychotherapist whose practice has focused on "working with the disturbed or malfunctioning relationships between babies and their mothers" (p. 1). Branching out from her direct clinical experience, she explores in this book a growing body of research on the developing brain in infants and how that might be influenced by early attachment experiences, as well as how psychopathology in the adult caretaker(s) could influence attachment experiences and brain development and therefore could affect adult behavior.

The author’s viewpoint is perhaps best illustrated by the following quote from the introduction:

My approach to understanding emotional life is a systemic one. I argue that human beings are open systems, permeated by other people as well as by plants and air and water. We are shaped by other people as well as by what we breathe and eat. Both our physiological systems and our mental systems are developed in relationship with other people—and this happens most intensely and leaves its biggest mark in infancy.

The human baby is the most socially influenced creature on earth, open to learning what his own emotions are and how to manage them. This means that our earliest experiences as babies have much more relevance to our adult selves than many of us realise. It is as babies that we first feel and learn what to do with our feelings, when we start to organise our experience in a way that will affect our later behaviour and thinking capacities. (p. 10)

The book is divided into three parts. The first deals with brain development in infants and how this can be influenced by attachments and the "corrosive" (p. 56) influence of cortisol. It is primarily based on attachment theory as postulated by Bowlby and Ainsworth. Largely missing is the widely recognized and pioneering work of Harry Harlow and other primatologists, which has recently been well summarized by Deborah Blum in her biography of Harlow (1). Also missing is discussion of even earlier work in animals, including primates, documenting the neurobiological effects of altered early attachments, including effects on brain cytoarchitecture and performance. If one is interested in developing an integrated model for understanding the role of early experience with a focus on early attachment systems, such work provides much of the basic science in this area. In addition, the potentially adverse neurobiological effects are not limited to cortisol alone. There are alterations in many neurotransmitter systems that can result from altered early experience, and we do not fully understand the complex interrelationships between these alterations and brain regions or the interconnections between different anatomical regions and how this might relate to adverse behavioral outcomes. However, the author doesn’t miss the key point—early experience/attachments systems do affect brain structure and function in complex ways that we do not even yet fully understand, and it is a critical area for future research.

Part 2 examines the relationship between different adult disorders and their roots in babyhood. The strength of this section is the highlighting of the general concept that insecure attachments to others in babyhood and the potential consequences can make one more vulnerable to specific psychopathologies. The author is careful to say in the introduction to this section that this does not mean one causes the other but "that the likelihood of finding dysfunctional solutions to emotional dilemmas in increased. There are many well trodden pathways to misery" (p. 87). While I found this interesting reading, extreme caution is urged. It is one thing to talk generally about enhanced vulnerability based on the nature of early attachments with the exact form of later disturbance (if any) being based on multiple variables, e.g., genetics, later life experiences, etc. It is quite another to be more specific, and unfortunately at times the book goes in that direction. By and large the data to support the degree of specificity that the author postulates are absent.

In part 3, the author finally acknowledges the possibility of development and change extending across a lifetime and not just in infancy. However, she argues that improving the relationship between parents and their babies is a much more cost-effective way to improve mental health than any number of adult therapeutic treatments: "Prevention is better than cure" (p. 196). The author advocates for parent-infant psychotherapy as one way to prevent damaging emotional patterns from repeating themselves.

There are a number of points in the book where the author makes overly sweeping dismissive statements, e.g.,

The psychiatric tradition, based on the medical model, attempts to restore the chemical balance from the outside with synthetic drugs. This makes some people feel better, although its success rate is not very high. However, it is a useful resource for emergencies when an individual’s capacity to manage is collapsing and long-term solutions are impractical. Faced with someone who is suicidal or psychotic, there is little else to be done. (pp. 201–202)

Likewise, she says that the psychiatric profession has not "taken fully on board the significance of early infant experience in particular in shaping the stress response and the bioamine pathways" (p. 213). This is not an accurate criticism of modern-day psychiatry, including child psychiatry, where concepts of early attachment are widely taught and used.

What are the implications of the recognition of the importance of developing secure attachment systems—a concept that is strongly supported by a variety of evidence? First, it is not gender specific, and the author points this out. Second, there are many ways that this can happen, and in our society, with so many situations where both parents are working, either by necessity or choice, childcare programs need to be aware of the importance of these concepts in developing programs of infant/childcare. As the author correctly points out, recognition of an infant’s needs in this area is not a disguised way to subjugate women. These needs have a biological basis, and the author’s discussion of this issue in chapter 10 is thoughtful.

The book is clearly written, poignant, and a good read. Although I think it seriously overextends in terms of relating specific patterns of early attachments to specific forms of adult psychopathology and does not properly put the parent-infant relationship in the context of a broad range of developmental experiences, it does emphasize the extremely important nature of this period and the need for our society to recognize this in terms of workplace patterns and childcare programs that need to be much more than places to drop off our children. Finally, much more research is needed in the critical area of the short- and long-term impact of altered early experience on both social behavior and neurobiology in humans as well as animals, including primates. Love does matter.

Blum D: Love at Goon Park: Harry Harlow and the Science of Affection. New York, Perseus Publishing, 2002
 
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References

Blum D: Love at Goon Park: Harry Harlow and the Science of Affection. New York, Perseus Publishing, 2002
 
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