第四章

皮膚饑渴

CHAPTER 4

Skin Hunger

和其他人一樣，醫(yī)生也喜歡自己的成就被認可。獲得醫(yī)學名聲的一個可靠途徑是發(fā)現(xiàn)一種新的疾病或解決一個特別艱巨的醫(yī)學難題。在我咨詢的一家德克薩斯州醫(yī)院，醫(yī)生們把723E病房的小女孩看作是這樣一個挑戰(zhàn)。四歲的勞拉體重只有26磅，盡管幾周來她一直通過插在鼻子里的管子進食高熱量的食物。我在護士站看到的她的醫(yī)療文件有四英尺高，比這個縮水的小女孩本人還要高。勞拉的故事，就像韋科的孩子們的故事一樣，幫助我們更多地了解兒童如何對早期經(jīng)驗作出反應。它說明了心靈和身體是如何不能分開對待的，揭示了嬰幼兒的大腦健康發(fā)展需要什么，并證明了忽視這些需要會對兒童成長的各個方面產(chǎn)生深遠影響。

LIKE EVERYONE ELSE, DOCTORS ENJOY being recognized for their achievements. One sure way of attaining medical fame is to discover a new disease or to solve a particularly daunting medical puzzle. And the physicians at one Texas hospital where I consulted saw the little girl in room 723E as such a challenge. At four years old, Laura weighed just twenty-six pounds, despite having been fed a high-calorie diet via a tube inserted through her nose for weeks. The stack of her medical files that confronted me at the nurses’ station was about four feet high, taller than the shrunken little girl herself. Laura’s story, like that of the children of Waco, helped us learn more about how children respond to early experience. It illustrates how the mind and body cannot be treated separately, reveals what infants and young children need for healthy brain development and demonstrates how neglecting those needs can have a profound impact on every aspect of a child’s growth.

勞拉的檔案包含了數(shù)千頁的文件，詳細記錄了與內(nèi)分泌學家、腸胃學家、營養(yǎng)學家和其他醫(yī)療專家的會面。還有無盡的血液檢查、染色體檢查、激素水平、活組織檢查的實驗室報告。這些文件包括更多侵入性測試的結果，這些測試使用了插入她喉嚨的窺鏡來檢查她的胃，以及插入直腸的窺鏡來檢查她的腸道。有幾十份咨詢醫(yī)生的報告。這個可憐的女孩甚至做了一次探查性腹腔鏡檢查，醫(yī)生將一根管子插入她的腹部，仔細檢查她的內(nèi)部器官；她的小腸被剪下一段，送到國家衛(wèi)生研究院進行分析。

Laura’s files contained literally thousands of pages of documents, detailing visits with endocrinologists, gastroenterologists, nutritionists, and other medical specialists. There were endless lab reports of blood work, chromosome tests, hormone levels, biopsies. The documents included results from even more invasive tests, which had used scopes inserted into her throat to examine her stomach, and scopes inserted rectally to examine her bowels. There were dozens of reports from consulting physicians. The poor girl had even had an exploratory laparoscopy, in which doctors inserted a tube into her abdomen to scrutinize her internal organs; a snippet of her small intestine had been clipped off and sent to the National Institutes of Health for analysis.

最后，在特殊的胃腸道研究單元呆了一個月后，一位社會工作者向勞拉的醫(yī)生施壓，要求他們進行精神病學咨詢。正如胃腸病學研究人員多年前第一次見到勞拉時認為他們發(fā)現(xiàn)了一個 "腸道癲癇 "的病例一樣，心理醫(yī)生也對勞拉的病例有一個新的理論。前來進行初步咨詢的心理學家專門研究飲食障礙，他認為他看到的是第一個有記錄的 "嬰兒厭食癥 "的例子。他很著迷也很興奮，與他的心理健康同事討論了這個病例。最終，他要求我提供咨詢，因為我有更多的學術出版經(jīng)驗，而且他確信這將是一個可報告的案例。他告訴我，這個孩子一定是在偷偷地排泄，或者也許是在晚上起來瘋狂地運動。否則，她怎么可能被喂了這么多卡路里卻仍然不長個？他想知道我對這個令人不安的新問題的看法，這是第一次在一個年輕的孩子身上看到。

