The Boy Who Was Raised as a Dog (14 page)

By then she had graduated high school. She was placed in a halfway house for children “aging out” of foster care in a low-income community. Cut off from her loved ones, with no clear-cut rules to follow and seeking affection, Virginia rapidly became pregnant. The father of her child left her, but she wanted a baby to love and she wanted to do the right thing, as her foster parents had taught her. She sought prenatal care and was quickly enrolled in a good program for high-risk mothers. Unfortunately, as soon as the baby was born, she no longer qualified for that program because she wasn't pregnant anymore. After she gave birth, she was on her own.

But Virginia had no idea what to do with her baby after she left the hospital. Having had her own early attachments abruptly and brutally terminated, she didn't have what some might call the “maternal instinct.” Cognitively, she knew what basic acts needed to be performed: feed Laura, dress her, bathe her. Emotionally, however, she was lost. No one had thought to specifically instruct her to provide the loving, physical interactions that infants need, and she didn't feel compelled to do them on her own. Simply, Virginia got no pleasure from these things and she had not been taught that she should do them. Not pulled by her limbic, emotional systems and not pushed by her cognitive, information-carrying cortex, Virginia parented in an emotionally disconnected way. She didn't spend much time holding her baby; she fed the little one propped up with a bottle, not nuzzled close to her bosom. She didn't rock her, didn't sing to her, didn't coo or stare into her eyes or count her perfect tiny toes over and over or do any of the other silly but hugely
important things that people with ordinary childhoods instinctively do when caring for a baby. And without these physical and emotional signals that all mammals need to stimulate growth, Laura stopped gaining weight. Virginia did what she thought was the right thing, not because she felt it in her heart, but because her mind told her that's what a mother “should” do. When she got frustrated, she either harshly disciplined the child or ignored her. She simply didn't feel the contentment and joy from the positive caregiving interactions that normally help parents overcome the difficult emotional and physical challenges of child-rearing.

The term used to describe babies who are born normal and healthy but don't grow, or even lose weight following this form of emotional neglect, is “failure to thrive.” Even back in the eighties, when Laura was an infant, “failure to thrive” was a well-known syndrome in abused and neglected children, especially those raised without enough individualized nurturing and attention. The condition has been documented for centuries, most commonly in orphanages and other institutions where there is not enough attention and care to go around. If not addressed early, it can be deadly. One study in the forties found that more than a third of children raised in an institution without receiving individual attention died by age two—an extraordinarily high death rate. The children who survive such emotional deprivation—like the recent Eastern European orphans, one of whom we'll meet later—often have severe behavioral problems, hoard food, and may be overly affectionate with strangers while having difficulty maintaining relationships with those who should be closest to them.

When Virginia first sought medical attention for her baby eight weeks after she was born, Laura was correctly diagnosed with “failure to thrive” and was admitted to the hospital for nutritional stabilization. But the diagnosis wasn't explained to Virginia. Upon being discharged she was only given nutritional advice, not advice on mothering. A social work consult had been suggested yet it was never ordered. The issue of neglect was ignored by the medical team in large part because many physicians find “psychological” or social aspects of medical problems less interesting
and less important than the primary “physiological” issues. Further, Virginia didn't seem like a neglectful mother. After all, would an uncaring mother seek out early intervention for her newborn?

And so, Laura still didn't grow. Several months later Virginia brought her back to the emergency room seeking help. Unaware of Virginia's history of disrupted early attachment, the doctors who saw her child next thought Laura's problems had to be related to her gastrointestinal system, not her brain. And so began Laura's four-year medical odyssey of tests, procedures, special diets, surgeries and tube feeding. Virginia still didn't realize that her baby needed to be held, rocked, played with and physically nurtured.

Babies are born with the core elements of the stress response already intact and centered in the lower, most primitive parts of their developing brains. When the infant's brain gets signals from inside the body—or from her external senses—that something is not right, these register as distress. This distress can be “hunger” if she needs calories, “thirst” if she is dehydrated, or “anxiety” if she perceives external threat. When this distress is relieved, the infant feels pleasure. This is because our stress-response neurobiology is interconnected with the “pleasure/reward” areas in the brain, and with other areas that represent pain, discomfort and anxiety. Experiences that decrease distress and enhance our survival tend to give us pleasure; experiences that increase our risk usually give us a sensation of distress.

Babies immediately find nursing, being held, touched, and rocked soothing and pleasurable. If they are parented lovingly, and someone consistently comes when they are stressed by hunger or fear, the joy and relief of being fed and soothed becomes associated with human contact. Thus, in normal childhood, as described above, nurturing human interactions become intimately and powerfully connected with pleasure. It is through the thousands of times we respond to our crying infant that we help create her healthy capacity to get pleasure from future human connection.

Because both the brain's relational and pleasure-mediating neural systems are linked with our stress-response systems, interactions with loved
ones are our major stress-modulating mechanism. At first babies must rely upon those around them not only to ease their hunger, but also to soothe the anxiety and fear that come from not being able to obtain food and otherwise care for themselves. From their caregivers they learn how to respond to these feelings and needs. If their parents feed them when they are hungry, calm them when they are frightened and are generally responsive to their emotional and physical needs, they ultimately build the baby's capacity to soothe and comfort themselves, a skill that serves them well later when they face life's ordinary ups and downs.

We've all seen toddlers look to Mom after scraping a knee: if she doesn't look worried, the child doesn't cry; but if baby sees a look of concern, the loud wailing begins. This is only the most obvious example of the complex dance that occurs between caregiver and child that teaches emotional self-regulation. Of course some children may be genetically more or less sensitive to stressors and stimulation, but genetic strengths or vulnerabilities are magnified or blunted in the context of the child's first relationships. For most of us, including adults, the mere presence of familiar people, the sound of a loved one's voice, or the sight of their figure approaching, can actually modulate the activity of the stress-response neural systems, shut off the flood of stress hormones and reduce our sense of distress. Just holding a loved one's hand is powerful stress-reducing medicine.

