Chris L. Minnick, M.D.

Breast Feeding and Kleinian Models

1 – Breast feeding is a topic about which people have very intense, often very personal feelings. From the perspective of infants it is huge and can have an impact on the rest of their life. From the perspective of mothers it is also huge but is more attached to their identity and self-esteem as a woman and a mother. When it goes well everyone wins and feels great about it. When it breaks down prematurely, it is a potential source of shame, guilt, and persecution for both.

2 – I believe Melanie Klein’s models of early development offer some means for thinking about breast feeding that have the potential to be helpful to mother and infant. Used in advance, as a means to think about breast feeding, they may assist the prospective mother. Applying these models after the fact, when the feeding broke down or was interrupted before mother and baby could agree they were ready to move on, is commonly an exercise in Monday morning quarterbacking. The “woulda, coulda, shoulda” hind sight evaluations often lead to more defensiveness than is helpful and make for a very dicey situation.

3 – I am going to try to offer some ideas about this all and take the risk of inevitably upsetting some while hoping to be of help to others. Several caveats apply:

– Motherhood is really hard and most women approach it with their very best, loving intentions.

– Obstetricians, pediatricians, family, and friends all come with advice based on their own (often highly personal) perspective and good intentions. Having said that, they often don’t know certain things about emotional development at a deeply unconscious or primitive levelthat might be worth adding to the mix as decisions are made.

– No one should ever be criticized in these situations when things break down. Everyone needs support and encouragement. Remember, the baby and mother have a lifetime together to regroup as needed.

Some Useful Assumptions about Breast Feeding:
Axiom #1: Interruption of breast feeding before the fourth month of life is at high risk to be traumatic to the infant. The potential likelihood and intensity of the trauma increases every month back closer to birth the interruption occurs.

Axiom #2: The impact of weaning in the first four months of life will typically be subtle until later in childhood and may even only be manifest after puberty. This link between early weaning and later development requires awareness that such a link is possible and common sense won’t lead most people to imagine that this link exists.

Axiom #3: If a woman, in her “heart of hearts”, does not want to be tied down by breastfeeding, or plans to go back to work full time after 3 to 6 weeks, then she might wish to consider not breastfeeding at all. This is often a very tough decision, especially if she feels she is being pressured into the breast feeding, by whomever for whatever reason.

Axiom #4: In taking a baby history, especially when trying to make sense of a deterioration of an adolescent for no obvious reason, always ask about breast feeding attempts. Just asking “Were you breast fed?” is not enough. You have to ask if it was even attempted for a day or two or a week. People don’t realize that this may be significant from the perspective of how the baby experienced its beginning life outside the womb.

The Infant’s Tasks Immediately After Birth:
1 – An infant’s first task, at birth, is to find a means to cope with the massive abrupt change that accompanies being born and out in the world, now physically separate from mom. It must simultaneously find a means to (1) bring order to its world and (2) hopefully come to a conclusion that the goodness and pleasure of being outside mom outweighs the distress and badness of a life separate from mom. In other words, the infant must decide “Is life worth it?” Some infants adapt easily and make use of what is available to get the most from mom and caregivers. Other infants find the impingement of so much stimuli, once outside the womb, to be an “overload” and they really convey a need for a huge amount of contact and reassurance that everything will be okay.

2 – This earliest life decision – “is worth it to be born and live life out in the world” – hinges on the relationship that the mother and infant establish. The word “bonding” is a useful shorthand summary for this first task, and is inextricably linked to mother’s availability, physically and emotionally. Needless to say, the same applies to whomever the primary caregiving is entrusted.

3 – This is where Klein’s models become useful. Since all infants are both totally concrete in their thinking, and do not yet have mind and body clearly differentiated, they respond to the pleasures and pains of life as if they are concrete things that can be separated. They wish to “hold on to that which is pleasurable” (and therefore “good”) while they inevitably try to “rid themselves of that which is unpleasant or painful” (and therefore “bad”). This is all very much analogous to the function of the alimentary tract in which things can be concretely “taken in” or “expelled”.

