【书籍连载】被狗一样养的男孩 中英文逐句对照 第四章：皮肤饥饿 01
第四章
皮肤饥渴
CHAPTER 4
Skin Hunger
和其他人一样，医生也喜欢自己的成就被认可。获得医学名声的一个可靠途径是发现一种新的疾病或解决一个特别艰巨的医学难题。在我咨询的一家德克萨斯州医院，医生们把723E病房的小女孩看作是这样一个挑战。四岁的劳拉体重只有26磅，尽管几周来她一直通过插在鼻子里的管子进食高热量的食物。我在护士站看到的她的医疗文件有四英尺高，比这个缩水的小女孩本人还要高。劳拉的故事，就像韦科的孩子们的故事一样，帮助我们更多地了解儿童如何对早期经验作出反应。它说明了心灵和身体是如何不能分开对待的，揭示了婴幼儿的大脑健康发展需要什么，并证明了忽视这些需要会对儿童成长的各个方面产生深远影响。
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.
劳拉的档案包含了数千页的文件，详细记录了与内分泌学家、肠胃学家、营养学家和其他医疗专家的会面。还有无尽的血液检查、染色体检查、激素水平、活组织检查的实验室报告。这些文件包括更多侵入性测试的结果，这些测试使用了插入她喉咙的窥镜来检查她的胃，以及插入直肠的窥镜来检查她的肠道。有几十份咨询医生的报告。这个可怜的女孩甚至做了一次探查性腹腔镜检查，医生将一根管子插入她的腹部，仔细检查她的内部器官；她的小肠被剪下一段，送到国家卫生研究院进行分析。
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，在特殊的胃肠道研究单元呆了一个月后，一位社会工作者向劳拉的医生施压，要求他们进行精神病学咨询。正如胃肠病学研究人员多年前第一次见到劳拉时认为他们发现了一个 "肠道癫痫 "的病例一样，心理医生也对劳拉的病例有一个新的理论。前来进行初步咨询的心理学家专门研究饮食障碍，他认为他看到的是第一个有记录的 "婴儿厌食症 "的例子。他很着迷也很兴奋，与他的心理健康同事讨论了这个病例。最终，他要求我提供咨询，因为我有更多的学术出版经验，而且他确信这将是一个可报告的案例。他告诉我，这个孩子一定是在偷偷地排泄，或者也许是在晚上起来疯狂地运动。否则，她怎么可能被喂了这么多卡路里却仍然不长个？他想知道我对这个令人不安的新问题的看法，这是第一次在一个年轻的孩子身上看到。
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。我从来没有听说过小儿厌食症。我去了医院，打算像往常一样开始咨询，通过查看病历，尽可能多地了解孩子的病史。但是，当我发现这四年来，二十次入院，六次专科门诊，四英尺高的一堆文件时，我只是扫描了入院接收报告，然后进去向病人和她的母亲介绍自己。
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，我发现了一个令人痛苦的场景。劳拉22岁的妈妈弗吉尼亚*正在看电视，坐在离她孩子大约5英尺远的地方。母亲和女儿没有互动。瘦小、憔悴的劳拉静静地坐着，她的眼睛很大，盯着一盘食物。她还插着一根喂食管，将营养物质打入她的胃里。我后来才知道，饮食失调的心理学家不鼓励弗吉尼亚在吃饭时与劳拉互动。这应该是为了阻止劳拉--所谓的狡猾的、幼稚的厌食症患者--在食物和用餐时操纵她的母亲。当时的理论是，厌食症患者喜欢在不吃东西时得到的关注，并利用它来控制其他家庭成员；拒绝他们的这种 "奖励 "应该有助于康复。但是我在这里看到的是一个绝望的、瘦小的小女孩和一个脱离现实的母亲。
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.
大脑是一个历史性的器官。它储存了我们的个人叙事。我们的生活经历通过创造我们大脑的模板记忆目录来塑造我们成为什么样的人，这些记忆指导我们的行为，有时我们可以有意识地认识到，更多时候是通过我们意识不到的过程。因此，弄清任何与大脑有关的临床问题的一个关键因素是获得病人经历的准确历史。由于大部分大脑是在生命早期发育的，所以父母的教育方式对大脑的发育有着巨大的影响。因此，由于我们倾向于以我们自己在童年时被照顾的方式来照顾我们的孩子，所以一个好的儿童 "大脑 "历史始于照顾者的童年和早期经历的历史。为了了解劳拉，我需要了解她的家庭，就她而言，家庭包括她的妈妈。
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.
我开始询问弗吉尼亚州无害的基本问题。几乎在第一时间，我就开始怀疑劳拉问题的根源在于她年轻、好心但缺乏经验的母亲的过去。
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.
