He is a man in search of the answer to one of life's most compelling and mysterious questions: What goes on in the mind of a baby?
Indeed, child psychiatrist Taghi Modarressi has devoted almost a lifetime of thought to mapping out the complex terrain of an infant's psychological life, beginning with its first primitive feelings.
There are, of course, big and complex words to describe what this learned professor seeks; words like self-reflexive awareness and preverbal subjective life. But, really, when you get right down to it, what Taghi Modarressi wants to know about a baby's experience of life is not unlike what every new parent wants to know:
How does a baby -- who has no memory and no knowledge of objects or words for objects -- experience himself and others? What does he feel when he's hungry? What goes on in a baby's mind while gazing at his mother's face? How does a baby flooded with uncontrollable and chaotic sensations learn to form such feelings into thoughts and wishes?
Trying to see the world through the eyes of a baby is like trying to imagine what the universe might have been like in the first hours after the Big Bang. In this case, however, Modarressi is trying to understand not how the world created itself but how human beings create a sense of themselves and their relation to others.
Or to put it another way: Modarressi is a man in search of the origins of the original Self -- of how we become who we are. Nothing less.
But how to go about finding the answer?
Unlike the astrophysicist who has at his disposal such technical miracles as the space telescope to aid his search, the psychoanalyst has only a patient's free associations and his own ability to build a bridge of insights from those associations. The infant psychotherapist has even less to work with: His small patients are nonverbal and have no memories.
Most people respond to the idea of the baby as a psychiatric patient with an attitude of puzzlement and skepticism. "How can you treat a baby," they ask Modarressi, "who can't talk or understand what is going on?"
The question is put to him one more time.
"But babies can talk," the Iran-born Modarressi responds, smiling. He has a light and pleasing accent and a manner that telegraphs both patience and charm. "In fact, babies are experts in communication. ... The language of babies is feelings. And babies are able to create or reflect feelings around them. By action, by a smile, by posture, by gesture, they communicate."
Sitting in his small office at the Center for Infant Study, located on Lombard Street near the University of Maryland medical school complex, Modarressi seems never to tire of talking about the world of the infant. Beneath the cap he wears, his dark eyes burn with youthful, almost boyish, optimism and interest. Warm and hospitable -- and funny, too -- he is a welcoming figure who immediately creates a sense of easy give-and-take. It is an attitude, one assumes, that must put his very young patients and their parents at ease as well.
Right now he is talking about the unsolved mystery of how a baby knows about "taking his turn." He urges you to try this experiment with a baby if you have any doubts that a Self exists inside:
"Talk to a baby. When you talk, the baby doesn't interrupt you. Baby listens and waits till you are done. And then Baby smiles. Or you coo with the baby. Baby doesn't interrupt you. Baby takes his turn. That is amazing!" says Modarressi, his voice rising in genuine excitement, his eyes widening.
"Takes his turn! Where did he learn about this?" He pauses. "So we not only believe that the baby has a sense of Self but this Self is also able to separate and distinguish himself from the others!"
He remains full of wonder at all this, at the miracle of a baby. The years in no way have diminished his interest in understanding the Big Bang of humankind.
Still, the cap he wears and the cane by his side hint at something else: The man who has studied the beginnings of life so intensely now has reason to reflect on endings.
His own beginnings
Sixty-five-year-old Taghi Modarressi, who lives in Baltimore and is married to celebrated novelist Anne Tyler, traces his own beginnings back to Tehran. The son of a lawyer, he grew up in a liberal family of educators and writers, a family that goes back 40 generations in Iran.
Young Taghi was interested in writing and literature. However, when it came time to enter university, he failed competitive exams in literature but passed the test for medical school and soon found himself attracted to psychiatry. "I felt there was a real connection between psychiatry and writing," he says. His interest, however, deepened when a friend and fellow student became psychotic.
