Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

When family separations become a threat to existence

Claudia M. Gold, MD
Conditions
July 25, 2018
Share
Tweet
Share

The face of a 2-year-old Honduran girl, dwarfed by the adults who only appear as legs in the photo, communicates undeniable anguish. Used to represent the horror of children separated from their parents at the U.S.-Mexico border, the photo became a lightning rod for controversy when it turned out that this particular child was not actually separated from her mother. In an interview for CBS News the border patrol officer involved in the incident explained that they asked the mother to put her daughter down so she could be searched. He explained, “It took less than two minutes. As soon as the search was finished, she immediately picked the girl up, and the girl immediately stopped crying.”

The fact that the girl recovered immediately shows that she has had accumulated a reservoir of experience with her mother coming back. Rather than falling apart, she was immediately comforted. The very presence of her mother appears to have given her the skills to manage her distress. In an instant she is OK.

But when separations are beyond a young child’s ability to manage, the capacity to recover in the face of disruption is compromised. Time is of the essence.   With too much time, “stress” is transformed into “trauma.”

Pediatrician turned psychoanalyst D.W. Winnicott captures the role of time in child development in a way that seems particularly poignant in light of current events. In his book Playing and Reality he describes how a young child comes to have a sense of himself in relation to the world around him:

“It is perhaps worthwhile trying to formulate this in a way that gives the time factor due weight. The feeling of the mother’s existence lasts x minutes. If the mother is away more than x minutes, then the imago fades, and along with this the baby’s capacity to use the symbol of the union ceases. The baby is distressed, but this distress is soon mended because the mother returns in x+y minutes. In x+y minutes the baby has not become altered. But in x+y+z minutes the baby has become traumatized. Trauma implies that the baby has experienced a break in life’s continuity … [his behavior] now becomes organized to defend against a repetition of ‘unthinkable anxiety.’”

When the Honduran girl’s mother picked her up her rapid recovery reflects an experience Winnicott describes with the lovely phrase “going on being.” The countless experiences of the mother coming back, in typical day-to-day interactions, literally builds a child sense of self. The “unthinkable anxiety” he references is the profound unraveling that accompanies a loss of bearings, a loss of sense of self.

While unfortunate that the photograph was misrepresented, in fact it proves a point about the actual separations known to have occurred in large numbers. Young children rely completely on their parents to hold them together. Self-regulation, the ability to manage on one’s own, is a developmental process that occurs over countless moment to moment interactions in co-regulation with primary caregivers. Separation beyond a young child’s ability to manage represents, from a developmental perspective, a fundamental threat to existence.

Claudia M. Gold is a pediatrician who blogs at Child in Mind and is the author of Keeping Your Child in Mind.

Image credit: Shutterstock.com

Prev

NP/PA vs. physician: Why is there a productivity gap?

July 25, 2018 Kevin 57
…
Next

The pathologic manifestations of professionalism

July 25, 2018 Kevin 7
…

Tagged as: Pediatrics, Psychiatry, Public Health & Policy

Post navigation

< Previous Post
NP/PA vs. physician: Why is there a productivity gap?
Next Post >
The pathologic manifestations of professionalism

ADVERTISEMENT

More by Claudia M. Gold, MD

  • Maybe mothers saved the Affordable Care Act

    Claudia M. Gold, MD
  • The value of moving through grief to healing and growth

    Claudia M. Gold, MD
  • a desk with keyboard and ipad with the kevinmd logo

    ADHD and early death: We often miss the story

    Claudia M. Gold, MD

Related Posts

  • 5 ways to maintain family bonds in medical school

    Micaela Stevenson
  • Is medicine really a model family-friendly profession?

    Kristina Fiore
  • You’re lucky to have a medical student in the family

    Nathaniel Fleming
  • The hidden threat of the 80-hour resident workweek 

    Anonymous
  • Family medicine and the fight for the soul of health care

    Timothy Hoff, PhD
  • What’s the greatest threat to health reform?

