by Simon House
THE PRENATAL CHILD AND SOCIETY: The Role of Prenatal Psychology in Obstetrics, Neonatology, Psychology & Sociology
Summaries - edited by Simon House
The previous (4th) instalment attended to practical care during gestation, to critical stages in brain development, and to an elaborate program for neonatal care for preterm babies. We were made conscious of their sudden experience of an incubator, so contrasting to the womb, and the lasting impact on their lives.
This 5th and last instalment describes research and methods in first-year maternal care, and in pre-schools for healing and enhancement of children's lives. Consideration of past and present prenatal psychology in the context of philosophy and culture conclude the series, with its grounds for hope for children's happier nurturing, to establish them in their own wholeness and transforming power for society.
J. POSTNATAL AND PRESCHOOL
Recognising the psychological-physiological influences of a mother and a father on their child as the main determinant in the first months of life, OM Philkina and colleagues assessed various factors including: personal features of parents; record of being alarmed in a work situation; personal hierarchy of values, relationships; self-estimate of physical and psychological health; and children's physical development and dynamics. Comparing with mothers and fathers of children with records clear of neurological maldevelopment, they assessed mothers and fathers of children with retarded neurological development in these 3 categories:
1. deviations of physical development
2. retarded psychological development
3. severe outcomes
Detailed correlations showed the importance of psychotherapeutic work with parents in developing their parent-child attitude, forming a system of mental self-control, and motivating active participation in treatment of any child with a perinatal neurological problem. (Philkina, OM, Kocherova BOJ, Shanina TG, Vorobjeva EA, Pyhtina LA).
On communication with the mother in the first year depends a child's health, physical and psychological, and socialization. E Zueva says that as the child grows older, these early experiences are left in unconscious memory from where they continue to influence decisions unconsciously, so they can become a source of intra-psychic conflict. This can lead to emotional disorders, anxiety, psychosomatic diseases, personality disorders and so on.
Following birth, symbiotic unity with the mother gradually weakens, though the child can still maximise close contact to ensure comfort. Yet the time-gap between the mother's rise of desire and satisfaction leads to the child's 2 states 'ego with mother', 'ego without mother' and sense of independent being. If the gap becomes too small, the child lacks space for personal growth. If too large, he is deprived of support and person whom he can imitate. Hence Winnicott's expression 'a good enough mother' means enough holding for her child and not too much. If he does not get enough holding, he may later regress towards the oral stage.
Problems of love or career can lead to dependencies (alcohol, smoking, drugs, eating disorder, gambling), with mood problems and incapability of achieving independence. So much depends on the first year of life. (Zueva, E ~ Russia).
For children suffering adverse programming, the earlier the intervention the better, especially pre- or perinatally, comments Paula Ingalls.
Conditions during pregnancy program the fetus. For instance, undernutrition or viral infections program a child for diseases and an earlier death in adulthood.
Further negative influences include: maternal stress, hypertension and depression; infections, environmental pollutants, medications and substance abuse; poverty and squalid living conditions; Caesarean section and other birth complications.
Even following birth, disorders of feeding, bonding and attachment; cultural bias, circumcision, domestic violence and child abuse; parental permissiveness; and last but not least, the child's responses to the experiences imposed upon it by nature and nurture. Such adverse effects on gene-transcription can affect the child psychologically, physically and neurochemically, leading to various neurobiological abnormalities, including for instance autism and ADHD.
Depressed mothers can be unresponsive and flat in their affective displays, alternatively intrusive and hostile, handling their infants roughly and overstimulating them. Babies treated either way display gaze avoidance, vocalize less, and are less assertive. Many are irritable, cry more, and cannot calm down after an upset. Some develop long-term emotional, cognitive and behavioural problems. Perinatal intervention combined with postnatal separation correlates strongly with later criminal behaviour (Raine).
