Mental Health Desk

Infant Mental Health?

As a counselor with a master’s degree in psychology and 15 years experience in the secular mental health arena, I find myself increasingly tongue tied. Over the years, my faith in psychology has waned as my faith in Jesus has waxed. As I am paid to provide secular counseling, I often find myself carefully couching my comments in order to soften the impression of my skepticism toward the mental health field. In a similar way, I frequently find myself knowing exactly what needs to be said but unable to say so because that would be crossing the line into pastoral counseling. I often walk a tight-rope between providing mental health counseling within acceptable guidelines and providing genuine support and insight from an individual counselor who happens to be a Christian. At times, this tight-rope walk can become tedious. So, I turn to this blog as a venue for expressing some of the ideas related to both psychology and Christianity that I am otherwise unable to express.

An example of these conflicting influences occurred a few weeks ago when I got an e-mail from a mental health administrator and the other day when I had a chance encounter with a religious volunteer. The e-mail from the mental health department was announcement for the First Annual Infant Mental Health Conference at Chatham University. My first thought was, “Infant Mental Health? Soon they’ll be diagnosing babies in the womb.” I laughed and thought I might mention it to the very interesting man who forwarded the announcement to me. Several days later, I ran into him and asked his opinion. He chuckled and said, “Infant Mental Health. Soon, they’ll be diagnosing fetuses in the womb.” We had the same thoughts. That was settled. I considered the whole infant mental health topic yet another quackery coming out of the mental health field. I didn’t think again about it until several days later, when I had the chance encounter with the religious volunteer. He was offering pastoral counseling at the local jail where I happen to work providing mental health assessment and counseling. I guess he had had a bad day because he commented that he wasn’t sure he was doing any good. He said, “These guys keep promising they’ll come to church when they get out and the next time we see them they’re back in jail.” I knew exactly what he was talking about. Anyone who has spent any time in corrections knows about jailhouse religion—saved inside jail and a sinner outside. This led me to a thought that has often troubled me: “Are there some people who are constitutionally incapable of a genuine faith in God?” Of course, with God, anything is possible. Nonetheless, there are a small percentage of people (maybe 20 percent of inmates and 2 percent of the general population) who do not experience what most people would call a conscience. These people, it seems, are able to mock a certain kind of religious conviction, but when given enough freedom to do other things, their religiosity disappears. How do they get this way? There are probably several different pathways to sociopathy, including head trauma and possibly some genetic anomalies, but the main suspect is early childhood development, a profound failure to attach to parents. In other words, for these few individuals, their inability to connect and empathize with other people--and ultimately with God--starts from very early childhood, with poor infant mental health.

The criminal justice system is currently deluged with a wave of young men and women who were first introduced through the media twenty years ago when they were infants. They are a forgotten segment of their generation. They are the crack babies come of age. Some of these individuals may have started out with neurological and organic difficulties. Almost all of them have dealt with abandonment, neglect, abuse, foster-care systems, and life on the streets. As a matter of survival, they have learned to trust no one, including their own parents. They have learned to fend for themselves often at the expense of others. In the past, there have always been such children, often from alcohol-dependent or drug-addicted parents. But never before have there been so many and with such severe problems. Their numbers seem to be growing.

In looking over the agenda for the First Annual Infant Mental Health Conference, the organizers seem to have these types of problems in mind. They are concerned with early intervention by providing support and resources for mothers and families so they can properly care for the children. They also are willing to step in when the parents are damaging the welfare of their children ages 0 to 3. There does seem to be a fair amount of information on infant mental health available, including the Infant Mental Health Journal, the Institute for Training in Infant and Preschool Mental Health, and the Infant-Parent Institute. Several of these organizations seem decidedly liberal in their leanings. They frequently refer to an overwhelming body of research that they fail to cite or delineate specifically. Nonetheless, I think there is something about this Infant Mental Health movement (can I call it a movement?) that is worth considering with a few minor caveats.

Barring what are essentially medical problems, it is impossible for an infant to be mentally ill. If there is a problem, the responsibility rests squarely with the parents. Attachment disorder is the single-most salient construct that comes out of this movement. This is both the most brilliant and idiotic mental health diagnosis ever. It’s brilliant because it links an early developmental circumstance to ongoing adult behaviors. It’s absurd because no other diagnosis identifies a patient with a problem that is fundamentally not theirs. Infants do not fail to attach; parents fail to attach with their infant children! So, when someone tells me their kid has attachment disorder, I resist the urge tell them, “No, your kid doesn’t have attachment disorder, you do!” Likewise, the problem is not infant mental health, but the lack of parental mental adjustment and their consequent inadequate parenting.

Organizations involved with the Infant Mental Health movement, for example, Zero to Three, do not take their apparently vast body of research and challenge the emerging status quo. While these organizations acknowledge the importance of parental bonding, they also spend a fair amount of time discussing appropriate daycare. Rather than focus on the fundamental relationship between mother and child, they discuss how to teach toddlers pre-math skills. They quote overwhelming evidence that supports the efficacy of head start programs, but they fail to acknowledge that student achievements are negligible by 2nd grade. In short, these organizations espouse shaping educational opportunities, from early potty training to reading, without acknowledging that children may be able to mimic these skills easily without much comprehension. The net result is a regimented and directed upbringing that makes parents feel good but does little to develop a real parent-child bond.

In some ways, the individuals in jail are very similar to the children in daycare. They lack any significant or reciprocal attachment to their caregivers but merely go through the motions. Many of them become jailhouse Christians—a person who can mimic Christianity without really grasping or maintaining that belief. They can read scripture verses together, sing songs, and talk about trials and tribulations. But if they cannot form a relationship, very little will come of it. Of course, many of these individuals are profoundly flawed and disconnected. Particularly with the most hardened individuals, it is only through God’s mercy and grace that a breakthrough is possible. I go to work. I do my best within the confines of what I can ethically do as a secular mental health provider. But, to me, the most important part involves the words that I cannot say aloud in the counseling office. The most powerful part of my day is in the quiet of my room when I pray for them.