The medicalization of attachment and the surveillance of mothers

CCTV surveillance system. Collection of security camera

On Monday I wrote about the pseudoscience of bonding.

It pseudoscience with a purpose. The purpose is to control mothers.

When the contemporary medicalization of attachment was proposed in the late 1970’s, there was no evidence we were experiencing an epidemic of “detached” children. Today, in the late 2010’s, it’s clear that the extensive implementation of bonding ideology hasn’t led to any improvement in children’s mental health. So why have so many parenting professionals embraced the nonsensical idea that mother-infant attachment requires ritualized behaviors at birth and in the following days and weeks?

The medicalization of attachment benefits the natural parenting industry. It harms mothers and babies, but who really cares about them?

Sociology Professor Mary Ann Kanieski addressed this issue in her paper Securing attachment: The shifting medicalisation of attachment and attachment disorders.

She starts with an ironic observation:

Scholars have argued that mothers have been subject to intensifying regimes of medicalisation in our society. While many feminists have focused on the medicalisation of reproduction and childbirth, other theorists have observed the ways in which medical expertise has attempted to regulate women’s behaviour in their roles as mothers. These perspectives have shed great light on the ways in which motherhood has become an experience that is dictated and regulated by external authorities.

Natural parenting advocates, attempting to de-medicalize childbirth, have medicalized attachment as justification.

It fits into the trend of surveillance medicine:

Under surveillance medicine, the attempt to distinguish between health and illness has been transformed into a search for risk factors that are probabilistically associated with the development of illness… When risk factors are found to be present, individuals are impelled to reduce their risk factors, often through lifestyle changes, in the promise of reducing disease. Failure to take action can be viewed as a moral failing resulting in individuals being held responsible for their own health … Individuals must be constantly monitored for the presence of risk factors as health is viewed precariously. Owing to the difficulty of surveying a large population, surveillance medicine requires that individuals be taught to monitor themselves for the risk factors of disease.

It is difficult to overestimate the impact of this changing perception of illness. Previously illness was viewed as something that happened randomly. Now illness is viewed — incorrectly — as something that only happens to people at risk who do not take steps to reduce their risk. We have created a culture of “wellness” that falsely reassures people they can control their own health and therefore are responsible for their own illness. All they need to do is trust “wellness” experts, buy their books and supplements and use their nonsensical — chiropractic, homeopathic — services.

How has that played out in mothering?

We have created a culture of “naturalness” — parenting “experts,” midwives, doulas, lactation consultants —that falsely reassures mothers that they can control the health (and IQ!) of their children by trusting “naturalness” experts, buying their books and supplements and using their expensive services. Why? To convince mothers that their attachment to their babies is precarious and must be constantly monitored for “risk factors.” Because it is difficult to constantly survey a large population, surveillance of mothers requires that individuals be taught to monitor themselves, constantly seeking to reduce the “risk factors.” Any women who refuses to behave in concert with the surveillance regime is labeled as lazy, selfish and a bad mother.

Because attachment came to be a protective factor as well as a risk factor, the aim of achieving secure attachment in children encouraged mothers to engage in intensive mothering as a means of achieving the benefits of secure attachment and avoiding the risks of less secure attachment. To be a responsible mother meant that one needed to be a sensitive, responsive mother. Mothers were taught to monitor themselves in relation to their behaviour towards their children as advice regarding attachment and bonding …

The ironies abound. Women are taught by midwives and doulas that rejecting the medicalization of childbirth promotes bonding, but that only makes sense if you medicalize attachment as precarious, contingent on risk factors — medicalized birth is supposedly a risk factor — and requiring constant expert maternal surveillance and self-surveillance to implement.

Women are taught by lactation professionals that rejecting the medicalization of infant feeding (formula) promotes bonding, but that only makes sense if you medicalize attachment as precarious, contingent on risk factors — formula feeding is supposedly a risk factor — and requiring constant expert maternal surveillance and self-surveillance to implement.

