Suffer the little children by Chong Siow Ann

                           The Straits Times  November 10, 2018


A child's early emotional attachments -- or lack of'-- continue to influence the individual long into adulthood


While reading Nobel laureate Toni Morrison's most recent novel, God Help The Child, I thought of the high regard and admiration that Sigmund Freud had for creative writers.

Freud is the universally acknowledged father of psychoanalysis that is both a theory and a way of treating mental disorders by investigating the interaction of conscious and unconscious elements in the mind.

He believed that creative writers have an intuitive understanding of the human psyche, and that they "are valuable allies and their evidence is to be prized highly, for they are apt to know a whole host of things between heaven and earth... In their knowledge of the mind, they are far in advance of us everyday people".

At the heart of Morrison's novel is an African-American woman who renames herself Bride. She was born so black, "midnight black, Sudanese black", that she was rejected by her light-skinned mother, who was so consumed with the fears and anxieties of colour prejudice, that she refused to breastfeed or let Bride call her mama.

Bride's father was unwilling to accept the child as his. Accusing the mother of infidelity, he walked out of the marriage and out of their life. Bride grew up ashamed and desperate for her withholding mother's love and acceptance. "I used to pray she would slap my face or spank me just to feel her touch. I made little mistakes deliberately, but she had ways to punish me without touching the skin she hated - bed without supper, lock me in my room," she recalled.

As a third-grader and to get her mother's attention and approval, Bride became the star witness at a trial where she falsely accused a kindergarten teacher of sexual abuse, which resulted in a 25-year prison sentence for the innocent woman. And though she grew up to be a beautiful woman with no lack of lovers, and a successful career woman, she was emotionally stunted and incapable of attaining any real intimacy in relationships that matter.

Later in the novel, her mother expressed her remorse: "All the little things I didn't do or did wrong... taught me a lesson I should have known all along. What you do to children matters. And they might never forget."



The central role of parents (especially a young child's relationship to his or her mother) in the development of the child's emotional and mental wellness and the sort of personality the child will form in time have been emphasised by psychoanalysts.

One of them, John Bowlby, an English psychoanalyst and psychiatrist, asserted that children - in order to ensure their survival - come into the world programmed to form an attachment with one main figure (usually the mother).

To get this attachment going, a baby will resort to a repertoire of behaviours, like crying, smiling and crawling, which would elicit a response from the mother; what the child seeks is not food but loving care and warm responsiveness.

Bowlby believed that if there is a failure or disruption of this attachment relationship, the child will subsequently have social and emotional difficulties, such as delinquency, aggression, depression and an inability to show affection and concern for others. In his view, such "intimate attachments to other human beings are the hub around which a person's life revolves, not only when he is an infant or a toddler or a schoolchild but through his adolescence and his years of maturity and on into old age."

D.W. Winnicott, another English psychoanalyst, elaborated on this and described the emergence of what he called the False Self when a child's need for care and love are not met by the main parent. This prompts the child to change tack and recalibrate his behaviour to meet the mother's needs and expectations. This mode of interaction is reinforced when the mother responds in a positive way. Over time, this False Self is formed and perpetuated, and the child grows up believing that meeting other people's expectation is of paramount importance. It is an imperative that dominates the way he interacts with others.

What sometimes happens is that children with insecure or disorganised attachments are not able to overcome the imprint of their experiences. Their hurts and sorrows are never quite salved, and these anxieties continue to shadow and subvert their relationship with others, even as adults.

Much of the practice of psychiatry involves making a strenuous effort to know how and why our patients got to be who they are. (It is particularly challenging these days given the scarcity of time and the temptation to prescribe a pill for every emotional complaint.)

It is a long and painstaking process. When patients come forward with the barest outlines of what troubles them, the psychiatrist tries to fill the gaps on how they feel and think, how they read and misread situations, and how they foist expectations on others. We explore the nature of their innermost fears, anxieties and conflicts, and trace their origins.

Still, it is near impossible to obtain complete knowledge. There would always be unknowable dark areas and periods in the life of each patient, and guesswork and inferences have to be used to complete the picture. (Freud likened the work of a psychoanalyst to an archaeologist - someone who patiently and painstakingly unearths the traumatic events of a patient's distant and buried past).

Sometimes we find evidence for these complex feelings and their putative causes to be rooted in their childhood. Such was the case with a 30-year-old patient of mine who suffered chronic anxiety about her work performance. She was plagued with constant and relentless worries about what others would think of her and would feel only as good (or as bad) as her last project.

Brought up by a single parent - an emotionally absent mother who was herself brought up by a depressive alcoholic mother - she nursed an unfulfilled yearning for an ideal mother which she tried to find in her partner. The leitmotif of her life has been an unceasing search for affection, approval and acceptance.



But we must guard against the dangerous reductionist tendency to lay all our emotional and psychological woes on parents.

One could think of the now discredited "refrigerator mother" hypothesis that autism is the result of a lack of maternal warmth and attachment. Similarly mistaken and damaging is the hypothesis of the "schizophrenogenic mother", once thought to be responsible for engendering schizophrenia in her child with a mixture of maternal overprotection and rejection.

From my clinical work with patients and a general observation of my own experiences and those whom I know well, I am still mystified by the different fates that befall us. Why are some more fortunate than others? Is it in the genes? Is it luck or love or intelligence. It is that age old "nature versus nurture" debate and the truth in these cases is perhaps, a bit of everything.

Despite the vast body of research that is suggestive of the potent influence of parents, it has been difficult to pinpoint the exact effects that parents have on their children. This holds true even for the most extreme experiences such as divorce and abuse.

It is a challenge to study complex attributes such as empathy, affection and trust, let alone the amorphous and shifting character of an individual.

Certainly there are forces other than parental influence that make us who we are. Other adults, siblings, peers, schooling, social media, religion, mishaps and other misfortunes are just some of the elements of an alchemy of environmental stimuli that are beyond parental control.

It is to the good if parents are not devastated by guilt when they have problems with their children, or when their children turn out differently than they would like, despite doing their best to love their children unstintingly and unconditionally (it is never an easy thing as love is more often situational and based on reciprocity).

Some parents do need help to be better parents, and it behoves all parents to be aware that their early responses to and interactions with their children could determine how these children come to view themselves and how they find their way about in this world, and how, in time, they would parent their children.

Professor Chong Siow Ann, a psychiatrist, is vice-chairman of the medical board (research) at the Institute of Mental Health.