Finally, after being on the special gastrointestinal research unit for a month, a social worker pressured Laura’s physicians to get a psychiatry consult. Just as the gastroenterology fellows thought they’d discovered a case of “intestinal epilepsy” when they first saw Laura years before, the shrinks, too, had a novel theory about Laura’s case. The psychologist who came for the initial consultation specialized in eating disorders, and he believed he was seeing the first documented instance of “infantile anorexia.” Fascinated and excited, he discussed the case with his mental health colleagues. Ultimately, he requested a consultation from me because I had more experience with academic publishing and he was sure that this would be a reportable case. He told me that the child had to be purging secretly, or perhaps getting up at night to exercise furiously. Otherwise, how could she be fed so many calories but still not grow? He wanted my insight on this disturbing new problem, seen for the first time in a young child.

我感到很好奇。我從來沒有聽說過小兒厭食癥。我去了醫(yī)院，打算像往常一樣開始咨詢，通過查看病歷，盡可能多地了解孩子的病史。但是，當我發(fā)現(xiàn)這四年來，二十次入院，六次專科門診，四英尺高的一堆文件時，我只是掃描了入院接收報告，然后進去向病人和她的母親介紹自己。

I was curious. I had never heard of infantile anorexia. I went to the hospital planning to start the consult like I always do, by reviewing the chart to learn as much about the child’s history as possible. But when I discovered the four-year, twenty-previous-admission, six-specialty-clinic, four-foot-tall pile of documents, I just scanned the admission intake report and went in to introduce myself to the patient and her mother.

在女孩的病房里，我發(fā)現(xiàn)了一個令人痛苦的場景。勞拉22歲的媽媽弗吉尼亞*正在看電視，坐在離她孩子大約5英尺遠的地方。母親和女兒沒有互動。瘦小、憔悴的勞拉靜靜地坐著，她的眼睛很大，盯著一盤食物。她還插著一根喂食管，將營養(yǎng)物質(zhì)打入她的胃里。我后來才知道，飲食失調(diào)的心理學家不鼓勵弗吉尼亞在吃飯時與勞拉互動。這應該是為了阻止勞拉--所謂的狡猾的、幼稚的厭食癥患者--在食物和用餐時操縱她的母親。當時的理論是，厭食癥患者喜歡在不吃東西時得到的關注，并利用它來控制其他家庭成員；拒絕他們的這種 "獎勵 "應該有助于康復。但是我在這里看到的是一個絕望的、瘦小的小女孩和一個脫離現(xiàn)實的母親。

In the girl’s hospital room I found a distressing scene. Laura’s twenty-two-year-old mom, Virginia*, was watching television, seated about five feet away from her child. Mother and daughter were not interacting. Tiny, emaciated Laura was sitting quietly, her eyes big, staring at a plate of food. She also had a feeding tube, which pumped nutrients into her stomach. I would later learn that Virginia had been discouraged from interacting with Laura during mealtimes by the eating disorders psychologist. This was supposed to stop Laura—the alleged cunning, infantile anorectic—from manipulating her mother around food and meals. The theory then was that people with anorexia enjoy the attention they get when they don’t eat, and use it to control other family members; denying them this “reward” was supposed to aid recovery. But all I could see here was a despondent, skinny little girl and a disengaged mother.