– A key point here, not easily seen just using “common sense”, is that when the infant feels in distress, it doesn’t just feel that a good mom is absent, but rather that a “bad mom is literally present” and producing the distress on purpose. This is compactly expressed with Klein’s crucial discovery that “THE ABSENCE OF A GOOD MOM IS EXPERIENCED AS

Klein’s Applicable Models:
1 – Klein viewed the infant’s initial task of bringing order to its world as requiring a successful separation of “good” (i.e. pleasurable) experiences from “bad” (i.e. distressing/painful) ones. Since separating the bad/painful component from the more positive experiences leaves the latter ones more “purified or ideal”, the process could be referred to with the shorthand phrase “splitting-and-idealization”. The good is held onto while the bad is evacuated outside to be gotten rid of, analogous to how an infant poops or pees out that which becomes physically distressing.

– Klein referred to this earliest period, approximating the first four months or so of life, as the “Paranoid-Schizoid Position”. It is the infant’s first “VALUE SYSTEM” of “SELF INTEREST”, during which the infant attempts to concretely bring order to its world by separating good experience and the persons (“objects”) linked with those experiences, from bad experience and the persons linked with those unpleasant experiences. In effect, it lives in two worlds that it tries to keep concretely “separate”. [This is so easily seen in the example familiar to every parent with a toddler when the juice from the pees runs under the meat on the plate and the child starts crying that the bad juice has spoiled the good meat and refuses to eat any of it.]

– The crucial point in this phase is that the “good parent”, who is felt to be giving love, comfort, and sustenance, is held separately from another version of a mother who is essentially seen concretely as “all bad”. Every bit of frustration, distress, and pain is felt to emanate from this “bad mother” (or caregiver) and is seen as being done “on purpose” to inflict pain. This has major implications for a “weaning” that occurs before the developments that will take place in the next few months of the middle of the first year of life.

2 – What becomes crucial is a shift in the middle of the first year of life as brain development and function leads to new capacities. The infant begins to develop a capacity to see that it is not living in two separate worlds, but just one that is more complex. It does not have two moms, a “good one” and a “bad one”, but rather just one mom who at times it loves and feels comfort from, and who at other times is frustrating and toward whom it temporarily feels anger and “mean” feelings. Enter the age of “ambivalence”.

– Klein recognized that the development of this “integration” (of the “good and bad versions of mom”) was key to the development of a capacity for stable loving relationships. This hinged on the recognition that the mom that one loved was also the same mom who was felt (i.e. imagined) to be injured, during periods of rage, for whatever reason. In turn, this recognition (that the good mom and bad mom are actually the same person) would then lead to a capacity to wish to repair any damage to the “good mom” while in that period of feeling full of rage. This act of restoring the “good mom” to an undamaged state in phantasy was referred to by Klein as “reparation”.

– This development of a capacity for “love”, “ambivalence”, and a “wish to make repair” can be seen as the growth of capacities that supplant the “self interest” in the “paranoid-schizoid position”. It represents a new VALUE SYSTEM in which “CONCERN FOR THE OTHER” can coexist side by side with interest in oneself. This is a central achievement in the middle of the first year of life and “greatly stabilizes” the developing infant’s character structure.

– Klein gave this phase of the development the unfortunate name “the Depressive Position”. She means to imply that “loving concern” for the welfare of the other leads to “depressive concern” for the object and “depressive anxiety” regarding its welfare, all very positive, non-pathological elements. Unfortunately, it is easily confused with being “depressed” in the problematic sense. The noted English pediatrician and psychoanalyst Donald Winnicott suggested that “Phase of Concern” would have been a more appropriate name for this developmental period.

