Abstract
A renaissance of relevance is bubbling away at the intersection of psychoanalysis, child development and infant, child and adult mental health. Driving this revolution in the nursery are authorities like Greenspan, Perry, Schore, Stern, Sroufe and in Australia, Dr Ann Morgan, at the Royal Children's Hospital, Melbourne. Dr Morgan's influence extends to a new generation of health professionals, in public and private settings: early parenting, parent–infant health and growing networks between mental health, paediatrics, nursing and the wider general community.
The baby as subject is a timely gem of a book. Dr Frances Thomson Salo and Professor Campbell Paul honour Dr Morgan's life work, highlighting how current practitioners apply her principles to what amounts to, often, life-saving interventions. So what is ‘new’ about Dr Morgan's views? The detailed case studies focus on the baby as subject. What does this mean in practice?
Thomson Salo and Paul provide a context to Dr Morgan's views based on her conviction that ‘issues a mother faces with the arrival of her baby are sometimes literally and psychologically life-or-death issues, and the mother's mind frames the baby's world’ (pp. 35–6). The seven-authored introductory chapter ‘Free to be playful: therapeutic work with infants’ should become prescribed reading for all infant mental health professionals providing a sound justification to adopt Morgan's ‘direct work’ model.
The book's 12 chapters together amount to a compelling argument and a sense of urgency to review our paradigm for interventions in infant mental health – and prepare for a radical shift. The traditional view of psychoanalytic psychotherapy's principle of ‘equidistance’ to be maintained between parents and baby (inner or outer) is soundly challenged by Morgan's insistence on direct engagement with the infant. Many traditional therapists would regard such a position with deep scepticism. Critics may even mistakenly label such an approach as nonanalytic ‘acting out’.
Thus, authors take care to provide scholarly evidencebased research to justify their clinical casework. They also insist that the ‘psychoanalytic background was important in providing a matrix in which the work with infants could be thought about’ (p. 9). The current renaissance in psychoanalytic relevance – as exemplified by viewing the baby as subject – contrasts with the tendency of the dominant paradigms to ignore early developmental experiences' central relevance to later mental health and pathology. This has resulted in inadequate intellectual models to meet the crisis in mental health services [1].
The book's message, to consider and adopt Morgan's ‘direct work’ model with infants, is intended to refine the traditional methods of infant–parent psychotherapy, interaction guidance and the ‘watch, wait and wonder’ approaches. Morgan's model attaches great import to the impact and specificity of gaze, tone and touch modalities, her clinical intuition increasingly backed by emerging research findings.
Further, the critical importance of a transitional ‘space’ between infant and caregiver for later mental health is evidenced by the resultant psychopathology in cases where this space is absent. The impact of such foreclosure ‘can be very profound and can be extremely difficult, if not intractable, to treat later on, whereas even severe pathology can be treated very quickly if the treatment is undertaken sufficiently early’.
The book's central message is stark: an urgent need to address directly the infant's experience as a critical step to prevent the organic changes in the brain consequent on early deprivation, trauma, severely disrupted or traumatic attachments.
This book should become essential reading well beyond the clinician's consulting room. If health policy advisers choose to remain ignorant or reject the evidence offered in this and other books [2] they may run the risk, according to some opinion in the US, of future legal action in that county's litigious culture. Further, Morgan's model offers an antidote to the inadequate intellectual models [1] that fail to counter the crisis in mental health care.
Morgan's principle of prevention is derived from two basic facts: first, view the baby as subject; second, work directly with the infant. Such radical ideas are a challenge to implement. Yet, a failure to seriously consider Dr Morgan's approach may result in the fulfilment of the WHO's dire prediction for 2020. I suspect many mental health professionals, despite the evidence presented by Thomson Salo and Paul, will continue to avoid recognizing the baby as a subject of relevance in mental health practice or policy.