Mei, mother of four-month-old Amy, called to make an appointment in my behavioral pediatrics practice. Her thick accent made it difficult for me to understand her concern over the phone. She arrived at my office with her husband, Yuan, who spoke little English. I learned that they had recently immigrated from China. Although I had a blanket on the floor covered with toys, Mei stood tentatively, her movements awkward and hesitant, until I suggested she put Amy down.
Immediately Amy gave me a huge grin, kicking her little legs that her mother had, with my gentle encouragement, released from her snowsuit. At first Mei sat tensely on a chair, not joining us on the floor, speaking in a somewhat remote and intellectual tone, while she told me her story. I played with Amy, smiling with her as I observed that she liked to be held in a standing position to better see the world. Mei eventually joined us on the floor but did not join me in playing with Amy.
Mei was fully absorbed in describing a scary moment just after Amy’s birth, when she had needed some oxygen. Amy had been in the special care nursery for about an hour before she was reunited with her mother. Multiple doctors had reassured Mei that Amy was fine. She had seen her regular pediatrician for checkups, and he had expressed no concerns about Amy’s development. Yet Mei was convinced that there was something wrong with her brain. Specifically with her ability to relate to other people—it was her social development that Mei was worried about.
Puzzled by the incongruity between this delightful healthy baby and this anxious, unengaged mom, I watched the story unfold so that I might make sense of it. About halfway through the visit, Amy began to fuss. Yuan swooped in from his position on the periphery of the room and immediately began to give Amy a bottle. She continued to fuss, her father making repeated efforts to force the bottle in her mouth while Mei helplessly looked on. Now I began to put the pieces together. Mei had told me that she was the breadwinner and worked long hours. Yuan had been a practicing physician in their home country, but he had not gotten his US medical license, and so was Amy’s primary caregiver.
As Amy continued to fuss, I asked Mei whether she perhaps knew what would soothe the baby. When Yuan moved in, she had withdrawn again, getting up from the floor and sitting stiffly in a chair. When I encouraged her to take the baby, she stood and made motions toward Yuan and Amy. I stood with them. The three of us were now standing in our socks. Even when Amy was in her mother’s arms, Yuan continued to make efforts to grab the baby back. I shared my observation that Yuan, likely because he was used to having primarily responsibility, seemed inclined to take over without giving Mei space to figure things out with her daughter. But she had a different interpretation of his behavior. “He thinks I don’t know how to take care of her.”
I now had a better understanding of the situation. Amy had been a fussy baby until she was about eight weeks old, just the time when Mei had gone back to work. They had never gotten a chance to learn to read each other’s signals. “I wonder if you miss Amy,” I said. Immediately her eyes filled with tears. Her whole posture changed. Words poured out as she shared her feelings of terrible inadequacy. She described her heartache and humiliation going to a mother-baby group where the other mothers seemed to know exactly how to respond to their infants, and she felt unsure and helpless. As she spoke, she stood with Amy in her arms, walking around the space and gently rocking her. Amy quieted and again smiled, this time at her mother.
Mei was not worried about Amy’s social development, but rather Amy’s connection specifically with her. It took this setting and this hour when we were free to move around and “play” to come to this new understanding. Mei came into the visit with a stance of defensiveness that was most likely completely out of her awareness. I did not ask her questions but instead let the experience of being with me, with an expanse of time to relax, allow her to let her defenses down. But it did not take much time. By forty minutes into the visit there was a profound transformation in the bodies of both mother and daughter as they relaxed into each other. While Yuan was limited by language, he, too, seemed relieved that his wife was happy.
While we were not measuring heart rate or blood pressure, we could see the change in physiology reflected in Mei’s change in posture, in the way she held her body. That stiff, awkward stance gave way to natural movement. We both stood, Mei facing me and looking directly at me as she gently rocked her baby.
Within the first five minutes of the visit, I could tell that Amy was a developmentally normal, healthy baby. But Mei was not ready to hear it. What seemed to me an “irrational” worry was her brain’s defensive response in the face of overwhelming shame. She was unable to engage the higher cortical centers of her brain responsible for rational thought. It is possible that, under control of the primitive vagus- a branch of the parasympathetic nervous system that takes over when a person feels threatened-Mei could not hear the doctors’ reassurances. I needed to offer her space and time to let those defenses down.
Yuan remained on the periphery of this dance. He made a few attempts to take Amy from her mother. I gently encouraged him to give her some time. My understanding of the situation was that Mei had not had a chance to learn her own dance with Amy. She needed to experience the normal mismatch and repair (as described in my recent book The Power of Discord with co-author Ed Tronick) to develop her own relationship with her daughter. When her husband, with the best of intentions, swooped in to take the baby whenever she fussed, Mei and Amy lost the opportunity.
I described to Mei her experiencing as common phenomenon for fathers. When mothers are the primary caregivers, they may claim they know the baby best and so not give fathers a chance. Here the situation was reversed and made even more painful because of the expectation that as the mother, Mei should instinctively know how to comfort her baby. I suggested that Mei share our observations with Yuan at home when they could speak their native language. She would ask him to give her a chance to comfort Amy before grabbing her away.
I learned, when I saw them a few weeks later, that Mei had changed a lot more in her life than the way she cared for her baby. That one-hour visit when the family moved through disconnection to reconnection had provided the energy to transform this young family. Mei had changed her schedule, working fewer hours so that she could spend more time with Amy. Yuan had gotten a job. While he could not practice medicine, he was willing to do work with less training required to help support the family if it would benefit the relationship between his wife and daughter. During our visit, Mei had an opportunity to feel her connection with her daughter and feel the pain of that lost connection. She saw that she did not want to live her life like that. During our follow up visit Mei’s confidence had increased dramatically. Her worries that there was “something wrong” with her daughter had vanished.
A great teacher once said to me, “Reassurance is an assault.” When a parent worries something is wrong with their child, reassurance that “everything is fine” can feel dismissive, producing a sense of being misunderstood and alone. Behind the worry lies a story. With protected time for listening, meaning can come to light.