"That was a very traumatic experience," he says. "He was one of the brightest students of all of us. So I went to see him and got interested. Of course, psychiatry in Iran was quite different than in this country. They were practicing psychiatry of the 19th century, almost organic, almost like neurological disorders. And I was fascinated. I'm sure most young people are fascinated by craziness because it's kind of strange and it's not them."
Then, without warning, fate changed the course of his life: While researching mental illness among primitive tribes of Southern Iran, Modarressi and an assistant became entangled with the shah's security police.
"When you go out of Tehran, you are in a wilderness," he says. "And we were going from village to village where they looked at us as strange people. We were city boys. What were we doing on the southern border of the Persian Gulf? And so we were confronted by security forces who thought I was one of the revolutionary leftists."
He was detained for questioning, searched, his notes and tapes confiscated. "It was a very bad experience, one that left me with a sense of rage and humiliation," he says. Confused and indignant, he left Iran in 1959 at the age of 26. "When I left I had $15 in my pocket," he says. "And I spent half of that drinking on the plane."
His American journey took him from an internship in Wichita, Kan., to a residency in psychiatry at Duke University. There he met and married a dark-haired writer and linguist named Anne Tyler. Shortly after their marriage in 1963, the couple moved to Montreal, where Modarressi began a residency at McGill University, one that led to his interest in infant psychiatry.
Modarressi's search for the origins of the Self, however, did not begin in earnest until the 1970s. By this time he was an associate professor of psychiatry at the University of Maryland School of Medicine. In Baltimore, his inquiry into the psychological life of a baby focused on a fundamental question: How do infants develop a sense of self-recognition, of differentiation from the mother and others?
In controlled settings, Modarressi and his team studied the development of body image during the first two years of life. They employed a variety of developmental, psychiatric and psychoanalytic techniques -- including the technique of videotaping infants confronting their own mirror images.
In 1982 Modarressi opened the Center for Infant Study, part of the University of Maryland medical school. There, his research broadened to include not only the way a baby experiences the outer image of his body but the way he experiences his inner life.
When, Modarressi wanted to know, does the individual Self -- the part of us that is unique -- develop?
Here is what Taghi Modarressi thinks about the inner life of a newborn:
"What I believe -- and others in the field support it -- is that infants are born with a sort of personality, a sense of self they can be aware of. And not only is the baby born with a sense of self but also with a certain way of looking at the world and with certain preferences. ... In other words, the baby is a person. The baby is not just a reflex."
This view -- that a baby is a person with a specific emotional outlook -- constitutes a major change in the way society regards infants.
"If you think back 25 years, there was a feeling that infants were just kind of there," Modarressi says. "That there was nothing much going on in their heads. That the baby's behavior was all reflective. The thinking was: Baby's a mirror.
"In fact, in the early days infants and young children were seen as less than human. And any time that something bad had to be done to a young child, the theory was, 'Do it early because they don't remember.' " Modarressi stops and shakes his head, almost laughing at the outrageousness of such an idea.
"But the baby is not just a reflex. The baby has a sense of being himself or herself. ... And I believe what we come into this world with is very essential."
One of the things babies arrive with, Modarressi believes, is a way of looking at the world. Even in those earliest weeks, when the baby's world is a random combination of sounds, sights, smells and touch, each child's response is different. "There are those ideas that automatically appeal to us from the beginning," Modarressi says. "They are part of our uniqueness."
His own two daughters, Tezh, now 30, and Mitra, 28, are perfect examples of this, he says. "They came with very different personalities. And it is uncanny that what we saw in those days still is there in some form."
"Temperament" is the word the infant researchers use to describe these individual preferences and physical tendencies. We're all born with a certain basic temperament, they say, one that cannot be fully explained by genetics.
Some of us arrive more ready to respond to the environment; others more ready to withdraw.
Some babies seem relaxed; others are tense, withholding.
Some infants are sturdy and able to survive whatever life throws at them -- they are the Arnold Schwarzeneggers of babies. Other infants -- the Woody Allens -- are more fragile and may or may not overcome early obstacles.
