This is a fantastic essay! It is by a nursing student; Kathryn. Email me if you would like the references.Disembodied from the beginning: the practice of controlled crying
In recent decades, nursing has moved away from biomedical theories in favour of theories that value individual experience (Madjar 1997, p. 55; Koernig Blais et al. 2006). Nurses are now expected to listen to patients and respect their experiences as embodied people (Erickson, Tomlin & Swain 1983, p. 46; Lawler 1991, p. 29), not separate the physical, emotional, social and spiritual aspects of self and treat people as just a body with a problem to be fixed. But what of those who have a voice that is misunderstood, or worse, ignored, whose attempts to communicate their most basic needs go unheeded? In western societies, babies, perhaps our most vulnerable and powerless members of society, are disembodied, and this is not simply condoned by the medical and nursing professions, but actively promoted by many.
This paper explains how controlled crying disembodies babies. It briefly reviews embodiment research specific to infants, explores the history and theories behind controlled crying and examines the societal factors that lead parents, particularly mothers, to adopt the practice. The implications of controlled crying for the infant are discussed, and the idea that it is as harmless as many doctors and nurses who promote it believe is challenged. The paper explains how embodiment theories specific to pain and illness apply to healthy infants, and concludes with implications for nursing practice. Not included is a detailed discussion of the effectiveness of controlled crying programmes. Knowledge of this is important in understanding why controlled crying is promoted by many and is in such wide use. The benefits for families when controlled crying is effective, particularly for mothers with post natal depression, is well researched, from Dr Ferber (1985) who pioneered the method, through to more recent studies (Pearce & Bidder 1999; Hiscock & Wake 2002; Hawkins-Walsh 2003; Skuladottir & Thome 2003; Hall et al. 2006), but is outside of the scope of this paper. Also omitted is a discussion of alternative settling methods and sleeping practices (McKay 2001; Pantley, 2002; Buckley 2005; Buckley 2006).
Early modern embodiment theorists include Sartre (c1960 cited in Lawler 1991, p. 57) who wrote about the body as being socially constructed, Merleau-Ponty (1962 cited in Madjar 1997, p. 55; Lawler 1991, p. 58; Marriner-Tomey & Alligood 2006, p. 172) who argued that the body is central in developing ones identity, and Heidegger (1962 cited in Madjar 1997, p. 55; Marriner-Tomey & Alligood 2006, p. 172) who wrote about existentialism and caring. These theories formed a basis for later embodiment and holistic nursing theorists such as Neumann (1989) Lawler (1991) and Madjar (1997), but most of these theories are concerned with illness and health in adults. There has been little written about infants and embodiment, perhaps because their communication skills are limited and it’s difficult to understand an infants’ lived experience. What little embodiment research specific to infants has been reported includes studies of the birth experience (Goldberg 2002), the mother/baby dyad (Bartlett 2000; Dykes 2005) and cultural embodiment and early experience (Rydstrom 2001), which are not very relevant in a discussion about controlled crying in western societies. This paper therefore focuses on how general embodiment theories illustrate the disembodiment of infants in the practice of controlled crying.
Over the past 150 years scientific approaches and ‘experts’ have taken over from maternal instincts and started telling parents how to raise children (Buckley 2005, p. 258; Kitzinger 2006). In the 1870’s parents were told that babies cry for exercise, that it is beneficial and should be ignored (Smiles 1871 cited in Kissinger 2006, p. 77). In the 1940’s the ‘rules’ dictated that every baby should sleep for 19 hours a day, be placed alone in its cot after the six o’clock feed and left to cry it out (Medley 1943 cited in Kissinger 2006, p. 77). Even quite recently parents have been told to ignore babies who vomit in ‘temper’ (Pearce & Bidder 1999, p. 45), or to manipulate parents (Ferber 1985, p. 70). These practices disembodied babies by treating them as a malfunctioning body, which was in accordance with the view of nursing and medicine at the time (Madjar 1997). This medicalisation or ‘scientising’ of nursing has been criticized as objectification, and care and comfort do not fit well with objectification (Lawler 1991, p. 30).
In this context, controlled crying, where a baby is left for increasing periods of time to cry but returned to at specified intervals, was seen as a kinder option (Ferber 1985, p. 15). Controlled crying is based on behaviourism, which is a school of psychology that only observes measurable responses, with no regards for emotions or ideas, and has been criticized by many (Block 2001). Behaviourism is in direct opposition to theories of embodiment, which view the person as a whole- ideas and emotions experienced seen as integral to the development of ones personal identity (Madjar 1997, p. 55; Lawler 1991, p. 29). Prompt response to the cries of a baby also recognizes that the body is a means of expression (Lawler 1991, p. 29). Communicating with the infant and treating it as an individual with unique needs, rather than adhering to a controlled crying program designed to be applied to all infants, respects that there is a ‘uniqueness in how people experience their own bodies for themselves…’ (Madjar 1997, p. 55).
A central theme in embodiment is understanding ones lived experience, that a person is not just a physical body but exists in a social and cultural context (Madjar 1997, p. 55). In a similar way to how culture is a major determinant of health (McMurray 2003, p. 23), the way babies are raised and how we view the role of parents and children is highly influenced by the culture that one lives in. When mothers follow their natural instincts, treat their babies as embodied people, and attend to their basic needs, children are likely to grow up with strong attachment and be secure, independent adults (Buckley 2005, p. 242).
