Book review for Sue Gerhardt, Why love matters: How affection shapes a baby’s brain

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Susie Elliott, freelance researcher and editor


The highly charged issue of a child’s first years is the subject of psychotherapist Sue Gerhadt’s second-edition release of Why Love Matters: How Affection Shapes a Baby’s Brain. Bolstering the work of the best-selling 2004 edition is this trade-meets-specialist publication that intersects neuropsychology with attachment theory to emphasise the foundational importance of secure attachment through one-on-one primary care.  The book is the product of impressive literature review and synthesis to further Gerhardt’s argument for a new consciousness in early parenting. Many of the conclusions she reaches have become familiar in the politics of early childhood that have played out in the 12 years between editions. The messages in its pages move to a steady, necessarily repetitive beat – notably that of the need to encourage connection between ‘primitive’ and frontal regions of the infant brain through early intimate relationships. This is right at home within a significant sector of popular psychology and parenting advice, often traced to Penelope Leach’s (2010) child-led thesis but most notably including Dan Siegel’s recent work (see The Whole-Brain Child, Siegel 2011), as well as Australian psychologist Steve Biddulph, Raising Babies: Why Your Love is Best (2006), not to mention the broad thrust of the attachment parenting movement (Sears 2001). What is striking about Gerhardt’s contribution is the volume of evidence she amasses and the wholistic, arguably ‘whole-brained’ approach she adopts. Perhaps most compelling, however, is the reported extent of the effects of attachment disturbances.
The subject is examined along three lines: firstly, by establishing the neurological, hormonal, and immunological impact of early experiences. Secondly, the reader is offered a long-term perspective of the consequences of early relationship disturbances, with portraits of common behavioural and mood disorders that can be linked to them. Finally, Gerhardt looks to ways forward, out the mires of attachment rupture and disturbance. 
The new edition of Why Love Matters starts at the very beginning of life, seeking to instate pregnancy as the first formative emotional-developmental stage. Enemies to optimum foetal brain formation are the usual ones of alcohol and poor diets, but we’re told that even moderate levels of stress in the mother can wreak havoc. Gerhardt summarises the primary research data and builds it into a compelling argument. Cortisol is key in this situation; more surprising, however, is the knowledge that the mother’s continual high cortisol blood concentration can cross the placenta to configure the child’s nervous system as highly reactive, perhaps permanently so (2015, p. 20). In this way, ‘fussy’ behaviour in newborns may be the result of a system wired for stress in utero, with early parental responsiveness taking on even greater importance if it is to be counteracted. The author even wades into murky waters to suggest attuned, responsive parenting may eliminate the category of ‘difficult baby’ altogether (2015, p. 35). Antenatal maternal depression is similarly damaging, as it can leave the unborn child with a compromised amygdala, poor serotonin production and use, and thus susceptibility to the same condition (2015, p. 26). 
The provocative nature of this work is apparent from the beginning, as an example of what’s been called ‘nurture psychology’ that places enormous pressure on mothers in particular to ‘get it right’ with their baby’s future (Guldberg 2004). The author ventures into politically charged territory in describing the increasingly normalised practice of working during pregnancy, including in the last trimester, as problematic (2015, p.19). To be fair, she makes clear that her target is the unfolding culture-wide shift away from interpersonal care activities, including the antenatal phase of child rearing. In this she offers a sociological perspective arguing that the pressures and expectations for the contemporary middle-class are such that women jumping on the long-hours work bandwagon has become an unquestionably virtuous thing. Gerhardt maintains that the trajectory of work and wealth acquisition in increasingly isolated, hyper-autonomous lifestyles has profound negative implications for our cognitive and emotional functioning, and, by association, for the broader society (see also Gerhardt’s The Selfish Society, 2010).
The kernel of Gerhardt’s perspective is that humans are relational beings and it is in relationship that we are able to reach our psycho-social potential. On this she is without qualification for, she argues, drawing from Fonagy’s ‘brain as a social organ’, that only a relationally stimulated brain can develop the neurological link-up mentioned earlier that allows sound, high level functioning (2015, p. 47). Thus an evolutionary understanding of cognitive development is overlaid with a social concern. The amygdala, she points out, is often searching for cues from other people, especially for signs of danger, and this primitive EQ possesses a survival practicality where our feelings are signals for action within that social realm. That is to say, for humans the emotional-social interchange is key to survival. We perform best, and our resilience is greatest, when we are socially calibrated, and this in turn relies on our abstract intelligence and the foundational emotional signaling system both developing sufficiently so as to enter into continual conversation and mutual modification (2015, p. 51). 
Rather than resort to genetics as the primary determinant of human behaviour, Gerhardt maintains that the precursor of associated brain formation takes place after birth, with brain size doubling in its the first year. ‘What needs to be written in neon letters lit up against a night sky is that the orbitofrontal cortex, which is so much about being human, develops entirely post-natally’ (2015, p. 55). As the infant begins to form expectations about life’s dangers and satisfactions, so the parasympathetic and sympathetic nervous systems and hormone receptors around the body become finely tuned for operating within this perceived environment. It follows, then, that it is our first relationship experiences that are of the utmost importance in setting up potentially life-long bio-behavioural styles (2015, pp. 56-7). 
Thus the book outlines how the work of parents in a baby’s early years is to build a physically present, loving, attuned and responsive relationship that moderates the infant brain’s primitive reactiveness and facilitates the inchoate capacity for self-regulation. In contrast to insecure attachment styles that effectively bind a person to a restricted range of habits and leave relationships brittle and people vulnerable to stress and hardship, the end goal is a neurologically well connected, secure adult who trusts the safer relationship rhythm of rupture followed by rapid repair and positive feelings (2015, p. 133). 