Over and over again infant researchers and therapists like Modarressi come back to one point: recognizing and responding to an infant's specific temperament is crucial to good parenting. Many parents are able to recognize this temperament and supply the right environment. Others have more difficulty and need coaching on how to read the baby's signals more sensitively. Still others require help in the form of an "intervention" in a program such as the one offered at the Center for Infant Study.
"The growing environment is very important in at least one respect," says Modarressi. "If the mother -- or the father or whoever takes care of the child -- understands and appreciates the uniqueness of the individual and what that person is about and relates to that ... Oh, this is a lucky thing." Modarressi's expressive voice rises enthusiastically, as though he'd just discovered the nature of babies.
Not so lucky, he says, is the infant whose environment does not recognize this uniqueness. "When this individuality and this inner core self of the infant is not understood, then you have a problem. ... What I'm saying is that behind all this is a longing for something an infant naturally expects: to be related to the world, to feel that this is his home."
When the infant feels securely connected to his environment, Modarressi says, "it usually leads to some kind of creative sense within the individual that allows you to make a world that really fits you."
The man telling you all this, it should be noted, knows something about creativity and making a world that fits: He is a novelist as well as a psychoanalyst. His first book was published in Iran when he was 23; his last three books were published in this country and all have been well-received.
Modarressi believes that the creative artist may have a great deal in common with the therapist. "Like therapists, the novelist and artist may have a facility for reaching people," he says. "Anne would make a very good therapist. She is so receptive. And [to do therapy] you have to be able to open yourself."
He expresses wonder at the insight his wife brings to her writing, particularly in "Celestial Navigation" -- his favorite Anne Tyler novel. "When I first read that book I was stunned. I was amazed at how she is able to go from outside the character to construct an internal world of someone who is a little bit off."
Creating the internal world of a fictional character, he says, is not unlike the way infant psychiatrists go about constructing a baby's inner life. In the case of the infant, the researcher must create a sort of biography to fit that specific child; must ask himself, as the novelist does: Who is this character waiting to emerge?
If you allow yourself to see a baby as Modarressi does, you too will become excited, awed and full of respect for this small person. And you will see the baby in a different way, perhaps: Crying becomes communication; cuteness becomes purpose; temperament becomes a unique personality in search of a comfortable, satisfying environment.
At no other time in our lives, says Modarressi, will we be confronted with the need to master as many profound changes as we are in the first 10 months of life.
"During this short period of time the child becomes a person who knows the world and has some linguistic ability -- not speech, but some linguistic ability that makes him quite capable of communicating to others," he says. "And at 10 months a baby has established strong ties to the mother and father and is able to distinguish them from others in a very specific way."
In what seems a minor miracle, most babies are able to navigate the first year with only minor disruptions. But sometimes events occur -- illness of the infant or parent, separation from the familiar environment, a trauma in the family -- that disrupt normal development, leaving behind the potential for emotional problems.
"Anything that interferes with a child's relationship to the world, anything that infants experience in a painful, unsatisfying way can leave a lasting impact on the child," Modarressi says."
"Now, what am I talking about? Well, research shows that we are naturally social animals. We need companionship. We need touch. We need contact. And once we get that, it's satisfying; it reaffirms something within us."
And if we don't get it? He cites as an example the lack of interaction that might occur between a baby and a mother who is depressed. "It's not the mother's fault," he says. "Depression can happen in anybody's life. And then when the baby reaches out to the mother and Mother is not receptive, it might interfere with that baby's sense of belonging."
Pediatrician T. Berry Brazelton, who over the years has been doing his own research at Harvard Medical School, agrees with Modarressi. "We were back in the dark ages before this research," Brazelton says. "But I think we've learned a lot about picking up on these problems early and paying more attention. ... We can pick up a mother's depression in the baby at three or four months. And we can remedy some of these problems if we start early, working with some parents who aren't interacting with their baby, not feeding them back a sense of success."
It is important in the first month of a baby's life, Modarressi says, to "gratify" a baby's needs. "At that age the baby is not aware that something is not available to him. When he feels the need, it has to be gratified. He can tolerate to a certain extent but if it goes beyond that it can be very damaging, because the baby is not prepared to assume the limitation that reality puts on him."
