Theology of the Body & Sleep Training–Part Deux (Or, every time you sleep-train, does a puppy really die?)

My post on sleep training, learned helplessness and the TOB predictably netted a lot of comments.  Many of those comments were not posted because they did not reflect well on the correspondent and I feel strongly that it is my job to protect people’s dignity.  I’m happy to publish criticisms, but  I won’t post something that I think you’ll regret when you calm down.

But some comments were stellar.  One exchange I had with Dr. Kathleen Berchelmann was, I felt, worthy of it’s own post.  While, as you can see, I disagreed with her comments, I appreciated her points.  I hope you enjoy the exchange.

Dear Dr. Popcak,

I want to personally thank you for all your excellent writing.  I’ve been a fan of yours from a distance for some time.  I promote your work on my blog under “Parenting Resources” at: http://www.catholicpediatrics.com/resources/parenting

In general I am a supporter of most aspects of attachment parenting.  I would, however, like to bring to your attention a September, 2012 article from the journal Pediatrics.  In case you don’t have access to their full-text articles, here is a popular press summary of the study: http://healthland.time.com/2012/09/10/its-o-k-to-let-babies-cry-it-out-at-bedtime/

I am assuming the study you refer to in your post is the August 2011 study from Early Human Development, “Asynchrony of mother–infant hypothalamic–pituitary–adrenal axis activity following extinction of infant crying responses induced during the transition to sleep.”  It’s a very interesting study.  I agree that persistently elevated cortisol levels show that there isn’t a lot of “self-soothing” taking place.  But I think, as parents and health care professionals, we have to ask ourselves the larger question, “What are the negative consequences of this physiologic sign of persistent stress?” 

I feel it is a big jump to equate this persistent rise in cortisol of a baby who cries him or herself to sleep with the learned helplessness of the studies you cite above.  The stressors in each case were different.  They are not equivalent experiments.  There is no data to suggest that babies who “cry it out” have an increase risk of depression or anxiety disorders as you suggest in your second to last paragraph.  The Pediatrics study I cite above actually showed the opposite– that babies who “cried it out” did not have increased risk of emotional, psychological, or behavioral disorders at age 6.  In fact, babies who were in the control group (not left to “cry it out”) actually had a higher risk of behavior disorders. 

Dr. Popcak, I also love Theology of the Body, and as a pediatrician I have found TOB an invaluable tool for teaching healthy sexuality to children and adolescents.  Please see my project, Text4RealSex, http://www.Text4RealSex.com.   To the best of my knowledge, however, Blessed John Paul II never mentions baby’s crying and sleep patterns in his development of Theology of the Body.  When we elaborate on TOB themes and apply them to new situations, as I often do, I think it is important to indicate that these are our thoughts, not JPII’s. 

There are many tired parents out there struggling to deal with crying babies.  I think we have to be very careful before we lead parents to think that they are causing irreparable harm to their infants or violating the teachings of the Catholic Church. 

Thank you for your faithfulness and your beautiful commitment to Catholic parenting and mental health. 

Warmest Regards,

Kathleen M. Berchelmann, MD Pediatrician Washington University School of Medicine and St. Louis Children’s Hospital

 

Dr. Berchelmann,

Thank you for your excellent comments. I appreciate your wisdom and your expertise.

As you know, good vagal tone  (note:  the vagus nerve resets the stress-out body to a normal unstressed state.  “Vagal tone”  refers to the efficiency with which the vagus nerve rests the body’s stress signs) is associated with healthy emotional regulation and greater resistance to both depression and anxiety. I’m sure you are also aware that long term cortisol exposure is antithetical to developing good vagal tone.

I want to be clear that I am not saying–as some have accused me in an attempt to exaggerate my point to make it easier to dismiss me–that sleep training causes “brain damage.” (Or, for that matter, as some have accused me of saying, that parents who sleep train are “abusers”  or “bad Catholics”  or for that mater, that every time a parent sleep-trains a baby, a puppy dies.)  What I am saying is that the idea of self-soothing in infancy is a convenient fiction.  What is the mechanism or process infants use to self-soothe?  How does this magic happen?  Everything I know about developmental psychology says that it isn’t possible.  Unless someone can show me the process of self-soothing, I have to assume that the idea that babies can self-soothe is wishful thinking at best and junk science at worst.  There is just no evidence that it can be done.  So, if the baby isn’t self-soothing, what IS happening?  Well, the evidence would appear to show that what is happening is learned helplessness.  When cortisol levels are elevated for a long-enough period that help seeking behavior is extinguished in the presence sustained stress, that is learned helplessness.

