66 Grief and Loss Across the Lifespan
Nondeath Losses
Loss of Caregiving
The literature on infants and toddlers emphasizes the importance of the
primary caregiver (generally the mother) to healthy development. During this
stage, the infant or toddler’s whole life is bound by the care and stimulation
she or he receives from caregivers; therefore, the most traumatic loss endured
at this stage is the death of a primary caregiver and/or parent. Even without
a death, the infant/toddler is likely to experience loss of the caregiver in both
normal developmental ways and in more dramatic ways. Certainly, optimal
frustration, as Winnicott (1965) discussed it, amounts to a temporary loss of
the caregiver; the felt need/desire of the child is not met immediately and she
or he feels abandoned. This is a normal and healthy experience after about
4 to 6 months of age. Because infants have not yet grasped “object constancy”
(that people continue to exist even if the baby does not see them), when the
mother is gone, the baby feels (briefly) as if the mother is lost forever. This
same phenomenon also allows him or her to adapt to the surroundings of
the present moment (after protest, an infant will eventually adapt to the per-
son who is providing care because they have “forgotten” their caregiver). Yet,
there is great joy when the mother returns. As the infant ages, object constancy
is such that the toddler knows mother still exists (somewhere) and protests
and yearning may last longer.
Temporarily losing care is a normal, maturational loss that contributes to
the development of the child. As she or he begins to recognize that the caregiver
is sometimes absent, but returns and generally provides attuned care, object
constancy grows and a sense of security develops. These types of maturational
loss occur within a secure and trustworthy relationship and promote develop-
ment. Development is threatened when the separation occurs in ways that are
beyond the youngster’s ability to cope, (for instance, when a parent is drug
addicted and unable to be engaged predictably) or where this loss is chronic
(parental depression means little caregiving extended to the youngster).
During the critical first 3 months of life, children need a caretaker attuned
to their physical and emotional state who not only provides care, but who can
soothe them and verbally reflect their experiences. Infants born to mothers
experiencing major depressive disorder and/or postpartum depression may
not receive the finely attuned care newborns need. Indeed, children born to
depressed mothers may never experience the sense of total care and attune-
ment that infants ideally receive to allow them to develop secure attachments
and a sense of trust in the world. Ideally the father or other surrogate caregiver
would meet the needs of the infant at this point. Often, other adults believe that
the mother’s mere physical presence is enough to keep herself and her baby
safe and she is deemed capable of managing her own and the baby’s care. This
can lead to tragic outcomes when postpartum depression occasionally evolves
into postpartum psychosis without appropriate supports in place (Abrams &
Curran, 2007; http://www.webmd.com/depression/postpartum-depression).
Parental depression has ramifications beyond infancy and toddler-
hood. Women with early onset depression are likely to have children with
dysregulated emotional patterns at age 4, decreased perceived competence