Trials have shown prevention to be possible and affordable. In Chicago, a high-quality preschool program beginning 1962 enrolled 123 African American children aged 3-4. They had been born in poverty and were at high risk of failing. Of the survivors, 97 percent were tracked till 40 years of age. The rate of success of the program children's graduation from high-school was 50% better than those not on the program, and only half the percentage of them were in prison (David Weikart). Economists estimate the investment of $15,000 per child to return more than $250,000.
Society may come to understand that pursuing health at least from conception onwards instead of treating diseases separately later on is a paradigm of much greater value to the global community. (Ingalls, Paula ~ USA).
Pre-school and kindergarten children present special opportunities for interaction and dialogue relating to the pre- & perinatal stage, since they are still close to it. Supported by research in attachment and neurobiology, Hans von Lupke uses ultrasound videos of children's prenatal development and communication. He recognises the continuity of characteristic fetal behaviour into childhood, as in Alessandra Piontelli's
work on twins (1992).
Working with this age-group, we also learn more about the impact of influences during that age on further development. Mutual child-parent care is guided by paediatricians and parents. Prenatal behaviour and circumstances of its modification gives fundamental cues for understanding of development as an actively initiated process in a continuous mutual exchange with the world, in particular in the context of mother-infant relationship.
This understanding offers the opportunity of using different aspects of this early development as constituents of development in general.
In this context, developmental psychology changes from a list of achievements during each stage to an understanding of fundamental constituents; that these will be modified and transformed during the process of development in a continuous rational context; that this induces mutual transformation of all participants, child, parents and even professionals.
Among these constituents, one of the most important is the development of the 'sense of a core-self' as conceptualised by Daniel Stern (1985), who recognizes:
A. Self-agency, sense of authorship and control of one's own actions.
B. Self-coherence, being non-fragmented either while active or while still.
C. Self-affectivity, sensing one's inner qualities of feeling associated with other experiences of self.
D. Self-history, sense of enduring, and continuity with one's past even while changing.
Stern's concept, limited by his belief that the core-self began at the age of 2 months, is supplemented by our realization of prenatal development, continuous through birth onwards.
Standing out too is the importance of an event in the context of relationship. Brain research shows that significance is derived from relationship, without which perception doesn't occur. Based on these fundamental aspects, issues such as affect control and theory of mind can be discussed, as well as empathy with its consequences for social behaviour. On the basis of these constituents, we can discuss learning processes, aggression, ADHD, trauma and resilience, integration of processes of mourning and being handicapped.
Training seminars over two weeks present the methods to educators working with children from 0 to 6 years. At these the ultra-sound video sequences always carry strong conviction.
K. HISTORY, PHILOSOPHY AND HOPES
The close connection between psychological and somatic fields has been studied since the time of Hippocrates and Aristotle. Ntalja Kovalenko lists some other researchers: Psychosomatic integrity: Z Chernoruzky, M Kabanov, R Gallon. Clinico-empirical approach: V Osler, R Konechny, M Boukhal. Specific emotional conflict: F Aleksander. Emotional stress: G Sel'e, R Lazarus. Psychophysiological approach: F Berezin, P Anokhin.
Psychoendocrinological approach: V Uspensky. Reconstructive person-centred psychotherapy: V Myasischev. Psychotherapy and psychosomatic health are most important of all for childbearing women, having such powerful effect on the wellbeing of her child. (Kovalenko, Natalja ~ Russia).
Difficulties with carrying a baby, complicated delivery, and fall in fertility became the focus of research for the Russian Psychology and Medicine Association in 1994, and was based on maternity home No 10 in S. Petersburg. Natalja Kovalenko relates that the search was for new effective forms of psychological help, advice in pregnancy and training for birth, with emphasis on natural delivery without surgical intervention. Important contributions were made by pioneer scientists Professors A. Batuev, V. Abramchenko, G Brekhman, I Dobrykov and many others. With scientific knowledge in medicine and psychology their new ideas and methodology were integrated, the seminars and annual conferences conducted by Academician G. Jacovlev. Cooperation then with the Association of Prenatal and Perinatal Development (Moscow), headed by N Chicherina, led to the development of RAPPM. In 2005 the Association began to cooperate with the International Society of Prenatal and Perinatal Psychology and Medicine, headed by R Linder (Germany). The association is also planning development with the Association of Integrative Medicine (S. Petersburg). (Kovalenko, Natalja ~ Russia).
