Abstract
In 1985, Daniel Stem published his book The Interpersonal World of the Infant. His first sentence read as follows, ‘Anyone concerned with human nature is drawn by curiosity to wonder about the subjective life of young infants’. I doubt indeed if this were true then or even now, and certainly 30 years ago it was of interest to very few individuals as the subjective life of infants was left almost entirely to the curiosity of their mothers. Since then, there has been increasing interest in infants and, as this book shows, an interest in the crying of babies has developed along with research into what this might mean.
The editors of this book see it as a venue for gathering together modern ideas about crying. They have used the alliterative subtitles (Sign, Symptom and Signal) to ‘capture the three primary themes in what might be called the modern era of cry research’.
A sign is seen as an objective indicator of the condition or state of the infant. The symptom is understood as a complaint highlighting the possibility of something being ‘not right’. The signal implies that ‘crying functions in context and that function or functions includes reception and interpretation of that signal but it need not entail that the signal is intentional’. The book sets out to explore ways of understanding crying, the universal expression of infants, and there are three main themes explored. The first theme is understanding the cry alone. If we could discriminate and learn about the specificity of the cry we would be nearer to translating accurately the meaning of the cry.
The second theme is understanding the symptom: the usual clinical question. What do we understand about the crying baby in the emergency room or the paediatrician's consulting room? The ubiquitous problem of colic is given considerable space and prominence. Barr's chapter suggests that colic is a transient benign condition due to increased responsivity in the infant at that time, rather than due to a difficult temperament which has long-term implications. The outcome of colic is seen as positive, although hidden in the group of babies that cry excessively will be some that will have ongoing problems. The difficulty for the clinican is to recognize which baby will need ongoing care and supervision.
The theme of the signal remains unsatisfactory and elusive. It was a relief to read Blackman's chapter where he states quite unequivocally that crying is the earliest and most powerful form of communication. Perhaps the problem lies in what is understood by communication as a signal seems to imply one-way communication (the smoke signal or the Mayday call for help). This might be so, but for whom is the help: the baby or the parent? Communication implies a two-way exchange such as conversation.
Professor Trevarthen's work on early communication shows clearly the capacity of babies to engage in a to and fro exchange. Why is crying not a conversation that tells of pain, unhappiness or distress? If it is a communication, might not the cry of the baby be a reaction to what she has heard or seen in the gaze and voice of the mother?
Implicit in this book is that, while crying is universal and normal, excessive crying and the abnormal cry are seen as problems. What about the baby that cries too little or too weakly? Perhaps with more awareness of the interpersonal and intersubjective world of the infant, this aspect would also be looked for and understood.
This book will be a helpful and valuable addition to a paediatrician's library, but we need to explore further the understanding of the baby's cry.