Now, it is a fair question to ask just how damaging this degree of learned helplessness really is, but I don’t think there is a question that it is, indeed, damaging to at least some degree. I don’t know of a single study that suggests learned helplessness is a good thing.  How helpless should anyone want to feel?

I appreciate the study you cite, and I have read it before, but to my eyes all it is saying is that sleep training gets babies to sleep and when babies sleep moms and dads are happy.  But to go from that to say that sleep training is safe begs the question of how sleep training actually works.  What is the mechanism?  If the mechanism is self-soothing, then how does that actually happen?  If the mechanism is learned helplessness, well then, let’s admit that and deal with the reality of the situation.  Maybe a little learned helplessness is a good thing maybe its not, but let’s not be too cowardly to ask the question.  Any pharmacologist will tell you that one really can’t say something is safe if one is unwilling to look at the mechanism of action.  That is where the study you cite over-reaches.  You cannot say something is “safe” if you don’t know how it works.

Likewise, the study indicates that sleep-trained children were easier than children who were not sleep-trained, but if the mechanism of action of sleep-training is learned helplessness, this makes perfect sense.  Parents typically report quiet children as better behaved. Children who have learned the pointlessness of crying through sleep-training will be quieter and seen as better behaved by parents.  But is a quieter baby really a healthier baby?  Or is a quieter baby a depressed baby?  We don’t know because the study you cite refuses to look at the mechanism of action behind the efficacy of sleep-training.

Finally, regarding TOB. I don’t believe I claimed JPII wrote anything on sleep training or crying-it-out but don’t make the mistake of thinking that TOB is just about sex.  JPII is the father of the theology of the body, but the theology of the body is it’s own theological discipline, like Christology or ecclesiology.  Just because JPII didn’t write about it doesn’t mean it isn’t consistent with the principles of the TOB. I am happy to take full credit for being among the first people to apply the principles of TOB to parent-child relationships and family dynamics.   That said, in my response to Terri, I referenced the work of Dan Seigel, author of Parenting from the Inside Out and Editor-in-Chief of the Norton Series on Interpersonal Neurobiology.  It might interest you to know that JPII was an admirer of Daniel Seigel’s work, and that he brought Dr. Seigel to the Vatican to present on Mother-Infant bonding and the developing brain.   There is a great deal of evidence showing that JPII was very interested in understanding the process of attachment and bonding and his interest is reflected in his work on the feminine genius–which is foundational concept of TOB.

In conclusion, I thank you for taking the time to write.  I do appreciate and respect both your expertise and your tone and I hope you will be a regular reader/commenter.  But until someone can show me how, exactly, an infant self-soothes, I cannot in good conscience do anything but remind people that the idea of self-soothing is a myth and that the mechanism behind sleep-training is, by all indications,  learned helplessness.  I believe parents should have the right to use it as long as they can give informed consent and they can’t do that if they aren’t told the truth.

May God Bless you abundantly,

Dr. Greg

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About Dr. Greg

Dr. Gregory Popcak directs the Pastoral Solutions Institute, an organization dedicated to helping Catholics find faith-filled solutions to marriage, family, and personal problems. Together with his wife, Lisa, he hosts More2Life Radio. He is the author of over a dozen books integrating psychological insights with our Catholic faith. For more info about books, tele-counseling and other resources, visit www.CatholicCounselors.com.

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  • http://www.catholicap.com Kim Cameron-Smith

    Dr. Greg,
    I used to feel heartbroken when I read the aggression and vitriol from parents when confronted by the overwhelming science on attachment issues, including the cry it out method. Now I just get angry. As an ordinary mom who is not a scientist but who can READ for heavens sake, it’s obvious parents cannot simply ignore the sheer volume of scientific evidence for the significance of bonding and attachment in the healthy development of children of all ages. Our culture is a very weak bonding culture. In societies that value connection and security in their young, parents are responsive, keep their small children close, and parent intensively. This is very inconvenient and complicated for modern parents because earning a living takes us away from our children. Parents, as protectors of their children, have to figure out how to protect their children’s hearts while still providing for their families. This is an issue that affects our entire society and shouldn’t be a burden for only parents to bear, but the unfortunate reality is that it’s up to us to ensure our children thrive and not just survive.
    Thank you for your beautiful parenting book, Parenting with Grace. I once felt like my attachment lifestyle was in a one box and my Faith in another — my husband and I thought we were closet hippies! Your book helped us see that attachment and nurturing connection is part of our call to build our families as a community of love. It’s a courageous book, and I know you’ve received criticism for it. You are doing the right thing by speaking the truth even when it’s inconvenient or uncomfortable for readers.