In western societies however, many mothers have never even held a baby before they hold their own, and most feel insecure about their ability to parent (Spencer 2003; Buckley 2005, p. 241). We have a history of being bombarded by advice by ‘experts’, whose books for parents are so prescriptive that parents feel guilty if the are not following the ‘rules’ (Kitzinger 2006), and the media portrays a good baby as one who is controlled and disciplined from birth to sleep a lot and rarely cry (Kitzinger 2006). Parents are under so much pressure to have a ‘good’ baby- a baby who does not sleep through the night is labeled a ‘bad’ baby, and the implication is that the parents, usually the mother, is responsible (Ferber 1985, p. 20; Kirschner 2006). In western societies there is a high value placed on self control and independence (Wilson 1993; Buckley 2005, p. 242) and controlled crying is seen as a way to enable babies to improve their self control and foster independence by developing self settling abilities. Ironically the reverse is true- babies who are taught to self settle through controlled crying are more likely to exhibit ‘clingy’ behaviour later in childhood, and be less secure and independent adults (Houlahan 2006; Buckley 2006).
Other adverse effects of controlled crying on the infant are also significant and lifelong. Psychoneuroimmunologists have found that under stress the adrenal cortex releases cortisol, which causes an inhibition in the formation of antibodies (Rapee 2001, p. 51), and, in chronic stress situations such as controlled crying, results in long term immunological impairment (Buckley 2006). Early adverse experiences can interfere with establishment of social bonds and the regulation of emotional behavior later in life (Wismer Fries 2005). Experiments on infant rats have even found that early maternal inattention adversely effects the development of the limbic system, the vermis and the hippocampus, which, for humans, has lifelong effects on sexual arousal and the ability to love, and results in an increased risk of developing borderline personality disorder (Teicher et. al. 2001, p. 157). These negative effects show that viewing and treating a person from a purely scientific perspective and completely disregarding the holistic, embodied nature of an infant, can have lifelong effects on the formation of a positive personal identity.
Madjar writes that in health, embodiment is taken for granted, that it is only when the body is malfunctioning that we become aware of our bodies (Madjar 1997, p. 55). This, however, is different for infants- even in health they are disembodied by practices that ignore their needs. Although there is no way of knowing for sure, it has been suggested that when left alone to cry, babies feel threatened and abandoned (Buckley 2005, p. 265; Buckley 2006) and experience feelings of terror and hopelessness (Leidloff 1977 cited in Pantley 2005, p. 10). This could be seen to be a type of mental pain, a term that has also been used to describe the pain felt by people with a mental illness (Baker 1996, p. 25). Madjar (1997, p. 62) writes ‘Pain has the capacity to enter the very fabric of one’s body and destroy the familiar, taken-for-granted being in the world.’
There is also a ‘trend towards an increasing pathologization of…personality and behavioural ‘difference’’ in children (Kirschner 2006). In this way, the child is seen as an object, and disembodied. The behaviour, in this case crying, is viewed as an illness- a problem to be fixed. For centuries, philosophers and theorists have maintained that the mind and body are interconnected (Lawler 1991; Madjar 1997; Erikson, Tomlin & Swain 2002).
Lawler (1991, p. 55) has even suggested that Descartes’ work, which has long been attributed to the so called ‘Cartesian dualism’, or mind-body split (Montgomery et al. 1988, p. 64; Madjar 1997, p. 56; Tomey & Alligood 2006, p. 172, Benner 2000) has been misunderstood, and that he too, recognized the interdependence of the mind and the body. If the infant is respected as an embodied individual, and if the mind-body interconnectedness holds true, then the cause of the crying when left alone is simple to understand. It follows that what the inner self experiences will be expressed bodily- in this case expressing feelings of abandonment, hopelessness and terror (Leidloff, 1977 cited in Pantley 2005, p. 10; Buckley 2005, p. 265; Buckley 2006) through one of the few ways infants have of communicating- crying. With the controlled crying method, however, crying is seen as a symptom of disease- and the symptom is treated without examining the underlying cause. Although embodiment theorists have claimed that during illness the mind and body are ‘emotionally, intellectually and practically inseparable’ (Lawler, 1991, p. 155), it is very common for people to feel as if their symptoms are being treated at the expense of their emotional self (Fassett & Gallagher 1998). Many parallels can be drawn from the illness experience, and that of a baby- the main difference is that although the baby is treated as ill, by crying when left alone and having disturbed sleep patterns it is displaying what proponents both for and against controlled crying agree are actually very common behaviours (Ferber 1985, p. 20; Skuladottir & Thome 2003, p. 376; Pantly 2005, p. 32).To empower parents to make informed choices with which they feel comfortable, the medical and nursing professions must present parents with a balanced view of the advantages and implications of controlled crying, and make gentler options more acceptable.
While the government provides information on a variety of gentle settling methods, and acknowledge that babies and children can be adversely affected by controlled crying (Parenting SA 2003), many doctors and nurses still promote controlled crying (Buckley 2005, p. 264, Houlahan 2006), and some sleep schools still use controlled crying (Cooke, 2003, p. 159; Houlahan 2006). Infants with severe sleep problems are at an increased risk of child abuse (Skuladottir & Thome 2003, p. 378), and controlled crying is certainly preferable to shaking or hitting a baby out of frustration (Buckley, 2005, p. 266). Nurses should, however, weigh this and other advantages of controlled crying against its potential long term effects before they suggest it to parents, and it should only be used as a method for improving infants sleep patterns when gentler approaches have failed. The experiences that each of us has, from birth to death, contribute to the uniqueness of our personalities (Madjar 1997, p. 55; Lawler 2001, p. 29). By choosing to communicate with and promptly respond to our babies we show a respect for their fundamental needs of human affection, touch, warmth and love. A shift away from treating them as objects of control is a positive move towards treating them as embodied humans.