"你来自哪里？我问她。
“Where are you from?” I asked her.
"我猜，奥斯汀，"她说。
“I guess, Austin,” she said.
"你的父母来自哪里？"
“Where are your parents from?”
"我不知道。"
“I don’t know.”
在几分钟内，我发现弗吉尼亚是一个寄养系统的孩子。弗吉尼亚一出生就被一个吸毒的母亲抛弃，父亲不详，她在那个时代长大，当时儿童福利系统通常每六个月将婴儿和幼儿转移到一个新的寄养家庭；理由是这样他们就不会对任何特定的照顾者产生太多依赖。当然，现在我们知道，婴儿早期对少数稳定的照顾者的依恋对于情感健康甚至身体发育都是至关重要的。但是在那个时候，这种知识甚至还没有开始渗透到儿童福利机构中。
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.
与其他任何物种相比，人类的幼年生来就很脆弱，而且依赖性很强。怀孕和幼儿期对母亲来说是巨大的能量消耗，并间接地影响到更大的家庭群体。但是，尽管有分娩的剧痛，怀孕和哺乳的诸多不适，以及新生儿的嘈杂和持续的要求，人类的母亲绝大多数都倾向于致力于安慰、喂养和保护她们的孩子。事实上，大多数人都很高兴地这样做；如果一个人不这样做，我们就会发现这是一种病态。
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.
对火星人来说，或者甚至对许多非父母的人来说，这种行为可能看起来像一个谜。是什么促使父母放弃睡眠、性、朋友、个人时间，以及生活中几乎所有的其他乐趣，以满足一个小的、经常令人恼怒的嘈杂的、大小便失禁的、需要的生命的要求？秘密在于，在许多方面，照顾孩子是一种难以描述的快乐。我们的大脑奖励我们与孩子，特别是婴儿互动：他们的气味，他们平静时发出的咕咕声，他们光滑的皮肤，特别是他们的脸，都是为了让我们充满喜悦。我们所说的 "可爱 "实际上是一种进化上的适应，它有助于确保父母会照顾他们的孩子，婴儿会得到他们的需求，而且父母会愉快地承担这项看似不容易的任务。
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，在我们的成长过程中，在一般情况下，我们会得到细心的、适应性的和爱的照顾。当我们寒冷、饥饿、口渴、惊恐或有任何苦恼时，我们的哭声会带来安慰性的照顾者，他们会满足我们的需要，在他们的爱的关注中化解我们的苦恼。有了这种爱的关怀，在我们发育中的大脑中，两个主要的神经网络同时受到刺激。第一个是与人类关系互动相关的一套复杂的感官知觉：照顾者的脸、微笑、声音、触摸和气味。第二个是对介导 "快乐 "的神经网络的刺激。这种 "奖励系统 "可以以多种方式被激活，其中之一是缓解痛苦。解渴、满足饥饿、平息焦虑--所有这些都会导致一种快乐和舒适感。正如我们前面所讨论的，当两种神经活动模式同时出现并充分重复时，这两种模式之间会产生关联。
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.
在回应性养育的情况下，快乐和人际互动不可避免地交织在一起。这种相互联系，即快乐与人际互动的关联，是重要的神经生物学 "胶水"，它连接并创造健康的关系。因此，我们能得到的最有力的回报是我们所爱和尊重的人的关注、认可和爱戴。同样，我们经历的最强大的痛苦是失去这种关注、认可和爱戴--最明显的例子当然是所爱之人的死亡。这就是为什么如果我们没有人与之分享，即使是我们最伟大的智力、运动或职业上的胜利也显得空洞。
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.
如果你是出生在一个充满爱的家庭的大多数婴儿之一，一个始终如一的、培养人的照顾者--比如说母亲或父亲--将出现并反复满足你的需求。一次又一次，父母中的一个或两个会在你哭的时候来，在你饥饿、寒冷或害怕的时候安抚你。随着你的大脑发育，这些充满爱的照顾者为你提供了人类关系的模板。那么，依恋是人与人之间联系的记忆模板。这个模板是你对人类关系的主要 "世界观"。它受到你是否经历过善良、调和的养育方式，或者你是否接受过不一致、经常中断、虐待或忽视的 "照顾 "的深刻影响。
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，大脑是以一种依赖使用的方式发展的。被使用的神经系统变得更有优势；而那些没有被使用的神经系统则变得更少。随着孩子的成长，大脑的许多系统需要刺激，如果它们要发展的话。此外，这种依赖使用的发展必须发生在特定的时间，以使这些系统发挥其最佳功能。如果错过了这个 "敏感期"，一些系统可能永远无法发挥其全部潜力。在某些情况下，与忽视有关的缺陷可能是永久性的。例如，如果一只小猫的一只眼睛在出生后的头几周一直闭着，它的那只眼睛就会失明，尽管这只眼睛完全正常。大脑的视觉回路需要正常的视觉经验，以便为自己布线；如果缺乏视觉刺激，闭上的眼睛中的神经元就无法建立关键的联系，就会失去视觉和深度感知的机会。同样，如果一个孩子在其早期生活中没有接触到语言，他可能永远无法正常说话或理解语言。如果一个孩子在青春期前不能流利地使用第二种语言，那么他在说任何新学的语言时几乎都会有口音。
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.
