A cause for lack of bonding between a mother and her newborn

A young mother, in her early twenties, who had the child just couple of months ago, complained that she cannot really bond with her baby.
"Is it postpartum depression?" she asked me.
She did not have quite the features of depression. But then these psychological concepts when used to complain about one's problem are so difficult to form a judgment upon.  Depression is after all a word and words are shorthand for complex phenomenon. And while words convey information they can only approximate to what the other person has in mind and cannot evoke the exact image in the hearer. Every individual experiences his or her mental misery somewhat uniquely and they all get lumped under the rubric of depression. Of course there are certain features which frequently cluster together, and gives the core of what we clinically understand as depression, but sometimes there may be none of those core symptoms and patient can still be not doing well and may be having what should be looked upon as depression (which is best defined as a general inhibition of functioning).
What exactly she meant by she cannot bond with her baby?
She described it as that while as a mother she does take care of the baby, she does it mechanically. She is not drawn to the baby as the baby's father and baby's two grandmothers are, who get so excited when with they are with the baby, and cannot wait for their turn to have it because they get so much pleasure out of cleaning, feeding and playing with her, and go into raptures if the baby smiles or does something that they were not expecting her to do.
Then the patient wondered if the baby will develop autism because of  this lack of bonding with her (mother).
While I agree that the etiology of autism may have similar origins, where the baby's caretakers are not quite in tune with the baby's emotional needs and may deal with the expressions of its emotions, especially aggression, without proper feel for it, suppressing instead of allowing them to blossom into age appropriate forms, forcing the baby's psyche to shove the manifestations of these aggressive drives back upon its own self, which will eventually find expression as autistic behaviors.
I assured her that most likely the baby will not have autistic traits because she seems to be getting enough acceptance and nurturance from her father and the two grandmothers.
"And you you may be overestimating your lack of emotional attachment to the child," I tried to be supportive.
Then I asked the patient if she was breastfeeding the baby.
It turned out she was not. She blamed it on some nutritional expert in the hospital who just after delivery came to teach her about breastfeeding but on hearing she was on Suboxone and Xanax immediately declared that it was not an option because Suboxone and Xanax will pass through the breast milk and will harm the baby's brain.
I felt sorry for the mother and the child who were harmed for life because some expert, based upon a single variable that Suboxone goes into the breast milk, had ignored all the other benefits of breastfeeding which easily outweigh the little opiate going into the baby's system. It is better to be ignorant than to have half-baked knowledge.
I asked her if she really wanted the child?
She was not sure if she did. She had known the baby's father for just six months before she got pregnant. They were living together but not because of any strong bond. They just moved in without thinking through and because they could never plan anything beyond what was right under their nose. They both were good looking, so there was physical attraction. But the biggest thing in common was their opiate dependence and addicts like to do drugs together as if they seek courage from others doing the wrong thing. Their partnership had persisted in trying to give up opiate abuse too and both were in treatment with me getting Suboxone, and supporting each other to remain abstinent.
There were couple of other points which held them together. She admired him as an exceptionally good tattoo artist, which he really was, and he once was  flown in to Florida from Michigan to tattoo a famous basketball player and had been feted while he was doing the job by that celebrity, which had made her really proud of him, but overall she did not think of him as a husband material. She claimed he worked only when he felt like - which was not very often - and feared when married they will be more broke than secure.  They were living together more for convenience in her mother's basement than anything else. Then she got pregnant and lacking decisiveness allowed the pregnancy to proceed till she had no choice but to go through the delivery.
Then both of them dropped out of treatment.
Six months later the girl's  mother came for her own session to my office and told how her daughter was back doing drugs, and raising Cain. She was stealing, partying and hanging out with all wrong men.
For all practical purposes she had abandoned the baby.
So the lack of bonding with the child had a motive. If she had gotten really bonded to the child, it would have been a powerful counter motive to return to drugs and party all the time. With the child latched on to her, she could not have abandoned herself entirely to fulfilling her these pregenital primitive selfish drives.
So what looked like a spontaneous failure of bonding was not all that spontaneous. There was a cause,  a hidden motive, the pull of living wild, with no restraints on one's basic animal urges.
