3-year-old Peter was referred to my behavioral pediatrics practice for help with “managing his aggression.” I met with his parents, Jonathan and Jalissa, for a full hour in which I listened to their story. In the second session a week later, we are all sitting on the floor. Peter drapes himself across his father’s lap, wriggling around while drawing with markers on a pad on the floor. His mother watches them. There is a long moment when it feels like nothing is happening. I observe in myself that sense of not knowing what’s going on, but will myself to tolerate the discomfort of uncertainty.
Jalissa tilts her head and quietly says “hmmm.” I notice and ask her what she is thinking. She starts to wriggle her body in a way similar to Peter. She tells me that his movement bothers her intensely. She feels herself becoming agitated just watching him despite the calm of the moment.
I then engage Jalissa in a detailed conversation about her experience. She says that she anticipates an impending escalation in his behavior. Drawing on the history she shared in our first session, I wonder aloud if this kind of interaction between them has been going on for a long time. She says yes, since he was born. When he would cry inconsolably, her agitation would quickly rise. She felt angry and inadequate. She gestures how she would throw the baby at Jonathan when he got home from work. We spend some time talking about how now she and her son set each other off. His behavior, which they name “aggression,” escalates, in turn escalating her distress. She recognizes the roots of his ability to “push her buttons” in her own family’s quashing of negative emotions when she was a child.
While we are having this conversation Jonathan engages with Peter in imaginary play. Peter takes a small toy bear from a box of toys on the floor. He places it under a chair and then wants to cover it over. He looks for something to hang over the chair. He finds a baby blanket and proceeds to drape it over the chair. The bear is completely hidden.
Once this setup is in place, Jonathan joins our conversation. Jalissa’s discussion of Peter’s difficult infancy seems to have come to a natural end. Jonathan shares a story to explain what has unfolded in their play. When Peter would have a difficult moment, such as screaming inconsolably in the car, they would ask him, ”were you born to a family of bears?” Jonathan pauses and then says, “ I wonder if he doesn’t like that we say that.”
In his book Playing and Reality, in a paper titled, “Uses of an Object” pediatrician turned psychoanalyst D.W. Winnicott uses the word “aggression” to describe variations in typical newborn behavior. “Temperament,” “state regulation” ‘sensory processing differences,” or simply variations in feeding, sleep, and crying are other ways to describe these individual differences. Pediatrician T. Berry Brazelton created the Neonatal Behavioral Assessment Scale to document the tremendous range of the unique qualities babies bring into the world at birth. Winnicott writes:
“Undoubtedly inborn aggression must be variable in a quantitative sense in the same way that everything else that is inherited is variable between individuals. By contrast, the variations are great that arise out of the differences in the experiences of various newborn babies according to whether they are or are not carried through this very difficult phase.”
“Difficult” refers to the helplessness of the newborn infant who relies completely on their caregivers to contain their experience. Winnicott recognized aggression as a healthy part of development. But for Jalissa, her son’s behavior held meanings different from his intentions. His intense cry likely communicated need for support managing the power of his bodily sensations. Baby Peter was not “angry.” But his mother was. Not at him, but at the suffocating silencing of her own aggression as a child. Before our visit, Jalissa, like her infant son, held these meanings in her body, in the form of physical agitation provoked by his behavior. Because of these hidden meanings, she struggled to “carry him through,” instead relinquishing the role to Peter’s father.
When I saw Jalissa and Jonathan alone the following week, they described a remarkable transformation. While preparing for a day trip to visit a relative, Jalissa had recognized the stress of the transition, both for herself and for her son. Observing the reaction in her body, she took deliberate steps to calm herself and found she could in turn help Peter to contain his distress. Jonathan told a similar story. Pushing Peter in the swing in a recent early morning outing to the playground, they were enjoying the peaceful quiet when a group of families arrived, suddenly puncturing the silence as children approached the swings with healthy shouts of glee. Jonathan saw his son’s body stiffen and his face freeze. In recalling the moment, Jonathan’s voice cracked. We all paused to give space for his emotion. Tears fell as he explained the newfound empathy for his son’s experience that he had gained the previous week. Jonathan’s calm presence and reassuring voice as he acknowledged his son’s response allowed them to finish swinging and leave the playground without incident.
When a parent’s own distress distorts their ability to receive and contain their child’s healthy aggression, a downward spiral of dysregulation for both parent and child may occur. This situation brought Peter and his family to my office. Winnicott points the natural progression of this kind of situation in a potentially dark direction. He warns of the possibility of a loss of hope when a child senses their caregiver’s inability to meet and contain their experience.
Just a little bit of time and space to listen to both his parents’ story and to Peter’s “voice,” as expressed through his play, led this young family from shame and anger to understanding and connection. Winnicott frames an interaction in which a parent “survives” their child’s aggression- without “retaliation”- as a source of hope. He describes the countless healthy repetitions of this process as “the unconscious backcloth for love.”
First, thank you for your years of dedication to babies and caregivers.
I am strugging with the word “disorganization” in your second to last paragraph. Would “dysregulation” be a suitable alternative? My concern is that “disorganization” can be misunderstood given its use over the past 40 years in the attachment (relationship) literature. “Dysregulation” may also present with similar challenges in the community of practitioners and scholars but it has not reached the popular imagination in a manner similar to “disorganization”.
Thank you for your thoughtful comment. Language is so important. My first thought is how Berry Brazelton often used to say “value disorganization” but the word does have dark connotations within the attachment literature. Bruce Perry often says that ” a dysregulated parent cannot regulate a dysregulated child” which is the idea I was trying to capture here. But “regulation” itself is fraught in both writings for both general and professional audiences with complex meaning that can be equated with “self-control.” In our book The Power of Discord (Little, Brown 2020) Ed Tronick and I address this question directly:
“Self-regulation is different from self-control, a relatively cold term which implies a need to rein in our intense feelings. Rather, it refers to an ability to engage in the world and experience a full range of emotions without falling apart.”