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  • Guest

    I’m no authority on developmental psychology, but I am a pretty seasoned and instinctual mom. With regard to infants waking at night, I wonder if having a small delay, for instance the time it takes to hear your baby cry, wake up a little, get up, put on your bathrobe and slippers, and walk to their room, (1-2 min?) before you pick them up isn’t healthier than the almost instantaneous response of co-sleeping. What I mean is doesn’t it give the baby some time to realize mom (or dad) is a separate person from themselves – and that they ( baby) have their own wondrous powers to reliably bring this separate person to come take care of them.

    If the response is almost instant, doesn’t the baby continue to see mom as an extension of themself that much longer, delaying or making that natural learning about their own autonomy just a little more difficult?

    • http://www.catholiccounselors.com Dr. Greg

      Here are the stages of individuation…
      1.Hatching (5 to 9 months): The infant becomes aware of the differentiation between itself and its mother but still sees them as one. It becomes increasingly aware of its surroundings and interested in them, using its mother as a point of reference or orientation.
      2.Practicing (9 to 16 months): The infant can now get about on its own, first crawling and then walking freely. The infant begins to explore actively and becomes more independent of its mother. The infant still experiences itself as one with its mother.
      3.Rapprochement (15 months and beyond): The young child once again becomes close to his mother, but begins to differentiate itself from his mother. The child realizes that his physical mobility demonstrates psychic separateness from his mother. The toddler may become tentative at this point, wanting his mother to be in sight so that, through eye contact and action, he can explore his world.

      Mahler further divided Rapprochement into three sub-stages:
      1.Beginning: The young child is motivated by a desire to share discoveries with his mother.
      2.Crisis: The child is torn between staying connected with his mother and venturing out from his mother and becoming more independent and adventurous.
      3.Solution: The child resolves the above Crisis according to the dictates of his own newly forming individuality, to his fledgling use of language, and to his interaction with the temperament of his mother.

      In short, individuation doesn’t happen until a lot later than most parents think it should. The best way to facilitate it is to not stress the kid out by making him doubt that his secure base will be there. Once he is absolutely sure of you, he’ll launch sooner. All the research shows that delaying responses to cries prolongs dependency rather than causing it.

  • Carrie M

    Very good explanation Dr. Greg!

  • Dave R

    Dr. Greg, I’d like to thank you for moderating the comments on these sleep training posts. I’m sure you got a lot of flak for not publishing the comments you deemed uncharitable by those attempting to submit them. I tend not to venture down into the comment section of most blogs because of all the negativity and enless arguing that occurs, but you have run your comment section very well. The first sleep training post had a lot of good, constructive disagreement and back-and-forth that was really interesting to read. Thank you for taking the time to moderate the discussion of your posts!

    • http://www.catholiccounselors.com Dr. Greg

      Oh, well, you’re more than welcome. I am working on publishing a comments policy that hopefully will clarify any confusion. I have taken some heat, to be honest. I even heard from Patheos higher-ups. But here’s how I feel about it. I have no problem posting intelligent, informed comments that agree or disagree with me, but I will not post abusive or ignorant comments or comments that are intended to inflame rather than enlighten. I want my blog to be a safe place for conversation. If that means I need to babysit and correct folks more than other blogs do to make that happen…so be it.

      Thanks for your support.

      Dr. Greg

  • Cam G.

    Dr. Greg,
    I don’t dispute your argument, but my question is, what better alternatives are there? With my son, now 16 months, we coslept, but he would wake crying 4 or 5 times per night. We tried a few of the no-cry sleep training methods to no avail (once we did the Sleep Whisperer’s pick up/put down in shifts for nearly 10 hours straight). Finally when he began waking every hour, we had to do something. We used the Ferber method, and while he did cry that first night, he cried less overall and slept better than any night cosleeping. We had to do some varient of cry it out twice more after we reverted to cosleeping during an illness and travel. Now, Ferber is far from perfect, and even now, months after sleep training, he cries for about 5 minutes after being put down for a nap or the night. But we figure it is better than him constantly waking up.

