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VOLUME 45 FEBRUARY 1970 Nmii 2
COMMENTARIES
THE
MOTHER’S
TIE
TO
HER
CHILD
S
EVERAL years ago John Bowiby wrote apaper entitled “The Nature of the
Child’s Tie to His Mother.” This and the
growing literature on “imprinting” pioneered
by the ethologists have focused attention on
the significances of early experiences for the development of the young organism-human and nonhuman.
The nature of “the mother’s tie to the
child” has not received as much attention. Therefore, it is heartening to note an early report of a study, “Neonatal Separation: The Maternal Side of Interactional Deprivation,”
in this issue.2 Maternal behavior has been
explored thus far mainly in animal studies.
Some years ago we demonstrated that brief
separation of newborn goats from their
mothers resulted in a significant interference with the specificity of the mother’s affection for her young.3 Postnatal separation for peri-ods as brief as 1 hour resulted in the mother’s loss of specificity in caring for her young as evidenced by the nursing of any of the kids in the herd-a distinctly abnormal behavior for this species. A point of interest was that this happened in only 50% of the mothers, indicating that there is considerable indi-vidual variation in maternal capacity, even in subhuman species.
It was also possible for us to demonstrate
the capacity of sheep and goats to adopt
strange kids and lambs within their species
as well as between species.4 The
arrange-ments under which the adoptions were
at-tempted needed to be delicately managed;
when this was done, there was no instance of
failure in the adoption process. The time
over which the adoption was permitted to
take place while the adoptive mother was
restrained from destroying the strange
in-fant was an important variable.
The study published in this issue is sig-nfficant in many ways. First, it takes advan-tage of the advances in the control of
infec-lions which have been taking place over
many years. Without these advances it
would have been difficult-if not impossible -to contemplate the bringing of parents into
intimate contact with prematurely born
babies. The concomitant systematic
collec-tion of microbiological data in this study is a valuable and needed contribution. Studies of patterns of infection in newborn nurseries
support the trend toward a more flexible
policy of parental visiting in nurseries.5 Sec-ond, the study takes advantage of the
grow-ing awareness of psychological factors
relevant to early development. There is
re-markable clinical sensitivity reflected in the
observations and in the report. There is no
effort to quantify exquisitely, through
psy-chological tests, matters which lend
them-selves to good clinical observation. The
sensitivity of the clinical team is reflected in their description of individual differences among mothers and their sensitive comments
concerning those mothers who did not find
it possible to enter the intimate caretaking
190 THE MOTHER’S TIE...
experiences with their prematurely born
babies. Third, the conceptual approach to
this study is one which deals with the
inter-actions between parents and babies. This is
a considerably neglected area for
investiga-tion, since we tend to be more competent at
describing what goes on in each individual rather than in describing the transaction be-tween them. In this instance, where one of the interacting people is nonverbal, the
pro-cess is even more difficult if we are not to
become adultomorphic in describing the
in-fant’s reactions. The authors are appropri-ately modest in approaching this problem, but they have not reached for
oversimplifica-tion and they have not walked away from
this difficulty. It appears to be part of their plan for further study. Perhaps conceptually
and methodically we will advance more
rapidly if we draw on the literature in
cyber-netics dealing with feedback phenomena.
This would seem to be a more fruitful
ap-proach than medical models which have a
tradition of focusing on single rather than multiple variables.
The authors point to the difficulties in
studying human mother-infant transactions.
The period of dependency of the infant is
much longer in man. For ethical reasons,
many variables do not lend themselves to
control and experimentation, and there are
often strong cultural resistances to being
studied. It is well-known that adoptive par-ents, who represent a “natural experiment” and might provide considerable information about the development of parental attitudes, are generally reluctant to be studied. In our longitudinal studies of parents and infants, we found rather striking attitudinal
differ-ences through interviews with mothers in
the prenatal period; these differences
be-came reflected in wide variations in maternal
care following the birth of the baby.6 But,
much more information is necessary for a
greater understanding of the process of
ma-ternal-infant bonding, one of the most basic processes in human development.
The matter of premature birth as a family crisis is alluded to in the study, but it was not studied specifically. In view of the
fre-quency with which prematurity occurs, it is
strildng that we have so few systematic
ob-servations of the adaptations of parents to this crisis. In pediatrics we have opportuni-ties
(
often not available in a psychiatricsetting) to observe how people master
ad-versity. While contributing to our
knowl-edge of premature care, such studies could
help us break out of our traditional focus on
pathology by helping us to understand the
much neglected field of psychological “well-ness” or coping ability.