But work for the parents it is! Gerhardt argues that the principle trigger for survival stress in babies and toddlers is separation from the mother in particular, and, if prolonged, will result in a distressed and overwhelmed baby. When protracted, this leads to an engaged parasympathetic nervous system that leaves the individual in a cortisol production loop, perennially geared for emergency and emotional insecurity. The author’s controversial point is clear here too: that ‘tough love’ behaviour modification strategies for infants and small children like ‘cry it out’ sleep training and physical and psychological punishment, however effective in the short term, are deleterious to a child’s present and future emotional life. This is especially the case in the 15 per cent of highly sensitive babies whom are even more reliant on calm, predictable reassurance to develop secure attachment and resilient nervous systems (2015, pp. 85-8). 
Without that assistance, the author describes the endless primary survival fear in a baby, emotionally abandoned by the withdrawal of reassuring connection, evocative of Kristeva’s pre-verbal abject state, of an infant in the ‘night of unponderable affect’ (Kristeva, 1982, p. 10). 
Likewise, punishing parenting styles can lead to a small child ‘abandoning themselves’, suppressing the signals they get from their amygdala to fit within the codes of desirable behaviour imposed upon them. Again, Gerhardt sees our Western social history as causal, particularly since the industrial era that has praised the wallpapering over of emotional vulnerability.  Indeed, many parenting and interpersonal norms in the West can be identified that discourage dependence on other people (2015, p. 113). Gerhardt makes the interesting observation that the Victorian era’s repression of feelings, while ‘suitable’ in mechanised society focused on goods production, has evolved into the 21st-century’s exhortation for consumers to indulge their feelings presenting something of a contradiction with a parenting style based on the denial of emotional needs (2015, p. 45). Gerhardt also points to poor socio-economic conditions and low self-esteem in parents as causes of the kind of harsh parenting that can lead to avoidant attachment (2015, p. 118). The book’s description of the immunological link with this behaviour is compelling. Far reaching biological consequences include chronic inflammation caused by the continual stress, frequently experienced beneath a calm appearance – in other words, the active suppression of the feeling-action sequence — and perhaps subsequent links to cancer and heart disease (2015, p. 116). Similarly, social rejection has been found to directly impact inflammation (p. 117), a fact Gerhardt uses to once more underscore the significance of early infant separation from the mother – known to cause lowered lymphocytes in monkeys and also thought to be the case in humans with increased susceptibility to disease (2015, p. 118). The suggested antidote is what you might expect: early oxytocin-inducing touch, eye-contact, gentle, loving, present connection, and breastfeeding – the cocoon of Winnicot’s ‘primary maternal preoccupation’ (2015, pp.139-141).
The message that mothers need to devote their energy to tuning into and responding sensitively to their children — Gerhardt says at least for the first two years of life — has been criticised as politically retrograde for women seeking greater independence and mobility in non-domestic realms.  However, Gerhardt argues that parents, in heeding the goal of female emancipation, have along the way taken on a Western patriarchal ‘intolerance of vulnerability’ (2015, p.111). This will be the case, she contends, so long as the dominant public sphere values are so at odds with caregiving (2015, p. 94). On the ‘domesticity trap’, she offers lucid critique: 
… the real source of many parenting difficulties is the separation of work and home, of public and private, which has had the result of isolation of caregivers in the home, without strong networks of adult support and without variety in their daily routines. These conditions – equally applicable to fathers who stay at home – themselves create much of the depression and resentment that are so problematic for babies’ development. Parents face the artificial choice of devoting themselves to their working life or to their babies, when the evidence is that they want both (2015, p. 37). 
Here she echoes arguments from social commentators like Anne Manne and Julie Stephens who maintain that the biological imperative of early physical and emotional attachment needs to be wrested from the grip of modern capitalism, which is turning even basic experiences into depersonalised, outsourced commodities. Instead, they gesture towards a more integrated practice of nurturing and productive social participation (Manne 2005; Stephens 2010).
Likewise, Gerhardt makes a strong case that the push for premature independence for infants and toddlers comes at an enormous personal and social cost. While she presents the impacts of the most severe cases of adults who have had their early care needs denied as including anorexia, depression, and borderline and narcissistic personality disorders, she says there is a spectrum where milder forms of attachment disturbances create long-term problems.
The paradox is that people need to have a satisfying experience of dependency before they can become truly independent and largely self-regulating …
People who constantly fall in and out of love, who are addicted to foods or drugs of various kinds, who are workaholics, who are endlessly demanding medical or social services, are seeking something or someone who will regulate their feelings at all times. In effect, they are searching for the good babyhood that they have not yet had (2015, p. 110).
This ‘infant determinism’ in Why Love Matters, as it has been labelled, is indeed both daunting and demanding, and has been criticised for underestimating the general resilience of human beings (Guldberg 2004). It doesn’t seem to possess much faith in life-long learning of the fundaments of intimacy and selfhood, although the author doesn’t deny the significance of neuroplasticity and therapeutic interventions. She does, however, argue that prevention is better than cure and her own clinic for new mothers operates on the idea that early intervention, through rudimentary adjustments to maternal eye-contact, touch, and accurate reading and response to a baby’s signals, can produce dramatic, rapid and permanent improvements (2015, p. 58).
In the end, Gerhardt makes the call for greater consciousness in the decisions we make in a child’s early years, and importantly, that the minimum social and cultural supports be installed to facilitate babies’ safe development in the womb and for the first critical years. She suggests expanded maternity leave and more equality in primary caregiving between the sexes. These are important steps that nonetheless leave the bigger complex question of what wholesale cultural changes would be required if we were to pursue new values as a group. That is, there is still the mothering question: how women in particular are to navigate looking after their children with the insights Gerhardt offers, particularly the tension between their productive activities and their nurturing ones. This may well be beyond the remit of this book, which regardless is a courageous and meticulously argued, highly elucidating call to take the care of our most vulnerable dependents more seriously, and install good, present, securely attached love at the centre of our plan to help children live well. 