One wonders too if postpartum depression does not just arise out of vacuum but has some similar hidden motive behind the profound dip in mood. If we go deeply into the psychology of Oedipal Phase of the female sex, one is left with no choice but to conclude that  the compensation for the lack of penis, which at that age the little girl suddenly realizes will relegate her to second class status in affairs of the world all through life, is having an exclusive possession over her own baby child when she has one.  What she was denied - the male genitals, which are so strikingly obvious in her male siblings and playmates - and the absence of which was most acutely felt during that phase was handled by fantasy of getting compensated on growing up via having a baby of one's own who will be completely dependent upon oneself. But in some women, rather in all women to different degrees, their birthing and having a baby over which one has complete possession is not felt as adequate compensation. The original penis envy and continued search for it through direct competition with men, which is manifested in all kinds of inexplicable behaviors which puzzles us to no extent, like entering into relationship to trick/cheat him into giving what he has to her (the woman's attitude on this matter is best explained by the saying, "What is mine is mine and what is yours is mine too", or through destroying him out of jealousy, often after falling in love with them and then once he becomes her life partner turning the relationship into a constant criticism of all his behaviors, or making his life miserable, governed by the illusion - unconscious of course - that this will hasten his destruction which will be equivalent to her getting what she has always envied and desired.
Girls who are into wild partying instead of settling down with a mate and seeing the purpose of life in having and raising children are really into this alternate lifestyle. The motive being to steal from some unsuspecting man - in the chaos of wild relationship - the penis that is so badly desired. Women's love for clutter, confusion and goofiness in conversation also owes to the same complex: in the disorder and turmoil to steal what one so badly wants. The tumultuous relationships, the modern generations are having, prior to settling down - for they are brought up with so much indulgence with all their desires immediately satisfied so they want everything - also owes to the young girls not giving up the desire to have the penis directly by stealing from a man through a deceptive relationship than through having a child by him and postponing that wish to the next generation.
And behind postpartum depression lies the same complex. "Let me kill this baby for it has not gotten me true parity with men and let me seek what I want not through marriage and playing with my child (the penis substitute) but through indulging in wild chaotic existence and changing places with a man. Even when these women come from socioeconomic backgrounds in which leading a wild sexual lifestyle is out of question just the fantasy of indulging in polymorphous perversions may act as sufficient counter motive to not take care of the baby to the point of even killing it; done under the delusional cloak of protecting him from evil (the evil itself being mother's own infanticidal tendencies).
Does a lack of instinctive understanding of the aggressive tendencies of the child who has disposition to develop autism on part of the mother also arises from some counter motive?
It is interesting that in the modern times as more and more information is being fed to people on how to be ideal parents paradoxically we are producing more and more obsessive/autistic children. It appears that more full of education, sophistication, and upper class one gets, greater is the chances for the child to turn autistic.
Why this paradox?
Perhaps all this acquiring of knowledge happens at a cerebral level and perhaps much of it as  an overcompensation for lack of feeling of natural motherly bond between oneself and one's child. In olden times women had children  in their teens and  twenties, when they were nearer to being child themselves and thus instinctively understood their babies and could instinctively identify with their children's drives. They did not need any Dr. Spock's books or Child Protective Services manuals and parenting classes on how to be a good parent. They did take care of the child instinctively and did not see themselves as separate from the baby. Mother and child were a unit. Of course, they neglected and ignored the child much more than they do today and the child was exposed to dangers and harm  far more than nowadays. Today the child is infinitely more protected and safe from physical dangers. But in earlier times while they had little time for their children, the time they did spend had far more emotional warmth and understanding than nowadays. And what the mother could not give emotionally, there were always siblings around picking up the slack, and acting as surrogate parents. Now with only one or two children in household, this substitute parenting role of siblings has disappeared.
Nowadays the parents are full of knowledge of how to raise a child but the counter motive to be drawn by other demands of life: their career, their friendships, their hobbies, their need to excel with peers, their social obligations which are far more ingrained in them for these distractions were practiced late into their twenties and thirties, with childbearing postponed to the limits of one's biological clock,  they all act against bonding with the child as the unsophisticated mothers of the past could instinctively do.
Once I was severely castigated by a neurologist for suggesting that inadequate parenting may be responsible for autistic children not finding proper outlets for their aggression. She insisted that of what she see of the parents of autistic children they are more attentive, more concerned, and more devoted to their child than ordinary parents.
I agreed with her but added that they may be more devoted and may be spending more time and may be doing everything as the book says they should do. But it is done more cerebrally than instinctively and spontaneously. Trying to heal problem of the heart with the carefully thought out solutions by the head often fail. These older aged mothers, who often become quite narcissistic, by postponing marriage and becoming androgynous for living by themselves rather than with a partner, try to bring up their children through doing everything right by the book instead of feeling emotionally one with the child.  