大腦是一個歷史性的器官。它儲存了我們的個人敘事。我們的生活經(jīng)歷通過創(chuàng)造我們大腦的模板記憶目錄來塑造我們成為什么樣的人，這些記憶指導我們的行為，有時我們可以有意識地認識到，更多時候是通過我們意識不到的過程。因此，弄清任何與大腦有關的臨床問題的一個關鍵因素是獲得病人經(jīng)歷的準確歷史。由于大部分大腦是在生命早期發(fā)育的，所以父母的教育方式對大腦的發(fā)育有著巨大的影響。因此，由于我們傾向于以我們自己在童年時被照顧的方式來照顧我們的孩子，所以一個好的兒童 "大腦 "歷史始于照顧者的童年和早期經(jīng)歷的歷史。為了了解勞拉，我需要了解她的家庭，就她而言，家庭包括她的媽媽。

The brain is an historical organ. It stores our personal narrative. Our life experiences shape who we become by creating our brain’s catalog of template memories, which guide our behavior, sometimes in ways we can consciously recognize, more often via processes beyond our awareness. A crucial element in figuring out any brain-related clinical problem, therefore, is getting an accurate history of the patient’s experiences. Since much of the brain develops early in life, the way we are parented has a dramatic influence on brain development. And so, since we tend to care for our children the way we were cared for ourselves during our own childhoods, a good “brain” history of a child begins with a history of the caregiver’s childhood and early experience. To understand Laura I would need to know about her family, which in her case consisted of her mom.

我開始詢問弗吉尼亞州無害的基本問題。幾乎在第一時間，我就開始懷疑勞拉問題的根源在于她年輕、好心但缺乏經(jīng)驗的母親的過去。

I started by asking Virginia innocuous, basic questions. Almost immediately I began to suspect that the source of Laura’s problems lay in her young, well-intentioned, but inexperienced mother’s past.

"你來自哪里？我問她。

“Where are you from?” I asked her.

"我猜，奧斯汀，"她說。

“I guess, Austin,” she said.

"你的父母來自哪里？"

“Where are your parents from?”

"我不知道。"

“I don’t know.”

在幾分鐘內(nèi)，我發(fā)現(xiàn)弗吉尼亞是一個寄養(yǎng)系統(tǒng)的孩子。弗吉尼亞一出生就被一個吸毒的母親拋棄，父親不詳，她在那個時代長大，當時兒童福利系統(tǒng)通常每六個月將嬰兒和幼兒轉(zhuǎn)移到一個新的寄養(yǎng)家庭；理由是這樣他們就不會對任何特定的照顧者產(chǎn)生太多依賴。當然，現(xiàn)在我們知道，嬰兒早期對少數(shù)穩(wěn)定的照顧者的依戀對于情感健康甚至身體發(fā)育都是至關重要的。但是在那個時候，這種知識甚至還沒有開始滲透到兒童福利機構中。

Within minutes I discovered that Virginia was a child of the foster care system. Abandoned at birth by a drug-addicted mother, father unknown, Virginia had grown up at a time when it was common for the child welfare system to move infants and toddlers to a new foster home every six months; the rationale was that this way they wouldn’t become too attached to any particular caregiver. Now, of course, we know that an infant’s early attachment to a small number of consistent caregivers is critical to emotional health and even to physical development. But at that time this knowledge hadn’t even begun to penetrate the child welfare bureaucracy.

與其他任何物種相比，人類的幼年生來就很脆弱，而且依賴性很強。懷孕和幼兒期對母親來說是巨大的能量消耗，并間接地影響到更大的家庭群體。但是，盡管有分娩的劇痛，懷孕和哺乳的諸多不適，以及新生兒的嘈雜和持續(xù)的要求，人類的母親絕大多數(shù)都傾向于致力于安慰、喂養(yǎng)和保護她們的孩子。事實上，大多數(shù)人都很高興地這樣做；如果一個人不這樣做，我們就會發(fā)現(xiàn)這是一種病態(tài)。

More than in any other species, human young are born vulnerable and dependent. Pregnancy and early childhood are tremendous energy drains on the mother and, indirectly, on the larger family group. But despite the severe pain of childbirth, the numerous discomforts of pregnancy and breast-feeding, and the loud, continuous demands of a newborn, human mothers overwhelmingly tend to devote themselves to comforting, feeding, and protecting their young. Indeed, most do so happily; we find it pathological when one does not.

