The Lasting Influence of Mother-Infant Attachment

A storied American pediatrician's international travels took him to Japan, where he worked with a population that never experienced postpartum depression -- possibly because new mothers regressed to babyhood for one month.

Jim Epler/Flickr

In 1983, I was invited by the Japanese government and my friend Noburu Kobayashi to come to Japan. Noburu (or Kobey, as we called him) and I had met at various international conferences. A pediatrician, he held a high position in the government, involved in infant health. When he learned about my Neonatal Behavioral Assessment Scale (NBAS), he sent one of his students to be trained. Noburu wanted him to train Japanese doctors to use the NBAS all over Japan. Noburu had a great friend and advocate, Mr. Masaru Ibuka, the former CEO of Sony. He was powerful and very interested in fostering Japanese awareness of the importance of infancy and of early attachment of parents to their infants. He saw that Japan was about to change, with more and more women in the workforce, and he wanted to be sure to protect the mother-child relationship.

An unusual event in Japan had taken place. It was reported that over a period of two years, several eight- and nine-year-old boys had killed their mothers. These tragedies were blamed on the intense desire for upward mobility among Japanese parents. They pushed, pushed, pushed their children to get into the right child-care center, the right preschool, the correct grade school, and the right secondary school. When the child didn't make it, some became so upset that they killed the only person they could blame: their mothers. This was absolutely frightening to the Japanese government, as well it should have been. Mr. Ibuka and Dr. Kobayashi made plans to get an unusual team of experts together to travel all over Japan, talking about early attachment and its importance. Jane Goodall, who worked at the Gombe Reserve in Africa for chimpanzees and may well know more about chimpanzee nurturing than anyone in the world, was invited. A famous Australian child psychiatrist, Paul Campbell; a French educator; and my wife Chrissy and I were to go.

When we arrived in Japan, we were housed in a fabulous old inn. The rooms were traditional Japanese: mats on the floor on which we slept; paper walls, which we rolled back to go from one room to another; bathrooms with squatting toilets. So many things to learn in a new culture; the paper walls were magnificent, with very subtle designs, but one could hear everything from one room to another.

The four of us "experts" went from city to city in Japan: Tokyo, Kyoto, Osaka, Nagasaki. Jane talked about her chimp babies in just the way I talked about our human babies. She showed how she held them gently out in front of her, to talk to them face to face. She had superb films of chimp mothers and even fathers nurturing their babies in the wild. As we went around to each city, hundreds of parents gathered for each presentation. None of us could speak Japanese, but that didn't seem to dampen the enthusiasm. We were told that we were making an impact on Japanese parents. Hard to believe.

In Osaka, a prominent private researcher took Chrissy and me out to his reserve so we could observe nonhuman parent-infant inter­action "in the wild." In Nagasaki, an orthopedic surgeon, Dr. Tomitaro Akiyama, introduced himself. He had translated the NBAS into Japanese and taught people to use it. In Japan, he explained, orthopedists are responsible for early intervention with children with special needs. He was interested in starting early intervention with these children from birth onward. At his hospital, they did very well in making up for a child's developmental delays that involved movement (motor delays), but he said that the children didn't "make the progress he'd like in cognitive and emotional development because their parents won't stay involved."

"Especially on the Goto Islands off the coast," he said, "we can't get parents interested enough to bring their children to us for early intervention." He asked for our help.

The Goto Islands are part of a chain in the Pacific from Okinawa to Korea. There are 140 islands in all, 5 main ones. (Goto means "five" in Japanese.) They were the last stops for sailing ships before leaving for China. They were undeveloped, still traditional fishing islands. Their whole economy is fishing. The men fish; the women mend nets and clean fish.

My son, Tom, and I went. We lived on the main island, Fukue, for a month. We enlisted thirty newborns for our study. At birth, the newborns were sturdy, beautiful, quiet babies who paid attention for prolonged periods. Their movements were liquid and gentle, and their fingers and toes were freely involved in their ballet-like movements. Like the Mayan babies I'd studied, they were born and raised in the context of low-keyed motor activity, and so a newborn would pay attention to a soft rattle, a red ball, or your face for as long as thirty minutes without a break. I had been able to produce at most three to five minutes of tracking and listening in US newborns. This difference in the ability to pay prolonged attention was amazing to me, representing differences in genetic endowment and early environment.

I decided to see how basic this prolonged attention would be if the environment were different. In the Goto Islands, women were quiet, slow moving, and never exposed to loud noises or activity. So I also observed mothers and infants in Tokyo. There, women were dashing around amid loud noises, traffic, and the like. Their newborns still had long attention spans, but not thirty minutes. They managed about eighteen minutes without a break. Later, a study of Asian babies in San Francisco showed that a newborn's attention span there was down to twelve minutes. We felt this was a great example of the effects of experience before birth in shaping the behavior of the newborn.

Mothers in the Gotos walk slowly and live a quiet life. They talk to each other in low-pitched voices. Tension is not high in the Goto Islands, as far as we could observe. The fetus's experience during pregnancy is a gentle, calm, well-fed one. In Tokyo, mothers are under much more stress. They walk differently; they rush to cross an intersection, looking up and down then hurrying across the street. All day, their movements and lives are more punctuated with jerky, tense movements, and stressful, noisy events. These provide the fetus with a different experience than that in the Gotos. In San Francisco, the effects of a stressfully active life are even greater. Nature and nurture already work together to create differences at birth. Add these to the effects of very different lives ahead. It isn't hard to visualize the different kind of adults this will produce.

The Goto mothers (who had been mending nets and cleaning fish until they delivered) stayed in the hospital for seven days. Then they were sent to their mothers' homes. There, they were expected to re­gress completely. Wrapped in a futon, each with her baby next to her, they were treated as babies themselves for one month. Their only job was to feed their babies. When they needed to go to the toilet, someone helped them. They were fed by chopsticks "like a baby." Spoken to in baby talk, they responded in baby talk. Chisato Ka­wasaki, a ­pediatrician who was with us, documented the fact that there were no postpartum depressions after this early treatment. In Japan, a new mother could regress to her own babyhood for one month.

The thirty newborns we evaluated on the Goto Islands were half from fishing families, half white collar. We scored them by their performance on the NBAS, especially for their responsiveness to faces and voices and to nonhuman stimuli, for their motor fluidity and competence, and for their ability to soothe themselves when they were upset. We planned to see whether these scores predicted how well the babies would do on cognitive tasks later on. We returned every two years to evaluate them. At first we used the Bayley exam, later the Stanford-Binet. Each year, these exciting babies maintained high scores. The children all progressed equally through the third year. Then, half of them continued to make optimal progress on the test scores, but the other half began to level off and even to lose levels of IQ functioning by the age of five. Those babies who lost IQ, however, were well equipped to respond, and, with pressure, extra time, and assurance, they could achieve the higher levels of their peers. It became apparent that it was not the ability to achieve optimal scores but the motivation and the excitement of being tested that were significantly different. The white-collar ­parents who wanted their children to succeed in the corporate world of ­Japan were pushing them -- four-year-olds in preschool, then school. The fishing parents were not pushing their children to perform cognitively. They expected them to stay on the island and fish. The ­potential of the child in the cognitive area was not their measure of success.

When we returned several years later, the fisherman's children were in school, but relaxed, content with joining their parents in their traditional work. Children pressed by their parents were likely to be tense, often with problem behavior. Many of them had gone to the mainland to be prepared for high-powered careers and thus were already out of touch with their families.

This is an excerpt from Learning to Listen: A Life Caring for Children.