Volume 10 Issue 9 September, 2019
A common phrase heard throughout a doctor straining journey is “Prevention is better than cure”. This became very apparent for psychiatrists while treating acute mental illness in adults. We realized that for many of our patients standard treatments were insufficient in reducing morbidity due to delayed on set of treatment. So a lot of emphasis was placed on youth mental health and early intervention: the earlier the treatment was commenced, even in what is known as prodromal phase (before the on set of active symptoms), the better the out come. Overtime, we realized that even in this group of young patients, there were some who had experienced trauma and adverse events in childhood that negatively affected their prognosis in adulthood. So it was important to mobilise efforts in child and adolescent mental health. But for some children even this seemed too little, too late. You may have guessed where I’m heading with this. Ultimately we now know that many risk factors for mental health conditions are established as early as while the foetus is in the development stage: during pregnancy and first two years of in fancy. So we can see why focusing on infant mental health can help reduce life long risk factors for an individual.
SO LETS START AT THE VERY BEGINNING…
When a pregnant woman is affected by stress, anxiety, depression or severe mental illness, it has a negative impact on the developing foetus. The risk of preterm delivery goes up and babies are smaller than gestational age.
Apart from many other factors, exposure to high levels of cortisolin the womb, leads to these babies being more fussy, having reduced facial responses and being less alert. If the mother remains unwell or becomes even more unwell after delivery, babies then goon to have difficulties in regulating their emotions, and difficulties with attachment.
INFANT ATTACHMENT
Attachment in early years is often a basis of relationships throughout an individual’s life and is a growing field of research in mental health. Attachment is a behavioural system that, when aroused, inhibits all other systems such as hunger, exploration, etc. The main function of attachment is to regulate stress in the infant by consistent availability of a familiar and responsive care giver. A reasonably secure availability of a caregiver regulates the hypothalamic-pituitary axis and forms the foundation of over all development.
Infants may generate their owns elf regulating mechanisms in response to stress. But presence of are liable and consistent parent, enables these strategies to work. Infants learn about their own emotional states by mirroring through an attentive parent. Needless to say if a parent is depressed, withdrawn or chaotic, giving contradictory signals, it can have quite a negative impact on the infant sability to manage his/her emotions, be confident in exploring away and feel safe to return to the parent. Donald Winnicott, a well known paediatrician and psychoanalyst, said“ There’s no such thing as a baby”. Babies form the development of their “true self” only in the context of their relationship with their immediate environment.
Depending on the type of environment, infants develop different types of attachment, which we’ve now learnt can lead to different ways of relating as adults.
»Secure attachment can lead to confident and self possessed adult relationships.
»Insecure-avoid ant attachment can lead to avoidance in expressing ones needs.
»Insecure-resistant attachment causes an individual to believe that only high intensity expressions are responded to
»Insecure-disorganised attachment can lead to incoherent strategies in dealing with stress
This can then lead to a myriad of problems in later years:
»Un met dependency needs
»Relationship difficulties
»Emotional dysregulation
»Anxiety: OCD, Eating disorders
»Self esteem issues
»Substance abuse
»Depression
»Antisocial/borderline personality structure
TREATMENT STRATEGIES: Apart from treating the mental illness in the mother or primary care giver, many therapies have been developed to improve the infant attachment and bonding. Such as circle of security, parent-infant psycho therapy, parent interaction guidance, video feed back therapy. Parents are guided to manage their own difficulties and respond to the infant in a consistent and reliable manner, leading to more secure forms of attachment. Many therapies for adults also use attachment as a focus, such as dialectical behaviour therapy, mentalisation based therapy and attachment focused family therapy, among others. Through these therapies patents can learn to recognise and regulate their emotions and develop secure relationships.
The Green Oak Initiative, Annasawmy Mudaliar General Hospital, Bangalore
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