    Mark Kelley, MD

More in Conditions

  • Why caring for a parent is hard for doctors

    Barbara Sparacino, MD
  • How older adults became YouTube’s steadiest viewers and what it means for Alphabet

    Adwait Chafale
  • Why hesitation over the HPV vaccine threatens public health and equity

    Ayesha Khan
  • Why your health is a portfolio to manage

    Larry Kaskel, MD
  • Pain control failures in fertility clinics

    Maire Daugharty, MD
  • Why what you do in midlife matters most

    Michael Pessman
  • Most Popular

  • Past Week

    • A doctor’s letter from a federal prison

      L. Joseph Parker, MD | Physician
    • When language barriers become a medical emergency

      Monzur Morshed, MD and Kaysan Morshed | Physician
    • A surgeon’s view on RVUs and moral injury

      Rene Loyola, MD | Physician
    • Why doctors are losing the health care culture war

      Rusha Modi, MD, MPH | Policy
    • A cancer doctor’s warning about the future of medicine

      Banu Symington, MD | Physician
    • Why caring for a parent is hard for doctors

      Barbara Sparacino, MD | Conditions
  • Past 6 Months

    • Rethinking the JUPITER trial and statin safety

      Larry Kaskel, MD | Conditions
    • The ignored clinical trials on statins and mortality

      Larry Kaskel, MD | Conditions
    • How one physician redesigned her practice to find joy in primary care again [PODCAST]

      The Podcast by KevinMD | Podcast
    • I passed my medical boards at 63. And no, I was not having a midlife crisis.

      Rajeev Khanna, MD | Physician
    • The silent disease causing 400 amputations daily

      Xzabia Caliste, MD | Conditions
    • Why medicine needs a second Flexner Report

      Robert C. Smith, MD | Physician
  • Recent Posts

    • Why caring for a parent is hard for doctors

      Barbara Sparacino, MD | Conditions
    • A pediatrician’s role in national research

      Ronald L. Lindsay, MD | Physician
    • How older adults became YouTube’s steadiest viewers and what it means for Alphabet

      Adwait Chafale | Conditions
    • The danger of calling medicine a “calling”

      Santoshi Billakota, MD | Physician
    • How retraining the physician mindset can boost resilience and joy in medicine [PODCAST]

      The Podcast by KevinMD | Podcast
    • How AI on social media fuels body dysmorphia

      STRIPED, Harvard T.H. Chan School of Public Health | Policy

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 5 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • A doctor’s letter from a federal prison

      L. Joseph Parker, MD | Physician
    • When language barriers become a medical emergency

      Monzur Morshed, MD and Kaysan Morshed | Physician
    • A surgeon’s view on RVUs and moral injury

      Rene Loyola, MD | Physician
    • Why doctors are losing the health care culture war

      Rusha Modi, MD, MPH | Policy
    • A cancer doctor’s warning about the future of medicine

      Banu Symington, MD | Physician
    • Why caring for a parent is hard for doctors

      Barbara Sparacino, MD | Conditions
  • Past 6 Months

    • Rethinking the JUPITER trial and statin safety

      Larry Kaskel, MD | Conditions
    • The ignored clinical trials on statins and mortality

      Larry Kaskel, MD | Conditions
    • How one physician redesigned her practice to find joy in primary care again [PODCAST]

      The Podcast by KevinMD | Podcast
    • I passed my medical boards at 63. And no, I was not having a midlife crisis.

      Rajeev Khanna, MD | Physician
    • The silent disease causing 400 amputations daily

      Xzabia Caliste, MD | Conditions
    • Why medicine needs a second Flexner Report

      Robert C. Smith, MD | Physician
  • Recent Posts

    • Why caring for a parent is hard for doctors

      Barbara Sparacino, MD | Conditions
    • A pediatrician’s role in national research

      Ronald L. Lindsay, MD | Physician
    • How older adults became YouTube’s steadiest viewers and what it means for Alphabet

      Adwait Chafale | Conditions
    • The danger of calling medicine a “calling”

      Santoshi Billakota, MD | Physician
    • How retraining the physician mindset can boost resilience and joy in medicine [PODCAST]

      The Podcast by KevinMD | Podcast
    • How AI on social media fuels body dysmorphia

      STRIPED, Harvard T.H. Chan School of Public Health | Policy

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

When family separations become a threat to existence
5 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...