Fear as the key etiological factor in Autism

In most cases of autism, that I have come across, there were extensive obsessive-compulsive disturbances in the mother. And whenever I got the opportunity to examine the father, which was not often, for most mothers were divorced or single, they were quite likely to be rigid and distant as well.
The most striking thing about the mothers was their lack of feel, or rather defective feel, for the child's correct needs. They were often grossly out of tune with the affective and cognitive world of the child. Their expectations not only were unrealistic but often bizarre, paradoxical and not synchronous with the child's developmental stage. In areas where the child could excel there was little interest and appreciation. In contrast, where the child was a laggard, and could not perform, there were unreasonable hopes and demands.
The following case whom I treated for about six months - the treatment came to an abrupt halt when one day the mother realized that the boy was getting emotionally attached to me and gaining strength from it would pose opposition to her dictatorial control - best exemplifies this type of oddity in mothers of autistic children.

He was 19-year-old autistic boy, an only child, completely dependent on her; as much as she was dependent upon him. It was not quite a case of folie a deux but close to it.

What piqued my special interest in him was his exceptional gift in drawing cartoons. He could draw a person in remarkable details and in no time. And he noticed everything about your facial features, every quirk and flaw. But, as if he paid a prize for such profound interest in the physiognomy, by not noticing much else about you, especially your emotional nuances. As if a disproportionate share of his cognitive abilities got concentrated upon noticing the physical aspects of your face and the physical contours of the body and so none of it was left for noticing other things about you. Or was it that he had been prohibited from noticing the emotional aspects of his mother and other people under fear of getting punished and so his interest in them had got shifted (displaced) on to just noticing the physical aspects of them? 

He showed me his portfolio of comic strips, the quality of which was professional. They were about a Japanese adolescent [his alterego, he was African-American], who lived in a magical world, abounded with goblins, ghouls, villains and pretty girls, where wizardry ruled the day. It. The theme was typical action adventure where the hero after meeting the usual life threatening obstacles (father substitutes) and witchcraft (mother's spell to hold him back from rising up in the world) would impress the heroine so much by these feats that she would fall head over heels fall in love with him. All the heroines were exquisitely beautiful and blond [his ego ideal]. They all dressed in overflowing and frilly dresses - compensation for their lack of penis - a sharp contrast to his mother's drab flat style that eschewed all adornments.

Now, amazingly, the mother frowned upon this great gift. She considered his passion for art an obsession that would deviate him from his true vocation which was to become a professor at the University of Michigan. And she was making active efforts in grooming him for that wonderful achievement. As to what kind of professor he would become at the university was of no concern. The subject in which he would specialize was of no consequence. What mattered was becoming a professor at the University at any cost. But one glance at the boy and you knew how grossly off target the mother was. The boy spoke like a computer. He could barely make himself understandable. There was something completely rigid and artificial about his speech. It lacked variations of tones, which rendered him unfit for delivering lectures. And in his choice of words he was so pedantic that he verged on incomprehensibility And as if this was not enough, he spoke in a pompous British accent, sometimes so inappropriately that it was obvious he would be laughed out of any lecture room.

Yet she was convinced that he had in him to become a professor, and one day demanded of me that I double his dose of Abilify, an antipsychotic, to achieve this aim.

When I enquired as for what the poor boy had done to deserve such a punishment, and how would a medication that straitjackets one would help him become a University of Michigan professor, she said that at his school - which was exclusively for developmentally disabled and autistic children- he had flown in a rage  and physically attacked his teacher. 