對火星人來說，或者甚至對許多非父母的人來說，這種行為可能看起來像一個謎。是什么促使父母放棄睡眠、性、朋友、個人時間，以及生活中幾乎所有的其他樂趣，以滿足一個小的、經(jīng)常令人惱怒的嘈雜的、大小便失禁的、需要的生命的要求？秘密在于，在許多方面，照顧孩子是一種難以描述的快樂。我們的大腦獎勵我們與孩子，特別是嬰兒互動：他們的氣味，他們平靜時發(fā)出的咕咕聲，他們光滑的皮膚，特別是他們的臉，都是為了讓我們充滿喜悅。我們所說的 "可愛 "實際上是一種進化上的適應，它有助于確保父母會照顧他們的孩子，嬰兒會得到他們的需求，而且父母會愉快地承擔這項看似不容易的任務。

To a Martian—or even to many nonparents—this behavior might seem like a mystery. What could prompt parents to give up sleep, sex, friends, personal time, and virtually every other pleasure in life to meet the demands of a small, often irritatingly noisy, incontinent, needy being? The secret is that caring for children is, in many ways, indescribably pleasurable. Our brains reward us for interacting with our children, especially infants: their scent, the cooing sounds they make when they are calm, their smooth skin, and especially, their faces are designed to fill us with joy. What we call “cuteness” is actually an evolutionary adaptation that helps ensure that parents will care for their children, that babies will get their needs met, and that parents will take on this seemingly thankless task with pleasure.

因此，在我們的成長過程中，在一般情況下，我們會得到細心的、適應性的和愛的照顧。當我們寒冷、饑餓、口渴、驚恐或有任何苦惱時，我們的哭聲會帶來安慰性的照顧者，他們會滿足我們的需要，在他們的愛的關注中化解我們的苦惱。有了這種愛的關懷，在我們發(fā)育中的大腦中，兩個主要的神經(jīng)網(wǎng)絡同時受到刺激。第一個是與人類關系互動相關的一套復雜的感官知覺：照顧者的臉、微笑、聲音、觸摸和氣味。第二個是對介導 "快樂 "的神經(jīng)網(wǎng)絡的刺激。這種 "獎勵系統(tǒng) "可以以多種方式被激活，其中之一是緩解痛苦。解渴、滿足饑餓、平息焦慮--所有這些都會導致一種快樂和舒適感。正如我們前面所討論的，當兩種神經(jīng)活動模式同時出現(xiàn)并充分重復時，這兩種模式之間會產(chǎn)生關聯(lián)。

So during our development, in the ordinary course of things we will receive attentive, attuned, and loving care. When we are cold, hungry, thirsty, frightened, or distressed in any way, our cries will bring the comforting caregivers who meet our needs and dissolve our distress in their loving attention. With this loving care two major neural networks are stimulated simultaneously in our developing brains. The first is the complex set of sensory perceptions associated with human relational interactions: the caregiver’s face, smile, voice, touch, and scent. The second is stimulation of the neural networks mediating “pleasure.” This “reward system” can be activated in a number of ways, one of which is the relief of distress. Quenching thirst, satisfying hunger, calming anxiety—all result in a sense of pleasure and comfort. And as we have discussed earlier, when two patterns of neural activity occur simultaneously with sufficient repetition, an association is made between the two patterns.

在回應性養(yǎng)育的情況下，快樂和人際互動不可避免地交織在一起。這種相互聯(lián)系，即快樂與人際互動的關聯(lián)，是重要的神經(jīng)生物學 "膠水"，它連接并創(chuàng)造健康的關系。因此，我們能得到的最有力的回報是我們所愛和尊重的人的關注、認可和愛戴。同樣，我們經(jīng)歷的最強大的痛苦是失去這種關注、認可和愛戴--最明顯的例子當然是所愛之人的死亡。這就是為什么如果我們沒有人與之分享，即使是我們最偉大的智力、運動或職業(yè)上的勝利也顯得空洞。

In the case of responsive parenting, pleasure and human interactions become inextricably woven together. This interconnection, the association of pleasure with human interaction, is the important neurobiological “glue” that bonds and creates healthy relationships. Consequently, the most powerful rewards we can receive are the attention, approval, and affection of people we love and respect. Similarly, the most powerful pain we experience is the loss of that attention, approval, and affection—the most obvious example being, of course, the death of a loved one. This is why even our greatest intellectual, athletic, or professional triumphs seem empty if we have no one with whom to share them.