虽然我们不知道正常依恋的发展是否像语言和视觉那样有一个固定的 "敏感期"，但研究确实表明，像弗吉尼亚这样的经历，即儿童在生命的头三年没有机会与一个或两个主要照顾者建立永久的关系，对人们正常和亲切地相互联系的能力有持久的影响。没有得到持续的、身体上的爱或没有机会建立爱的纽带的儿童，根本就没有得到必要的模式化、重复性的刺激，无法正确建立大脑中连接奖励、快乐和人与人之间互动的系统。这就是发生在弗吉尼亚身上的事情。由于童年时期短暂而零散的照顾，她没有像大多数母亲那样从抱着孩子、闻着气味和与孩子互动中获得同样程度的回报--快乐。
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岁时，弗吉尼亚终于在她最永久的童年之家安顿下来。她的养父母是充满爱心、道德高尚的基督徒，是好父母。他们教她礼仪。他们教她 "以德服人"。他们提供了一个基本的、人性化的、正常行为的脚本。他们教她偷东西是不对的，所以她没有未经允许就拿别人的东西。他们教导她，毒品对你有害，所以她不使用毒品。他们教她要努力工作和上学，所以她也这样做了。他们想收养她，她也想被他们收养，但州政府从未终止她亲生父母的权利，而且她的个案工作者偶尔会谈论她与亲生母亲团聚的可能性，所以收养一事从未进行过。不幸的是，这意味着当她年满18岁时，国家在法律上不再对弗吉尼亚 "负责"。因此，她不得不离开她的寄养家庭，寄养父母被告知不能再与她接触。他们作为其他孩子的寄养父母的未来与他们是否遵守个案工作者的意愿有关。由于另一项不人道的儿童福利政策--旨在减少该系统的法律责任，而不是保护儿童--弗吉尼亚失去了她唯一真正认识的父母。
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.
那时，她已经高中毕业。她被安置在一个低收入社区为 "脱离寄养 "的儿童设立的中途之家。与她所爱的人隔绝，没有明确的规则可循，并寻求亲情，弗吉尼亚很快就怀孕了。孩子的父亲离开了她，但她想有个孩子来爱她，她想做正确的事情，就像她的养父母教她的那样。她寻求产前护理，并很快被纳入了一个为高危母亲提供的良好计划中。不幸的是，孩子一出生，她就不再有资格参加那个项目，因为她不再怀孕了。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.
但弗吉尼亚不知道离开医院后该如何处理她的孩子。由于她自己早期的依恋被突然残酷地终止了，她没有一些人所说的 "母性本能"。在认知上，她知道需要进行哪些基本行为：喂劳拉，给她穿衣服，给她洗澡。然而，在情感上，她却迷失了方向。没有人想过要具体指导她提供婴儿所需要的爱和身体互动，她也不觉得有必要自己去做这些事。简单地说，弗吉尼亚没有从这些事情中得到乐趣，也没有人教她应该做这些事情。
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.
弗吉尼亚没有被她的边缘情感系统所牵引，也没有被她的认知、信息携带皮层所推动，她以一种情感上脱节的方式养育孩子。她没有花很多时间抱她的孩子；她用奶瓶支撑着给小家伙喂奶，而不是紧紧地依偎在她的怀里。她没有摇晃她，没有给她唱歌，没有咕哝，没有盯着她的眼睛，没有反复数她完美的小脚趾，也没有做任何其他愚蠢但非常重要的事情，这些都是拥有普通童年的人在照顾婴儿时本能地做的。没有这些所有哺乳动物都需要的刺激生长的身体和情感信号，劳拉的体重就不再增加了。弗吉尼亚做了她认为正确的事情，不是因为她心里有感觉，而是因为她的头脑告诉她这是一个母亲 "应该 "做的。当她感到沮丧时，她要么严厉地管教孩子，要么不理会她。她根本没有从积极的护理互动中感受到满足和快乐，而这种互动通常能帮助父母克服养育孩子的艰难情感和身体挑战。
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.