 I asked the boy the reason for the violence and he replied that they were discussing the issue of capital punishment and the very idea was so barbaric to him that anybody who even suggested that it had some  value deserved physical attack. [To understand the boy's pathological abhorrence for capital punishment I must mention that in his unconscious mind he harbored extensive death wishes against his mother, and as a consequence feared for his life for he believed that his thoughts were powerful enough to cause her death one of these day, and the punishment for it then would be his own death. He even heard voices urging him to kill her - projection of his wishes/thoughts from inside his head to the outside world - and strongly believed that if under the promptings of the voices if he does kill his mother it is the voices who should be hanged and not him. So behind the attack upon his teacher was his fear that if capital punishment becomes legal then one day he would be hanged, for it is only matter of time before he will cause the death of his mother, though in all fairness he should not be held guilty of it because it is not him but the voices that were wishing her death.]

When I asked the mother how doubling Ablify will help, since he is already on 30 mg., maximum FDA approved dosage of that medication, she said that she expects him to go to University of Michigan - he was 19 and had still not cleared high school - and behaviors such as physically attacking one's professors in a prestigious University like that would not be tolerated for a minute and as a psychiatrist I should know that Abilify controls aggression.
Now to the Biological Psychiatrists the mother's logic would have made perfect sense and in fact they might have made her an honorary member of the College of Neuropsychopharmacology for such profound  thinking, but to us, governed more by common sense than mutual back scratching, there is something not quite right about the way the child and the mother were using the language. The boy just on hearing the teacher say that capital punishment could have merit physically attacked the teacher. The teacher was just facilitating the topic and had nothing to do with the actual capital punishment with real criminals. But the language, or rather the words of the language, were not quite correctly connected to the underlying concepts which those words were conventionally suppose to capture. And they certainly were not connected to the right emotional nuances that had accompanied them when he had first heard them, while acquiring language in his formative year. So while the discussion on capital punishment would have provoked at worst a little horror and queasiness in a sensitive individual, in this boy it provoked outright violence - he attacked the messenger (teacher) instead of dealing with the message.
And this disturbance in language was present in mother as well. Ambition for her son was associated in her mind with his becoming professor at the University of Michigan. The word 'ambition' in a regular mind would be associated with studying hard, burning the midnight oil, getting good grades, applying to different universities, entrepreneurship  invention etc. But in her mind there was only one association: her son giving a lecture at the University of Michigan.  What entails in becoming a professor and what her son could realistically achieve were not associated with her conception of ambition.  The way the mother and son used words, rather language as a whole, did not make comprehending the world easier but more confusing. The language was more a means of obfuscation than enlightenment.
In fact in this mother-and-child-autistic-bond, all communications occurred in a cloistered fashion and in a verbose and schizotypal language. Additionally, to make things worse with language, the mother often dealt with the son by keeping "morally uplifting" books in her reach from which she would quote to win  arguments, which they were always having. Her conversation with him was littered with references to the exemplary and literary people from the past, and as to what they would have said about the matter under discussion. So instead of teaching the child using normal language, she dealt with him, rather dealt with her  aggressive impulses towards her by bringing impersonal language of the high class books. The language, the faculty of communicating through sound, was being used to create distance not closeness between them.

And taking the cue from the mother the boy had developed his own peculiar way of speaking. Since mother had the upper hand because of her age, greater experience, and the means to support them, the boy to counter her aggression had acquired the British accent  to match mother's pedantry and pomposity. The mother was so out of touch with the boy's real emotional needs that she had made no attempt to understand as to why the boy had abandoned his Detroit ghetto accent for an English Lord's. She had accepted it as a matter of course, and made it a point to tell me that his speaking like a cartoon character - for that perfect English accent in the boy from Detroit appeared cartoonish - did not bother her a bit. She was completely insensitive as to how such an accent had made him an object of ridicule with his peers. She had no curiosity as to its psychological origins and had made no attempt to stop it.
In the six months that I treated the boy and the mother - for she always barged in in the sessions, convinced that what she had to say about him was infinitely more important and meaningful than what he had to say about himself - it became apparent to me that behind the pomposity, peculiar language, and high-mindedness lay excessive fear of the world from which the two were escaping not only from each other but with the world as a whole too together by denying its fearfulness through a deviant use of language. 