如果你是出生在一個充滿愛的家庭的大多數(shù)嬰兒之一，一個始終如一的、培養(yǎng)人的照顧者--比如說母親或父親--將出現(xiàn)并反復滿足你的需求。一次又一次，父母中的一個或兩個會在你哭的時候來，在你饑餓、寒冷或害怕的時候安撫你。隨著你的大腦發(fā)育，這些充滿愛的照顧者為你提供了人類關系的模板。那么，依戀是人與人之間聯(lián)系的記憶模板。這個模板是你對人類關系的主要 "世界觀"。它受到你是否經(jīng)歷過善良、調(diào)和的養(yǎng)育方式，或者你是否接受過不一致、經(jīng)常中斷、虐待或忽視的 "照顧 "的深刻影響。

If you are one of the majority of infants born to a loving home, a consistent, nurturing caregiver—say a mother or father—will be present and repeatedly meet your needs. Time and again, one or both parents will come when you cry and soothe you when you are hungry, cold, or scared. As your brain develops these loving caregivers provide the template that you use for human relationships. Attachment, then, is a memory template for human-to-human bonds. This template serves as your primary “world view” on human relationships. It is profoundly influenced by whether you experience kind, attuned parenting or whether you receive inconsistent, frequently disrupted, abusive, or neglectful “care.”

如前所述，大腦是以一種依賴使用的方式發(fā)展的。被使用的神經(jīng)系統(tǒng)變得更有優(yōu)勢；而那些沒有被使用的神經(jīng)系統(tǒng)則變得更少。隨著孩子的成長，大腦的許多系統(tǒng)需要刺激，如果它們要發(fā)展的話。此外，這種依賴使用的發(fā)展必須發(fā)生在特定的時間，以使這些系統(tǒng)發(fā)揮其最佳功能。如果錯過了這個 "敏感期"，一些系統(tǒng)可能永遠無法發(fā)揮其全部潛力。在某些情況下，與忽視有關的缺陷可能是永久性的。例如，如果一只小貓的一只眼睛在出生后的頭幾周一直閉著，它的那只眼睛就會失明，盡管這只眼睛完全正常。大腦的視覺回路需要正常的視覺經(jīng)驗，以便為自己布線；如果缺乏視覺刺激，閉上的眼睛中的神經(jīng)元就無法建立關鍵的聯(lián)系，就會失去視覺和深度感知的機會。同樣，如果一個孩子在其早期生活中沒有接觸到語言，他可能永遠無法正常說話或理解語言。如果一個孩子在青春期前不能流利地使用第二種語言，那么他在說任何新學的語言時幾乎都會有口音。

As noted earlier, the brain develops in a use-dependent manner. Neural systems that are used become more dominant; those that are not grow less so. As a child grows, many systems of the brain require stimulation if they are to develop. Furthermore, this use-dependent development must occur at specific times in order for these systems to function at their best. If this “sensitive period” is missed, some systems may never be able to reach their full potential. In some cases the neglect-related deficit may be permanent. For example, if one of a kitten’s eyes is kept closed during the first few weeks of its life, it will be blind in that eye, even though the eye is completely normal. The visual circuitry of the brain requires normal experience of sight in order to wire itself; lacking visual stimuli, the neurons in the closed eye fail to make crucial connections and the opportunity for sight and depth perception is lost. Similarly, if a child is not exposed to language during his early life, he may never be able to speak or understand speech normally. If a child doesn’t become fluent in a second language before puberty, he will almost always speak any new language he does learn with an accent.