    We now have a 6 week old daughter and I’m wondering what to do differently this time. We are cosleeping but I can see the same pattern emerging where she is waking every hour or so. Now, of course it is normal at this stage, but what do we do when she progresses just like her older brother? Really, we would be fine cosleeping but chances are she won’t get a good night sleep that way–and while the jury is out on the harm of cry it out, surely waking 8 times a night is at least as bad. Thanks for any advice.

    • http://www.catholiccounselors.com Dr. Greg

      Comboxes are terrible places to give advice. There are so many factors that we would need to look at. The fact is that it is not normal for a baby to sleep hard all through the night. Babies have more shallow sleep because their brains are still developing. They wake, in part, to reset their respiration. Usually, when a child is nursing and co-sleeping, the baby fusses (as opposed to crying) and mom nurses baby back to sleep in a brief time. Light waking several times a night is normal. Crying is a sign that there is something wrong. The question I can’t answer based on the info you’ve given me (and I don’t think I could answer without a consultations) is why is the baby crying? What is the problem that we are missing? As I pointed out, Ferberizing doesn’t solve the problem because there is no psychological or physiological mechanism to allow for babies to self-soothe. Therefore, ferberizing is just teaching learned helplessness. That is, baby’s problem isn’t solved. He just stops asking for it to be fixed. Find out the reason behind the crying and you’ll have your answer. Dr.Greg

      • http://kristenwestmcguire.wordpress.com Kristen

        This is really interesting…I am past the baby years, but have been helping a younger friend who has a toddler and a baby, as well as two school-age sons. Each has some diagnosis or issue – including autistic spectrum disorder and cleft palates. We try as a family (my teens are terrific) to jump in there and make sure mama is getting some sleep. As an older mom whose babies were NOT good sleepers and had some autistic spectrum issues, it is so important to me now to support those who are open to life and facing extraordinary struggles in the day to day. You are absolutely right that usually there is a reason baby is crying…but it is equally true that all humans have their limits, even mamas.

        And, unfortunately, often the advice that people give to the special mamas can be less than helpful, and more guilt-inducing. My friend is heroically holding that crying baby all night, and her husband jumps in when he is home (work takes him away alot), but believe me when I say, that if she lays the baby down for a bit to soothe others in her home, it is not by choice but out of necessity. Her heart breaks all day long. And, she has to get at least enough sleep to stay sane herself. It is very, very difficult. I hope others will join me in trying to be sensitive to those moms who are doing their best, and are facing difficult circumstances. Mothers need to know they can ask for, and receive needed help. It is part of being pro-life.

  • http://twitter.com/MomDocKathleen Kathleen Berchelmann

    Dear Dr. Popcak,

    Thank you for making my comment a blog post of its own! I’m honored! At long last, here is my formal reply to your thoughts on infant sleep training and learned helplessness.

    http://childrensmd.org/browse-by-age-group/newborn-infants/stress-cortisol-and-getting-your-baby-to-sleep/?utm_source=rss&utm_medium=rss&utm_campaign=stress-cortisol-and-getting-your-baby-to-sleep

    Warmest Regards,

    Kathleen M. Berchelmann, MD
    Pediatrician, Director of MomDocs Media Initiative
    Washington University in St. Louis and St. Louis Children’s Hospital

  • Becca

    Well, I’m having internet issues so this question may be posted twice. Sorry for any redundancy.
    I see that learned helplessness is not something to wish upon our children and that infant’s cries should be responded to, but is there ever a point in a baby’s life when it’s “safe” so to speak to simply stay present and compassionate while he cries about being tired and falling asleep? When do we stop with the nursing and rocking and patting and singing and switch to the “this is so hard and I’m here for you while you figure it out,” or rather, at what point developmentally do we switch from “you’re upset and I’ll fix it” to “you’re upset and I’m listening.”
    I don’t rock and bounce and swaddle my toddler when he cries about being “helpless” to gain access to the bleach. He knows to eventually give up trying, but he also knows I am there to empathize with and listen to his grief about it. At what age could a parent structure the kid’s universe such that he knows he can no longer be nursed or rocked to sleep and gives up on that request but also knows that mom and dad are present and compassionate and he’s not alone in his tears.

    Does that make sense?
    Anyway, thank you for your ministry. My husband and I have been very blessed by your books


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