Modarressi doesn't downplay the work involved in caring for a baby. "Babies are difficult," he says. "But the difficulty is not the source of the problem between mother and baby. Because I have seen mothers go through a lot of difficulty without feeling oppressed or attacked. The problem comes when a mother cannot make sense of that difficulty. It is when the baby is sick or unhappy and she doesn't know why. Because the mother's pride is based on knowing her baby and when she can't make sense of the difficulty, the baby becomes like a stranger to her."
You could argue that this is all just guesswork. That nobody, not even a team of learned psychiatrists, can ever really know what's going on inside a baby's head. It's not hard science; there's no proof. Of course, you could make the same argument about much of theoretical physics.
But one major change that seems to have gained wide acceptance is this: The burden of a baby's psychological well-being does not rest solely on the parent who is the primary caregiver.
"I think what parents resented about childhood theories for so many years is that everything was laid on them," Modarressi says. "And so many mothers felt guilty if the child was not perfect." He pauses, laughs, his face lit with good humor. "I mean, I wanted to be a perfect parent and, of course, you can't."
As a father it didn't help him at all, he says, that he knew "all this stuff" before he had his daughters. "Oh, yes, I knew it all. Everything." He pauses, then adds: "Unfortunately." He laughs out loud and in that laugh lurks a man who understands the elusive nature of practicing what you preach -- psychologically speaking.
He explains: "If you read too much of all this stuff, all it does is intimidate you. And anything you do, you are going to criticize yourself and think you haven't done the right thing. And, in fact, that was the situation with me.
"And so one of the things I try to help the parent with is just to be natural. And part of being natural means sometimes you don't understand. Sometimes you do a wrong thing. But we are human beings and you don't have to be 100 percent right. In fact, it's a good thing you are not."
In our society, however, parents are not the only important influence on the infant: We also have the substitute caregiver. As more mothers enter the work force, more infants enter some kind of day care arrangement. Modarressi says no one -- not the experts or the parents -- is certain yet what impact such an arrangement may have on young children.
"This is one of the major, major questions of our time. We know that it is possible to provide nursery care but we do not know what sort of people this future generation of Americans will be."
So how do you learn to better "read" your baby? As in most relationships, the answer lies in better knowing yourself. Therapists at the Center for Infant Study, which has been under the direction of Dr. Robinson J. Munoz-Millan since Modarressi stepped down a year ago, spend as much time working with parents as they do with children.
Dr. Jacqueline Haimes, a child psychiatrist at the center -- which accepts for treatment children from birth to age 5 -- says that some parents just need reassurance that their baby's behavior is normal. Others, however, need help in exploring how their own behavior -- or even their own personal history -- affects their baby.
Six-month-old Chelsea Steiner was brought to the center three months ago when her parents became concerned about her constant crying and extreme irritability. No medical cause could be found for her symptoms.
"I think that on the spectrum of babies Chelsea was in the normal but difficult-to-soothe range," Haimes says. "And that raised a lot of anxiety in the parents, wondering 'What's wrong with this baby?' Which taps into the insecurities parents have about whether they'll be good parents. Especially if they didn't have good role models when growing up."
Over a period of months, Haimes met with Chelsea and her parents. "We tried to explore how they feel about themselves as parents; how they reacted to Chelsea; certain marriage issues and issues in the relations between the two of them," Haimes says. She has recommended they each pursue their own therapy outside of the infant center.
"I think the worry you have," she tells them, "comes from your own backgrounds. And I think the more one works through those old issues, the more you can be there and be present for this little baby."
Chelsea has calmed down a lot in the past three months and her parents, Sharon and Robert Steiner, feel the center has helped them. Sharon Steiner says she now finds mothering less stressful than before. "I've gained more patience and I think Chelsea learned to trust -- trust that someone would be there when she cried," says Sharon. "I used to look forward to having a baby sitter. I don't anymore."