雖然我們不知道正常依戀的發(fā)展是否像語言和視覺那樣有一個固定的 "敏感期"，但研究確實表明，像弗吉尼亞這樣的經(jīng)歷，即兒童在生命的頭三年沒有機會與一個或兩個主要照顧者建立永久的關系，對人們正常和親切地相互聯(lián)系的能力有持久的影響。沒有得到持續(xù)的、身體上的愛或沒有機會建立愛的紐帶的兒童，根本就沒有得到必要的模式化、重復性的刺激，無法正確建立大腦中連接獎勵、快樂和人與人之間互動的系統(tǒng)。這就是發(fā)生在弗吉尼亞身上的事情。由于童年時期短暫而零散的照顧，她沒有像大多數(shù)母親那樣從抱著孩子、聞著氣味和與孩子互動中獲得同樣程度的回報--快樂。

While we don’t know whether there is a fixed “sensitive period” for the development of normal attachment the way there appears to be for language and sight, research does suggest that experiences like Virginia’s, in which children are not allowed the chance to develop permanent relationships with one or two primary caregivers during their first three years of life have lasting effects on people’s ability to relate normally and affectionately to each other. Children who don’t get consistent, physical affection or the chance to build loving bonds simply don’t receive the patterned, repetitive stimulation necessary to properly build the systems in the brain that connect reward, pleasure, and human-to-human interactions. This is what had happened to Virginia. As a result of transient and fragmented caregiving during childhood she just didn’t get the same degree of reward—pleasure, if you will—from holding, smelling, and interacting with her baby that most mothers would.

在5歲時，弗吉尼亞終于在她最永久的童年之家安頓下來。她的養(yǎng)父母是充滿愛心、道德高尚的基督徒，是好父母。他們教她禮儀。他們教她 "以德服人"。他們提供了一個基本的、人性化的、正常行為的腳本。他們教她偷東西是不對的，所以她沒有未經(jīng)允許就拿別人的東西。他們教導她，毒品對你有害，所以她不使用毒品。他們教她要努力工作和上學，所以她也這樣做了。他們想收養(yǎng)她，她也想被他們收養(yǎng)，但州政府從未終止她親生父母的權利，而且她的個案工作者偶爾會談論她與親生母親團聚的可能性，所以收養(yǎng)一事從未進行過。不幸的是，這意味著當她年滿18歲時，國家在法律上不再對弗吉尼亞 "負責"。因此，她不得不離開她的寄養(yǎng)家庭，寄養(yǎng)父母被告知不能再與她接觸。他們作為其他孩子的寄養(yǎng)父母的未來與他們是否遵守個案工作者的意愿有關。由于另一項不人道的兒童福利政策--旨在減少該系統(tǒng)的法律責任，而不是保護兒童--弗吉尼亞失去了她唯一真正認識的父母。

At the age of five Virginia had finally settled into what would be her most permanent childhood home. Her foster parents were loving, highly moral Christian people, and good parents. They taught her manners. They taught her to “do unto others.” They provided a basic, humane, script for normal behavior. They taught her that stealing was wrong, so she didn’t take things from others without permission. They taught her that drugs were bad for you, so she didn’t use drugs. They taught her to work hard and go to school, so she did that, too. They wanted to adopt her and she wanted to be adopted by them, but the state never terminated the parental rights of her biological parents and there was occasional talk by her caseworkers of the potential for reuniting her with her biological mother, so the adoption never went through. Unfortunately, this meant that when she turned eighteen, the state was no longer legally “responsible” for Virginia. As a result she had to leave her foster home and the foster parents were told to have no further contact with her. Their future as foster parents for other children was linked to their compliance with the wishes of the caseworkers. Because of yet another inhumane child welfare policy—one aimed at reducing the system’s legal liabilities, not protecting children—Virginia lost the only parents she’d ever really known.