Theoretical Implications for Breast Feeding and Weaning:
1 – The logic that Klein’s models suggest is that a “weaning” from the breast, before a more integrated relationship with a whole mom has been established, has a tendency to cement in the developing psyche a feeling that “damage” has taken place to self and object that cannot be understood or repaired. This is a result of a rather permanent installation of a “paired relationship” in the internal world between a part of self and an object (i.e. a version of mom at a very primitive, part of her level) that is dominated by loss, distress, harm, etc. as a result of the premature rupture of that relationship (i.e. the early weaning).

2 – Most infants will push the weaning aside automatically even though it has registered in the psyche as this “paired relationship”. It will often seem as though this premature breakdown of the feeding relationship was “not registered” and the infant has simple “moved on”. Sometimes the early weaning will lead to a more obvious period of distress or temporary disruption of the developmental achievements that had been made. Most parents will not make the connection between the weaning and an impact on the infant unless the infant’s reaction is dramatic. I BELIEVE IT IS ALWAYS REGISTERED EVEN WHEN NOT APPARENTLY MANIFESTED.

– A crucial point to understand about this aspect is this that this “confusing and distressing event” has occurred before the “view of mother has been integrated”, so it tends to reinforce the need to keep “good” and “bad” versions of anything in life more extremely and rigidly “separated”. It is axiomatic that the more “wide and deep the splits” (between good and bad versions of elements in life), the more handicapped the personality, and the more predisposed to anxiety and possibly depression the individual will be during life.

3 – Let’s assume that life has gone wonderfully between mom and infant since the early weaning in the first few days, weeks, or months of life. The point to be remembered is that there will be this “one area” of life experience stored in the psyche that will either add a “colored filter” through which all experience will be seen, or it will remain as a “walled off, encapsulated piece of experience” that can break open given the right stimuli in later life.

This stored experience will be in the above mentioned internal relationship between a baby part of self and a version of mom that “went away”. In a manner analogous to adoption, some inevitable questions will remain, probably universally in all infants:

– Where did the breast go and why did it go away?

– Did it get damaged by me, or even die because of me?

– If it was my fault, can I repair it or will it come back to hurt me in retaliation?

You can see that the mood of the relationship to mother at the time of the weaning is likely to have an impact on these questions. If the relationship was “going well” from the baby’s perspective, then the weaning is a “huge loss” and typically a great source of fear that the baby “devoured it”. This could, for example, give a faintly sad, worried about the welfare of others, “stamp” to that infant’s later adult personality.

In contrast, if the relationship with the mother was stormy from the start, filled with frustration and rage, then the infant is likely to feel its aggression toward mother destroyed her. It is at some risk to grow up with a “predisposition to depression” of varying degree, or a more “paranoid, prickly expectation” of things never working out well and others being out to harm one.

In either type of situation, the weaning, and how it was experienced and stored in the psyche, becomes a template that has a lifelong impact. I have seen this impact over and over in patients in analysis who had such an early weaning experience.

4 – I am not suggesting that there is a one to one correlation that is predictable. The “timing” and “abruptness” of the weaning are key variables as is the nature of the relationship to the mother at that time. I am saying that it will have been recorded in the psyche and will in some manner inform future development. If one is aware of this as a possibility, then one can address it appropriately later in life, often after puberty begins.

5 – The most common time for a premature weaning that was traumatic to the infant to become manifest as a “problem” is around puberty. This is because the “baby core” of the personality comes prominently back to the surface of the personality at puberty and usually remains prominent for several years thereafter.

Some Practical Guidelines for Breast Feeding and Weaning:
1 – The ideal length of breast feeding is predicated on the assumption that infants do not develop a significant sense of differentiation between themselves and their mothers until the middle of the first year of life. Prior to that they feel “joined up” with and attached to the mother so that weaning before four to six months of age becomes increasingly traumatic and problematic for every month less than four months of age at which it takes place.

– Most infants (in the U.S.) seem spontaneously wean themselves between six months and a year, but will hold on to one last feeding, typically the night one, for a number of months more.

– A breast feeding (i.e. as the primary daily means of nutrition) that lasts significantly longer than twelve months needs to be explored. After that period it is likely either evidence of an infant whose first year had trauma in it, or it is evidence of a need in the mother to preserve that specific mode of relating. After two years, in my experience, the ongoing breast feeding is always more evidence of a need in the mother than in the infant.