There is also a class of nerve cells in the brain known as “mirror” neurons, which respond in synchrony with the behavior of others. This capacity for mutual regulation provides another basis for attachment. For example, when a baby smiles, the mirror neurons in his mother's brain usually respond with a set of patterns that are almost identical to those that occur when Mom herself smiles. This mirroring ordinarily leads the mother to respond with a smile of her own. It's not hard to see how empathy and the capacity to respond to relationships would originate here as mother and child synchronize and reinforce each other, with both sets of mirror neurons reflecting back each other's joy and sense of connectedness.

However, if a baby's smiles are ignored, if she's left repeatedly to cry alone, if she's not fed, or fed roughly without tenderness or without being held, the positive associations between human contact and safety, predictability and pleasure may not develop. If, as happened in Virginia's case, she begins to bond with one person, but is abandoned as soon as she feels comfortable with her particular smell, rhythm and smile, and then abandoned again once she acclimates to a new caregiver, these associations may never gel. Not enough repetition occurs to clinch the connection; people are not interchangeable. The price of love is the agony of loss, from infancy onward. The attachment between a baby and his first primary caregivers is not trivial: the love a baby feels for his caregivers is every bit as profound as the deepest romantic connection. Indeed, it is the template memory of this primary attachment that will allow the baby to have healthy intimate relationships as an adult.

As a baby Virginia never really got the chance to learn that she was loved; as soon as she grew used to one caretaker, she was whisked off to another one. Without one or two consistent caregivers in her life she never experienced the particular relational repetitions a child needs to associate human contact with pleasure. She did not develop the basic neurobiological capacity to empathize with her own baby's need for physical love. However, because she did live in a stable, loving home when the higher, cognitive regions of her brain were most actively developing, she was able to learn what she “should” do as a parent. Still, she didn't have the emotional underpinnings that would make those nurturing behaviors feel natural.

So when Laura was born, Virginia knew that she should “love” her baby. But she didn't feel that love the way most people do, and so she failed to express it through physical contact.

For Laura, this lack of stimulation was devastating. Her body responded with a hormonal dysregulation that impeded normal growth, despite receiving more than adequate nutrition. The problem is similar to what in other mammals is called “runt syndrome.” In litters of rats and mice and even in puppies and kittens, without outside intervention
the smallest, weakest animal often dies in the few weeks following birth. The runt doesn't have the strength to stimulate the mother's nipple to produce adequate milk (in many species, each baby prefers and suckles exclusively from a particular nipple) or to elicit adequate grooming behaviors from the mother. The mother neglects the runt physically, not licking or grooming him as much as she does the others. This, in turn, further limits his growth. Without this grooming his own growth hormones turn off, so even if he does somehow get enough to eat, he still doesn't grow properly. The mechanism, rather cruelly for the runt, directs resources to those animals best able to utilize them. Conserving her resources, the mother feeds the healthier animals preferentially, since they have the best chance of surviving and passing on her genes.

Infants diagnosed with “failure to thrive,” are often found to have reduced levels of growth hormone, which explains Laura's inability to gain weight. Without the physical stimulation needed to release these hormones, Laura's body treated her food as waste. She didn't need to purge or exercise to avoid gaining weight: the lack of physical stimulation had programmed her body do so. Without love, children literally don't grow. Laura wasn't anorexic; like the scrawny runt in a litter of puppies, she just wasn't receiving the physical nurturing her body needed to know that she was “wanted,” and that it was safe to grow.

 

 

WHEN I'D FIRST ARRIVED in Houston, I'd gotten to know a foster mother who often brought children to our clinic. A warm, welcoming person who didn't stand on ceremony and always spoke her mind, Mama P.* seemed to know intuitively what the maltreated and often traumatized children she took in needed.

As I considered how to help Virginia help Laura, I thought back on what I'd learned from Mama P. The first time I met her I was relatively new to Texas. I had set up a teaching clinic where we had a dozen or more psychiatrists, psychologists, pediatric and psychiatry residents,
medical students and other staff and trainees. This was a teaching clinic designed, in part, to allow trainees to observe senior clinicians and “experts” doing clinical work. I was introduced to Mama P. during the feedback part of an initial evaluation visit for one of her foster children.

Mama P. was a large, powerful woman. She moved with confidence and strength. She wore a large brightly colored muumuu and had a scarf around her neck. She'd come for a consultation about Robert, a seven-year-old child she was fostering. Three years before our visit, this boy had been removed from his mother's custody. Robert's mom was a prostitute who'd been addicted to cocaine and alcohol for her son's whole life. She had neglected and beaten him; the boy had also seen her beaten by customers and pimps and had himself been terrorized and abused by her partners.

Since being removed from his home Robert had been in six foster homes and in three shelters. He had been hospitalized for out-of-control behaviors three times. He had been given a dozen diagnoses including attention deficit hyperactivity disorder (ADHD), oppositional deficit disorder (ODD), bipolar disorder, schizoaffective disorder and various learning disorders. He was often a loving and affectionate child, but he had episodic “rages” and aggression that scared peers, teachers and foster parents enough for them to reject him and have him removed from whatever setting he was in after he went on one of his rampages. Mama P. had brought him to us because once again, his inattentiveness and aggression had gotten him into trouble at school and the school had demanded that something be done. He reminded me of many of the boys I had worked with in Chicago at the residential treatment center.