Angle of vision
All of us, says Taghi Modarressi, have a way of looking at the world; an angle of vision that from our earliest days shapes our view of life. And, he believes, shapes our view of death as well.
He says this one day while sitting in his cozy office. His just-completed novel, 600 pages long, is stacked up next to his computer. Lining the walls are drawings and paintings done by his daughters; on the table near his desk is a photograph of his wife. Her face, serene and intelligent, seems to cast a glow over the small room.
In Modarressi's own face, the world has found a home: Joy and pain, self-knowledge and self-doubt, serenity and disruption, boldness and resignation -- all of life's troublesome polarities seem to reside in his arresting features.
It is the face of a man who, after studying the mystery of life's
emotional beginnings, must now contemplate another mystery: How does one make sense of and organize an emotional response to the ending of life? Modarressi's own illness -- he has chronic lymphoma and is scheduled to have a bone marrow transplant -- has caused him to reflect on such a question.
"You know, before I became ill my attitude toward death was very serious. I thought of death as very oppressive, some kind of malignant force that would ..." He stops, thinks. "I thought I would feel frightened, I would be depressed, I would lose my interest, not be able to sleep. I thought I would not have the ability, the stamina to deal with death. This this came ..." Modarressi's voice trails off.
Then, in a strong voice, he continues: "The first response that came to me is that nothing is stable, nothing is permanent. It really, really changed my view of life. I had thought everything was written in stone; every person is there forever. But now ..."
He looks away briefly, then starts again. "The emotional effect of death, to me, is a sense of loss. Not fear, not being oppressed by it. But the fact that you are so little in the face of all this."
But the illness also has had the opposite effect on him; it has widened the angle of his view of the world -- and of himself.
"It really brought me to myself," he says. "In some way it liberates me. I feel so much alive. It's so funny to say -- but I'm enjoying life. People think it's denial. It is not. I know the seriousness of the situation. But it doesn't threaten me. It doesn't take me over. Since I have been ill, I really feel I'm tapping some resources in me that I didn't know I had."
Taghi Modarressi says all this with some emotion. But even when he struggles with his feelings, he seems a man in control, a man who has not become his illness. He is still himself.
Near the end of the conversation a memory occurs to him. His earliest memory, he says.
Taghi is 2 or 3 years old, sitting on the veranda in Tehran with his mother. His father is also there, sitting in the courtyard next to a brook. His father is smiling. There is some kind of plant growing there in the courtyard. His mother asks young Taghi: "Did you plant that?" The boy answers: "No." But the mother persists: "I thought maybe you had planted this."
They are gone now, the mother, the father and the plant that grew in the courtyard of a house in Tehran. But clearly something was planted there all those years ago. Something that still resides in the man who sits before you, the one who is talking about beginnings and endings:
"I believe it is part of you, the way you look at life," Taghi Modarressi says. "And I feel very grateful. I have had a good life."
The world of infants, according to Taghi Modarressi
Baby's first month
"What is important is not only that the mother gratifies and tends to her baby's needs but does it in such a way that really establishes a unity between them..."
The second month:
"What baby needs most is socialization. Talking, cooing, showing, playing."
The third month:
"We are moving toward the time when there is a bonding; when the baby begins to differentiate between gratifications and body sensation. ... In other words, an angry mother might create as much distress as hunger at this time; or loving can be much more gratifying than a good feed."
Baby at 6, 7, 8 months:
"This is a time when the baby has a newly discovered sense of self. The most important issue is that the mother does not get anxious or take this as a sign of rejection but instead supports it. ... At the same time, there is clinging. This is the time when the baby is afraid of strangers."
10 months to 15 months:
"This is the most delightful period of childhood. The baby has given up the idea of magical change and now knows he has to do something to make change come about. For example, if you put a ball where he cannot reach it, he doesn't just sit there. He tries to make a connection. ... He is fascinated by the world: any changes, any brightness, any roundness, any movement."
Pub Date: 11/10/96