2 – The most common “potentially traumatic weaning”, commonly unrecognized as significant, is the result of an attempted breast feeding that lasts less than a week after birth. This typically occurs because (1) the mother fails to “catch on” how to do it or fears that it is not working; (2) is ambivalent (consciously or unconsciously) about breast feeding; (3) has breasts with inverted nipples; (4) has breasts that are large and become over engorged and painfully inflamed; (5) has an infant who for whatever reason makes too feeble an attempt to engage with the breast feeding; etc.

– A well-meaning pediatrician or obstetrician will commonly suggest stopping the feeding and switching to a bottle with formula. He or she may even give the mother a shot to stop lactation (common in the “over engorgement” scenario).

[Note: I counsel pregnant mothers who say they intend to stop breast feeding before a minimum of 4 months that the infant may find the “weaning” traumatic and it might be wise to consider not breast feeding at all under those circumstances. Mothers who want to “give the baby the benefit of immunity from mother’s milk” may actually do more harm than good if they intend for the breast feeding to be stopped in the first three months to go back to work, etc.]

3 – Recognizing the association of weaning and behavior change is key to considering that it may be a trauma that needs factoring in as later life milestones are addressed, particularly those linked to separation. Evidence that the weaning was distressing is often subtle. Behavior changes, like disruption of an established sleeping pattern, increased clinginess, or its opposite “turning away”, etc. often go unrecognized as correlating with the early weaning. Knowing that the weaning has been registered by the infant is key to recognizing that the weaning was emotionally significant to the infant.

Later pubertal and adolescent emotional states and behavior will go unrecognized as linking to an early, traumatic weaning if no one has a model for such a link. [See Module Four on “How to Take a Baby History and Understand Its Implications”]

Can a Baby Be Breastfed (or Sleep in the Parent’s Bedroom) For Too Long?
1 – This is a topic about which people will have intense emotional reactions. I would like to share some of my impressions on these topics as a result of considerable personal experience as a psychoanalyst where I have spent nearly four decades pondering these questions. I have had a number of patients who slept in their parent’s bedroom for up to four years after birth.

The difficulty in assessing the impact of such experience is that it is so variable. Parent/child combos are of every stripe and persuasion. With that in mind, I do think some issues can be addressed to give the prospective parent some working models of variables to assess.

Clearly, any parent, considering how long to breast feed or keep an infant in their bedroom, is reacting to some issues or concerns about their own needs and the infant’s welfare. They want the infant’s health, both physically and emotionally, to be paramount.

Additionally, they may have anxieties about parenting and they may have strong feelings about babyhood as a result of their own infancy and relationship to their parents. Most new parents want their own children to have a better experience of infancy and early childhood than they had themselves if anything was felt to have gone wrong (e.g. prematurity, colic, mother going back to work, divorce, etc).

There are two crucial developmental issues to be addressed in this discussion, “separateness” and “jealous/envy”. I’ll tackle “separateness” first since it is chronologically slightly earlier, but not by much.

2 – “Separateness” is simultaneously an enormously important issue, psychoanalytically speaking, and yet also very subtle as a developmental issue, until it is time in mid adolescence to leave home to go to college, the military, etc. True “emotional maturity” is profoundly linked to the capacity to remain “psychologically separate” as a person, while also having the capacity to enter into a committed, loving relationship with someone else. Its underdeveloped contrasting state is to unconsciously wish to be an “unborn, inside baby” and/ or to remain “joined up” to one’s objects as a precondition for having a relationship.

Dr. Benjamin Spock (the pediatrician who guided millions of parents through having an infant with his book “A Handbook for Infant and Child Care”, before infant psychiatry was born) had sound basic advice when he said that every infant should feel that it is the most important person in the world during its first year of life.