Inter-relating the various disciplines concerning the psychobiological and cultural aspects of human reproductive attitude, behaviour and experience, Lucio Zichella has been focusing on the role of anthropology. Anthropology has been acquiring a more and more specific philosophical dimension. Philosophy itself plays a role in understanding, preventing and treating, at a human level, human discomforts in health.
An interdisciplinary perspective on the individual and couple situation raises the need to express a meta-thought. Zichella thinks that anthropological philosophy, concerned with the human being in the world, could be the right way to contextualize the meta-thought in a cultural dimension. (Zichella, Lucio ~ Italy).
Peacefulness can be ours, through changing ways of parenting from forcefulness to tenderness, and at the most vulnerable levels, gestation and infancy. Ludwig Janus rejoices in our joining as nations in this vital work. Prenatal psychology has to be a multi-disciplinary study, including culture and social values. Parenting skills and the prevention of harm are key.
Since our large human head has shortened our gestation to less than half that of other mammals, the baby's helplessness has necessitated the ability to engage the maximum care from mother and family. We have continued this dependence, even as we grow up, to create exceptional social formations around us throughout life.
In contrast, repressive cultures and wars have imprinted on us violence, which repeats generation by generation until it is interrupted yet, within the huge autocratic configurations, the Enlightenment and our recognizing the virtues of some simpler societies, have allowed us safe havens and more intimate relationships. It is good that we from Germany are this time in Russia to cooperate in generating peacefulness. So we share internationally the ways parenting becomes gentler, while obstetrics and other disciplines have made childbearing safer, so engendering gentler attitudes in society.
Destructive tendencies still arise due to mental, social and somatic illnesses, resulting from deprived socialization. Relationships, parenting especially, must become a key part of our education systems. Our systems, rooted in the 19th century, still keep their patriarchal focus on achievement. 20th century depth psychology and recognition of emotions are not yet in the curricula. Our schools pay scarce attention to the other half of adult life outside work, leaving young people to experience problems in partnerships and parenthood, which are passed on to their children. Only countering measures will counteract the high level of domestic violence, and promote the great human potential of children that they so urgently need to benefit our ever more complex world.
(Janus, Ludwig ~ Germany).
This concludes the series, with its grounds of hope for the happier and more skilful nurturing of more children, establishing them in their own wholeness and transforming power for society. I give below the series' Contents, followed by the summaries' author index:
Below is a list of our Newsletter's instalments of Moscow Congress 2007
42/2 A. The context of conception in the environment and evolution, B. Views of contraception and falling birth rates.
42/3 C. Unwanted pregnancies - caring and prevention D. Being and feeling an unwanted child E. Prenatal stress and science of the brain - preventing and resolving negative psychological imprinting.
41/1 F. Researching reproductive risk factors, psychological and physical G. Enhancing experience prenatally and postnatally against risk factors.
41/2 H. Preterm babies - prenatal and neonatal care, with attention to critical stages of brain development.
41/3 J. Postnatal healing in maternal care and preschool K. Philosophy, culture and hope in pre-and perinatal understanding.
(continued on next page)
Author index of summaries
||D1 Kafkalides C
||D2 Kafkalides Z
||F2 Vasilieva EV
||H4 Vasilyeva M
||J4 von Lüpke
My fuller summaries (20,000 words) are published in the International Journal of Prenatal and Perinatal Psychology and Medicine - the Society's website being www.isppm.de
Most of the articles/presentations were published in: THE WORLD CONGRESS - THE PRENATAL CHILD AND SOCIETY: The Role of Prenatal Psychology in Obstetrics, Neonatology, Psychology & Sociology, MOSCOW, 2007, May 20-24. by Academia MOCKBA.