This study is not without practical clinical applications. It demonstrates that premature infants can be cared for very effectively with the participation of the parents. It also
mdi-cates no unusual hazards of infection and
it demonstrates that the nursing and
pro-fessional staff can enter into new
con-structive programs without being unduly
threatened by the novelty. All of these
ob-servations should provide a basis for a
re-view of long-established practices by health departments and hospital staffs. The liberal-ization of care, in addition, offers great re-spect for the individuality of the parents.
And, even if there was no good scientific
reason to believe this would be better, it is a
more humane approach to meeting the
needs of babies and parents.
Juuus B. RIci1Mo1m, M.D.
Dean, The College of Medicine Professor and Chairman Department of Pediatrics State University of New York Upstate Medical Center Syractsse, New York
REFERENCES
1. Bowlby, J.: The nature of the child’s tie to his
mother. Tnt.
J.
Psychoanal., 39:350, 1958.2. Barnett, C. R., Leiderman, P. H., Grobstein, R., and Klaus, M.: Neonatal separation: The maternal side of interactional deprivation. Pwriucs, 45:197, 1970.
3. Hersher, L., Moore, A. U., and Richmond,
J.
B.: Effect of post partum separation of mother and kid on maternal care in the domestic goat. Science, 128:1342, 1958.de-The investigations on which this communication is based were supported by Public Health Service research grants CA-2599, CA-10456, CA-7918, CA-3927, CA-4737, CA-4326, CA-5462, CA-11028,
CA-4646, CA-3735, CA-4457, CA-7968, CA-802.5, CA-5923, CA-7757, and CA-8080 to members of
Acute Leukemia Group B from the National Cancer Institute.
COMMENTARIES
191
Pimwriucs, Vol. 45, No. 2, February 1970 velopment of maternal behavior in sheep and
goats. Behaviour, 20:311, 1963.
5. Williams, C. P. S., and Oliver, T. K., Jr.: Nursery routines and staphylococcal
coloniza-tion of the newborn. PEDIATRIcs, 44:640, 1969.
6. Caidwell, B. M., Hersher, L., Lipton, E. L., Richmond, J. B., Stern, C. A., Eddy, E., Drachman, R., and Rothman, A.: Mother-in-fant interaction in monomatric and polymatric families. Amer. J. Orthopsychiat., 33:653, 1963.
HOPES
FOR TOMORROW
VERSUS
REALITIES
OF TODAY:
THERAPY
AND
PROGNOSIS
IN ACUTE
LYMPHOCYTIC
LEUKEMIA
OF
CHILDHOOD
T
HE inability of Drs. Stein, Ablin,Kush-ncr and Zoger, in their Letter to the
Editor,’ to “see what good can come of
ex-aggerating the effectiveness of current ther-apy” for childhood leukemia is not
surpris-ing. They imply that others have such
dis-torted vision that they see castles where
only hovels stand. The implication of
Dr. Stein and his colleagues, were it true, would be damning. I believe that faulty
logic, poor data, sketchy analysis, and
em-bellished accounts in the popular press over which the interviewed exercises no editorial control led these correspondents to improper conclusions.
In the design of clinical investigations to explore potentially improved therapeutic approaches to acute lymphocytic leukemia,
the Acute Leukemia Group B has
struc-tured from two to five regimens into
con-current comparisons on a multi-institutional level. When the results are accumulated, the total survival for that study or that year
is composed not only of the best but of all
the less effective regimens of the study. Drs. Stein, Ablin, Kushner, and Zoger are
inter-ested in the best regimens, not the mean.
They find disparity between the reports of
achievement with the best regimens and
the composite data for all studies, yet fail to make the distinction.
In data recently reported formally for
the first time, although allusions to them by
others have constituted some of the basis
for therapeutic assessment and prediction
of which the correspondents complain,
reg-imen D of ALGB protocol 6601 was
analyzed.2 This treatment consisted of
yin-cristine and prednisone followed by 5-day
parenteral intensive courses of methotrexate
for a period of 8 additional months. After
every third course of methotrexate, another
inducer course of vincristine and
predni-sone was added. Seventy-five percent of
these children are alive at 24 months. The
shape of the projection curve, considered in
the light
of
our past data, implies that aconsiderable proportion (perhaps 25%) will
survive 5 years or more (Fig. 1).
Furthermore, after the intensive
treat-ment, these children were all observed in
