The last weekend in the IPMH fellowship, we were treated to researchers on postnatal depression (PND) from the U.K., Lynne Murray and Peter Cooper. In this summary, I cannot do justice to the rich presentation and discussions that followed. What I will do instead is to note some of the main points and then illustrate them with descriptions of some of the wonderful film examples Lynne and Peter showed us. At the end I will include references to some of the studies so that those who are interested may read about the research in greater detail. http://www.reading.ac.uk/pcls/people/lynne-murray.aspx
On Friday, Lynne Murray lectured on the effects of PND on the child. She pointed out that PND occurs at a time when the infant is maximally dependent on the mother and also highly sensitive to the caregiver’s communications. Depression influences the communications that the caregiver gives the baby. The baby picks up for example whether the caregiver’s eyes are open or closed, whether her gaze is direct or indirect. By 8 weeks old, the baby is ready for “proto-conversations” – a variety of gestures and expressions that indicate the baby’s affect and intention and that demand contingent responses to maintain engagement.
When a mother is clinically depressed, she may fall into two broad patterns of insensitivity, either remoteness and disengagement, or hostility and intrusiveness, and in turn the infants may avoid contact and become depressed themselves. Boys are more vulnerable, perhaps because they intrinsically tend to need more support.
Murray showed a film of the first pattern of interaction with a depressed mother and her 12-week old baby. The mother says to her baby, “Oh, poor baby! I feel so sorry for you sitting there (in an infant seat) all by yourself! You’re struggling to get out!” In this example, the mother seems to perceive her baby as feeling as trapped as she herself might feel. Perhaps because she is weighted down by her own negative affect state, the mother cannot respond to the baby’s cues of widening eyes and open mouth, and so the baby gives up and withdraws. Naturally, the mother gets discouraged. A cycle gets going in which mother and baby both feel helpless.
In a film exemplifying the second pattern, the mother seems a little speeded up and anxious. She behaves in an pushy manner and cannot seem to sit back and attend to the baby’s cues. As the baby pulls away, the mother pushes forward. The mother changes the play agenda all the time; she decides the baby is fed up with a toy without any evidence from the baby’s behavior, and she takes it away, abruptly substituting another. This interaction also ends up in a discouraging experience for both mother and baby.
Two experimental paradigms demonstrate the effect on the baby of an interruption of maternal responsiveness. The first is Ed Tronick’s still face procedure in which the mother is instructed to interrupt her play with her baby and become unresponsive for a period of 1-2 minutes; the babies in these experiments are powerfully affected by the loss of their mother’s responsiveness. The second is a study by Lynne Murray that illuminated the refinement of the contingency response pattern between young infants and their mothers (Murray & Trevarthen, 1985). When babies were shown their mothers’ images on a television screen as the mothers were reacting to them in real time, the babies responded to them as if they were their interactive partners. Then when the mothers’ images were played back to them with the timing manipulated so that there was no contingency with the babies’ gestures (same mother, same baby, but gestures played back a little later than they were made), the babies’ gaze dropped off, the smiling stopped, and the baby became confused and distressed.
What are the ways that non-depressed mothers behave that support their babies’ psychological growth and development? The mother of a 3-month old facilitates the baby’s attention by closely monitoring the baby’s expressions to maintain the baby’s attention on an object, varying the experience enough to keep the baby’s interest. This is difficult for a depressed mother to do because she has difficulty picking up the baby’s cues. The non-depressed mother will also facilitate the baby’s potential by holding the toy at the right distance and keep the baby in the right position so that the baby can get the maximum benefit out of the toy. The non-depressed mother of a 12-month old will for example pick up toys to make them available to the child – indicating what the baby can do with it without taking over, steadying the toy so that the baby can achieve his own goals. In an example of a non-depressed mother sharing a book with her baby, the mother put her thumb under the page so that the baby could more easily turn the page himself.
Both the general patterns displayed by PND mothers – without intervention – can end up in persisting interaction difficulties, and in different kinds of negative outcomes in the developing child. Examples of these outcomes are a depression in IQ and school achievement, behavior regulation problems in childhood, and depressive disorders in childhood (Murray et al, 2010).
Murray L & Trevarthen C (1985). Emotional regulation of interactions between two-month olds and their mothers, In T A Field & N A Fox, Social Perception in Infants, Norwood, N.J., Ablex Publishers, pp. 177-197.
Murray J (2010). The effects of maternal postnatal depression and child sex on academic performance at age 16 years: A developmental approach, Child Psychol & Psychiat, 51(10):1150-1159.
Photo – Joshua Sparrow, M.D., Nov. 2012