Women are taught by attachment parenting experts that rejecting careers and work outside the home in favor of “wearing” babies promotes bonding, but that only makes sense if you medicalize attachment as precarious, contingent on risk factors — any maternal separation no matter how short is supposedly a risk factor — and requiring constant maternal surveillance and self-surveillance to implement.

But perhaps the biggest irony is this: attachment occurs naturally and there’s no evidence that it requires experts, rituals or self-surveillance.

In contrast to childbirth, which has a high natural death rate, and breastfeeding, which has a high natural failure rate, attachment has a very low natural failure rate. While complications of childbirth and breastfeeding are common, complications of attachment are rare.

But don’t tell women that critical truth. What would happen to the employment prospects of midwives and doulas if women understood that childbirth has little to nothing to do with mother-infant bonding (as any father or adoptive parent could tell you)? What would happen to the income of lactation consultants if women understood that infant feeding has nothing to do with mother-infant bonding? What would happen to the book sales of attachment parenting experts, if women understood that mother-infant bonding happens spontaneously and there’s no need to read any books or practice specific parenting rituals?

The medicalization of attachment — and the self-surveillance and self-doubts of mothers — benefits the natural parenting industry and that’s why they have promoted it aggressively and relentlessly.

It harms mothers and it harms babies, but let’s be serious: who really cares about them?

  • Shawna Mathieu

    Between “failing” at BFing and being hospitalized several times for PPD after my son was born, I was TERRIFIED that I’d completely and utterly blown any chance at “bonding” with him.

    He’s nearly 8, We are very close, and I probably couldn’t detach him with a crowbar.

  • Allison

    Like so many things in parenting… take what works for your family and use it, but don’t measure yourself by another family’s ruler – the units will always be incorrect.

    For instance, I babywear. Not for the sake of attachment (didn’t need any help with that), but because it makes my life easier. We didn’t spend the money on an infant carrier car seat, instead using a rear-facing convertible car seat from day one (and consequently are still able to use that same car seat 5.5 years later) – we wore him when we were out running errands because it was easier than carrying him around in the crook of our arm. Now, at 5.5, I still babywear. Not for the sake of attachment (still don’t need any help with that), but because he’s autistic and has no sense of danger – if he gets overwhelmed, he will bolt into a crowd or into traffic, so if we are somewhere likely to prove overwhelming, he goes on my back to keep him safely with me. But babywearing to make my life easier didn’t require giving up my career – I work full time, and have since before he was born, in a field I greatly enjoy.

    • Allison

      Similarly, I did breastfeed – but not for the sake of bonding. It was working for us, it was a damn sight cheaper than formula, and while the provable benefits are small, I was all in favor of that statistical slightly lower rate of ear infections and gastroenteritis. But I didn’t freak out when he outpaced my pump and we needed to fill in here and there with formula while I was at work.

  • It’s sad, really, how strongly kids get attached even to truly awful caregivers–and even in institutionalized children, I’m given to understand that attachment disorders aren’t inevitable.

    • Mel

      Humans are very vulnerable for a very long time so attracting a caregiver is strongly imprinted on babies, tots and kids. IOW, the vast majority of babies will attach to at least one caregiver without ever thinking “Is this the best caregiver I can get? Should I reject this one and get another one?”

      On the flip side, humans are vulnerable for a very long time so caregivers show much more pickiness in deciding whether to rear this baby. I’ve mentioned before how I had a gut-level reaction of “Well, I was really looking forward to this baby, but there’s no way he’s going to make it” after my son was born at 26 weeks. I found him fascinating. I loved him. And I was gobsmacked at a gut level every time I showed up at the NICU to find him alive, pink and wiggling instead of having died. My brain knew that he was in good shape; he was pink, wiggling, playing with his wires/tubes, and the doctors/nurses were happy with his progress – but my gut was shaped by hundreds of generations of women who knew that a baby that young might hang on for a few hours but was doomed.