Instead of becoming physically aggressive - though that would break through once in a while as it happened against the teacher who dared to talk about - that happens in a lot of people as an adaptation towards fear, they had become pompous and full of stilted words, by which they could look down upon those who they feared. The pompous and peculiar use of words had become a shield (defense) against the frightening world.

However pedantry alone could not allay the fear completely and sometimes one could hear the fear behind the stilted language. Adoption of the British accent was the next step in dealing with that anxiety. By imagining himself to be a pompous Englishman the boy was trying to convince to himself and others that he was way above fearing them. Occasionally the fear would break through the British accent as well and strike upon individual syllables. For example he had to drop the sound "r" in many words to avoid a panic attack. Rabbit had to be enunciated as "vabbit" to forestall panic.  On other hand he could say r in many other words such as road with no problem at all. While he could say the word "thumb" perfectly well he could not say 'thought' or 'think' and had to substitute 'fought' and 'fink' respectively. Interestingly the mother showed same kind of difficulty with the language though not in pronouncing words. She one day claimed that it is the astrologist who predicts the weather. It took me some time to figure out that what she meant was that it is the meteorologist who predicts the weather The distortion in language and use of words and even sounds of words at its very bottom was nothing but ways to deal with fear..
What lies behind this extreme fear? Deep down these mothers - at least a majority of them that I came across - have great ambivalence towards their autistic child. Hatred exists alongside love. And the fear arises as a means to check acting out their hatred with punitive aggression. The aggression is not completely eliminated by fear though. It finds outlets in distortion and in obsessive behaviors. Trying to control obsessive impulses - behind which lie hatred of the child - exhausts the mother and leaves little room for love and understanding to emerge in her interactions with the child.

What are the roots of this hatred? Is the hatred primary because the mother did not find herself equal to the task of being an ideal mother - obsessive people place high demands upon themselves to be perfect parent and many postpone or never get married fearful that they will be too inadequate/intolerant towards their children - from the beginning, or does it arise from the emotional exhaustion that occurs in a parent from taking care, day in and day out, of such a time consuming task as bringing up an autistic child.

There is no question that an autistic child is a burden for the parents. Here we are reminded of high prevalence of autism in children who are born to older parents - in the eve of their birthing years - and with less ability to be spontaneous and truly emotionally interactive with their children. Autism also occurs more frequently in higher socioeconomic strata. The same class which has least number of children. As if the person who has all his or her desires fulfilled easily has little motivation left to beget children, postponing it to the very end of his/her biological clock. The greatest motivation for having children is to see fulfillment of one's own thwarted ambitions; to vicariously achieve through them the successes that one could not in one's own life. Successful people have little motivation to enjoy life vicariously. Even when they have children they have greater ambivalence towards them for having to give up their own pleasures in order to take care of the little ones.

It is not that these parents do not have love for their children. In fact the love by noisy exaggeration hides the true state of affairs to even experienced clinicians. Their [unconscious] realization that they are out of sync with the emotional world of the child makes them try their utmost to obsessively search for some wonder drug or some fancy gluten free or manganese loaded diet or some other snake-oil to cure their child magically.

Sometimes they spend a fortune chasing the newest fad even going as far away as Afghanistan or Mongolia to prove to themselves and the world at large as to how much they care for their child.

And how does the fear manifest in autistic children? There is little doubt that autistic children are extremely sensitive to noise and other stimuli. They startle easily and overreact to any unusual or jarring stimuli. This appears to be a genetic endowment. An exaggerated inborn fear of the outside world. As Freud put it in his "Instincts and their vicissitudes": The relation of hate to objects is older than that of love. It is derived from the primal repudiation by the narcissistic ego of the external world whence flows the stream of stimuli. This fear provokes premature and strong aggressive drives in children genetically predisposed to autism and in pell-mell. Their love for complete order such as fascination with trains whose compartments follow in such a sequence, or fans that go in a completely predictable fashion appears to be a reaction to this emergence of their aggressive drives in such a helter-skelter fashion.

When this premature aggessive way of relating meets a stonewall, and little emotional acceptance for aggression on part of the mother who herself is struggling vainly with her aggressive/obsessive drives and wants everything perfect and in order, the child withdraws into his own autistic world, taking out the aggression on his own self and in internal secretions.