那時，她已經(jīng)高中畢業(yè)。她被安置在一個低收入社區(qū)為 "脫離寄養(yǎng) "的兒童設立的中途之家。與她所愛的人隔絕，沒有明確的規(guī)則可循，并尋求親情，弗吉尼亞很快就懷孕了。孩子的父親離開了她，但她想有個孩子來愛她，她想做正確的事情，就像她的養(yǎng)父母教她的那樣。她尋求產(chǎn)前護理，并很快被納入了一個為高危母親提供的良好計劃中。不幸的是，孩子一出生，她就不再有資格參加那個項目，因為她不再懷孕了。生完孩子后，她只能靠自己了。

By then she had graduated high school. She was placed in a halfway house for children “aging out” of foster care in a low-income community. Cut off from her loved ones, with no clear-cut rules to follow and seeking affection, Virginia rapidly became pregnant. The father of her child left her, but she wanted a baby to love and she wanted to do the right thing, as her foster parents had taught her. She sought prenatal care and was quickly enrolled in a good program for high-risk mothers. Unfortunately, as soon as the baby was born, she no longer qualified for that program because she wasn’t pregnant anymore. After she gave birth, she was on her own.

但弗吉尼亞不知道離開醫(yī)院后該如何處理她的孩子。由于她自己早期的依戀被突然殘酷地終止了，她沒有一些人所說的 "母性本能"。在認知上，她知道需要進行哪些基本行為：喂勞拉，給她穿衣服，給她洗澡。然而，在情感上，她卻迷失了方向。沒有人想過要具體指導她提供嬰兒所需要的愛和身體互動，她也不覺得有必要自己去做這些事。簡單地說，弗吉尼亞沒有從這些事情中得到樂趣，也沒有人教她應該做這些事情。

But Virginia had no idea what to do with her baby after she left the hospital. Having had her own early attachments abruptly and brutally terminated, she didn’t have what some might call the “maternal instinct.” Cognitively, she knew what basic acts needed to be performed: feed Laura, dress her, bathe her. Emotionally, however, she was lost. No one had thought to specifically instruct her to provide the loving, physical interactions that infants need, and she didn’t feel compelled to do them on her own. Simply, Virginia got no pleasure from these things and she had not been taught that she should do them.

弗吉尼亞沒有被她的邊緣情感系統(tǒng)所牽引，也沒有被她的認知、信息攜帶皮層所推動，她以一種情感上脫節(jié)的方式養(yǎng)育孩子。她沒有花很多時間抱她的孩子；她用奶瓶支撐著給小家伙喂奶，而不是緊緊地依偎在她的懷里。她沒有搖晃她，沒有給她唱歌，沒有咕噥，沒有盯著她的眼睛，沒有反復數(shù)她完美的小腳趾，也沒有做任何其他愚蠢但非常重要的事情，這些都是擁有普通童年的人在照顧嬰兒時本能地做的。沒有這些所有哺乳動物都需要的刺激生長的身體和情感信號，勞拉的體重就不再增加了。弗吉尼亞做了她認為正確的事情，不是因為她心里有感覺，而是因為她的頭腦告訴她這是一個母親 "應該 "做的。當她感到沮喪時，她要么嚴厲地管教孩子，要么不理會她。她根本沒有從積極的護理互動中感受到滿足和快樂，而這種互動通常能幫助父母克服養(yǎng)育孩子的艱難情感和身體挑戰(zhàn)。

Not pulled by her limbic, emotional systems and not pushed by her cognitive, information-carrying cortex, Virginia parented in an emotionally disconnected way. She didn’t spend much time holding her baby; she fed the little one propped up with a bottle, not nuzzled close to her bosom. She didn’t rock her, didn’t sing to her, didn’t coo or stare into her eyes or count her perfect tiny toes over and over or do any of the other silly but hugely important things that people with ordinary childhoods instinctively do when caring for a baby. And without these physical and emotional signals that all mammals need to stimulate growth, Laura stopped gaining weight. Virginia did what she thought was the right thing, not because she felt it in her heart, but because her mind told her that’s what a mother “should” do. When she got frustrated, she either harshly disciplined the child or ignored her. She simply didn’t feel the contentment and joy from the positive caregiving interactions that normally help parents overcome the difficult emotional and physical challenges of child-rearing.