As every parent knows, the “Catch 22” is in balancing the needs of the infant, with the needs of the parents as individual’s and as a couple. Here are a couple of axioms I think are worth living by.

Axiom #1: All children need to feel that their parents are willing to “sacrifice” on behalf on the infant in need. [In fact, the word “sacrifice” is the only word I have ever been able to come up with as a synonym for the word “parent”.]

Axiom #2: All children need to feel that their mother and father (or any parental couple) have a loving, dependable relationship that provides the basis for security to the infant. Being a parent is hard, being an infant is harder, and parenting requires a “tag team” approach of two adults. The infant needs the reassurance that it cannot consume and destroy one parent with its needs. Single mothers or fathers do the best they can, but it is not ideal for parent or infant/child.

Axiom #3: Children will put their parents together in every possible way except the right one. That quote from noted English psychoanalyst Roger Money-Kyrle is a truism that is a testimony regarding how profoundly children do not want to be left out of anything the parents do, have, or are.

Parents who are “put together” in the “right way” are allowed to have a loving a relationship that includes things that they do with each other without the child’s involvement, most quintessentially have a loving sexual relationship. I believe every child intuits that fact, but does not want his or her “nose rubbed in it”. They want mom and dad to love each other but not “leave the child out” of anything. Part of growing up in life is the acknowledgment that one cannot be mom or dad’s life partner and must seek out one’s own partner in life.

So what happens if breast feeding goes on for years and/or the child sleeps in the parent’s bedroom for more than a month or two after birth. The likelihood is that the developing child will believe that “separation” and “separateness” are not a necessary part of development. It will also likely reinforce the idea that mom and dad are not entitled to a relationship except to serve the infant/child.

This latter idea seems rampant in modern Japan, where parents seem to stop having a sexual relationship by the age forty or so, and mistresses and pornography have filled the void. In my own consulting room I have observed many couples who at a deeply unconscious level had difficulty feeling entitled to a loving, sexual relationship when as children they had not allowed the same to their parents. Couples often only begin to have marital difficulties after a child has been born and their find themselves more identified with the “left out” child that requires “split apart” parents.

3 – This leads to the question of “oedipal jealousy” and “envy” of the parent’s relationship. If mother is monopolized for years by breast feeding, one has to split off one’s sexual phantasies about mother’s body and deny that mom and dad have a sexual relationship with each other. Most mothers become progressively more uncomfortable with their child wanting to touch or fondly their body as the child progresses from being a baby to being a child.

I grew up in a poor neighborhood where homes where small, children could hear their parents’ sexual relationship, and experimenting with sex with siblings and neighborhood children was the norm. Everyone was exposed to and curious about sex. Pubertal siblings and peers often initiated the curious younger children.

While I cannot prove it, I have always felt that countries that are impoverished, and have cramped living quarters, expose children to adult sexuality very early. The oedipal jealousy and envy aroused may have a significant impact on why women are treated as “possessions” and prevented from being sexual in their own right. One need not look very far in the world today to see that fear of women being free to be seen as sexual is very threatening to many men around the world.

The point I wish to make by this digression is that children who monopolize mother for years of breastfeeding, and split mom and dad apart in their minds (or even literally) by sleeping in the parental bedroom for years, are at risk to develop serious distortions about “separateness” and “parental sexuality” that may prove significantly problematic in later years.

It is like global warming, it is difficult to see in the moment, but why risk denial when the upside is a minor cost and the downside is potentially catastrophic.

All other things being equal, don’t have children sleeping in the parental bedroom with any regularity after a month or two after being born. Breast feed according to the baby’s needs and response, not the parent’s preconceived ideas about how long it should be. Everything in life is a trade-off and these two situations are powerful examples of that truism.

If the breastfeeding is seriously likely to go for less than four months, seriously consider not doing at all as the immune benefits are highly likely to be outweighed by the emotional costs of a weaning before a baby’s brain is sufficiently organized to figure out why it is coming to an end. The loving quality of relationship with the infant is more important than breast feeding done for outside pressure or guilt.