Biddulph, S. (2006) Raising Babies: Why Your Love is Best, London, HarperThorsons.

Gerhardt, S. (2015) Why Love Matters: How Affection Shapes A Baby’s Brain, 2nd edn,
          London and New York: Routledge.

Gerhardt, S. (2010) The Selfish Society: How We All Forgot to Love One Another and Made Money
          Instead, London, Simon & Schuster.

Guldberg, H. (2004) ‘The Determinism Myth’, The Guardian, 4 November, available
          at <http://www.theguardian.com/education/2004/nov/03/research.highereducation>

Kristeva, J. (1982) Powers of Horror: An Essay in Abjection, New York: Columbia University Press.

Leach, P. (2010) Your Baby and Child: From Birth to Age Five, London: Dorling Kindersley.

Manne, A. (2005) Motherhood: How Should We Care for Our Children? Sydney: Allen and Unwin.

Sears, W. and Sears, M. (2001) The Attachment Parenting Book: A Commonsense Guide to
          Understanding and Nurturing Your Child, Boston: Little Brown.

Siegel, D. (2011) The Whole-Brain Child: 12 Revolutionary Strategies to Nurture Your Child’s
          Developing Mind, New York: Bantam

Stephens, J. (2010) ‘The Industrialised Breast: How Neo-liberalism Milks Female Labour’,
          Overland, 201, pp. 77-81.


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