SUNDAY PROFILE : Talkin’ Babies : Child Psychiatrist Justin Call of Newport Beach Studies the Problems of Infants and Their Methods of Communication

NEWPORT BEACH — Look into the cradle, and what do you see?

It’s cute, yes, but helpless, passive, and its movements are merely random. It’s driven only by the most primitive internal needs. It’s utterly unaware of what’s going on out here.

That used to be the truth back when Justin D. Call started paying attention to babies.

Now, more than four decades later, the truth is something else, and that’s due in great part to Call himself. While his psychiatric practice is in Newport Beach and his teaching is at UC Irvine, his reputation is worldwide as a researcher in and a founder of the field of infant psychiatry.

“I have great respect for him,” says Eleanor Galenson, a psychiatrist and professor of child psychiatry at Mt. Sinai School of Medicine in New York. “He’s considered one of the gray eminences, one of the big shots, in our field.”

“He’s done major work bringing to people’s attention that infants do have problems and we can do something about them,” says Joy Osofsky, a psychologist and president of the World Assn. for Infant Mental Health, an international organization of 800 professionals that Call helped found.

“I think his contribution has been crucial.”

Call, first trained as a pediatrician, was shocked to discover that more than half of the ailments he was treating were psychological. The discovery deflected him toward psychiatry.

After 14 years of additional study and residency at various institutions, including UCLA and the Los Angeles Psychoanalytic Society and Institute, Call graduated first as an adult psychiatrist, then as a child psychiatrist and psychoanalyst.

His string of more than 100 scientific journal articles and books began in 1957 and continues. Now he is writing a children’s book to explain the quirks of their parents.

Call reached a turning point in 1963 when he published that newborns were not mindless eating machines.

Within about three days after birth they had learned their mothers’ individual feeding habits and styles and had adapted to them, he wrote. They could tell when feeding was going to happen before it started. And they could signal by turning and opening their mouths that they were ready.

Seemingly simple, yet the implications were enormous.

If that was true--and it is now generally accepted as true--then a newborn baby is immediately able to begin adapting its reflex actions to its mother’s feeding style. It meant the baby is not a blank slate. It is born with a predisposition to rudimentary learning and communication.

And if babies can adapt and communicate, some will be more adroit than others. The mind’s individuality, though primitive and subtle, is ready to function at birth.

And there was a dark side. If newborns had mental processes sensitive to their environment, then their mental processes could be damaged as well as nurtured by that environment, even at this earliest age. Some of the psychological ailments Call had observed in 5- and 6-year-olds might have their roots in the very first weeks or months of life.

“It was a neglected area,” Call says. “People considered it somewhat sacred, that you really shouldn’t look at these things at this early age. The child is almost born with a halo around his head, and the mother is included in that halo that says, ‘Don’t touch. This is God’s work. Science has no place here. Leave it alone, especially you psychiatrists who are going to screw it up.’ ”

But after decades of research, “one thing I’m sure of is that from birth to age 3, there are seven distinct epochs of development-- at least seven. And from age 3 on, for the rest of your life, there are no more than six or seven.

“Infancy is the most dynamic period of the life span. So much is there. A lot of it shows up in dreams and fantasies and symptoms and personality traits. It’s a vastly important part of your life, and you can’t remember it. What we can remember is only the surface of the iceberg.”

*

Call’s fascination with babies seems appropriate when you meet him. His white hair and Van Dyke beard give him a benign, grandfatherly look. His voice is gentle and measured. His demeanor bespeaks patience and enough vigor that you are surprised to learn he’s 71 years old.

Life must have been good to him, you assume, and he confirms it is true. It has been a smooth trip, he says.

Call was born in Salt Lake City in 1923, the second of what was to be five children. His father, a railroad machinist, had quit medical school in order to support his growing family, but he passed his goal along to his eldest son. It took root in junior high school when young Justin discovered he enjoyed his biology class immensely.

“I thought, ‘Wow, this is for me. This is fun.’ It was my first taste of science,” Call says. “Medical school resonated with the hopes of my parents and the encouragement I got from them. I was the first doctor in the family. Most of the professionals in my family--uncles and grandparents--were lawyers, judges and teachers.”

To help his family, which was scrimping through the Depression after his father died, Call started selling home-grown watercress at age 8. By the time he was ready for the University of Utah, he had worked as a farm laborer, soda jerk, night watchman, bookkeeper, chief clerk and orderly. But then the scrimping ended for him.

“My timing was lucky. The war broke out in 1941, at which time I just had my first quarter of college. Within a few months, I joined the Navy as a midshipman, and the Navy paid my way. And then about the time I was finished with medical school, the war was over.”

Instead of treating sailors, he found himself treating skiers at Sun Valley, Ida., which had just reopened in 1947 after closing during the war. This was paradise for an avid skier such as Call, but when he was offered the chance to be physician for the U.S. Olympic ski team, he turned it down “because I had my goals all set.”

He was going to become a pediatrician, then join a university to teach and research. “Even in medical school, my colleagues always had me tagged as a professor-type person, which I think I always have been.”

During a one-year stint of research at Children’s Hospital in Boston, he co-wrote and published two research papers on lung hemorrhage in infants, which attracted some attention in the profession and opened doors.

But his residency in pediatrics at New York Hospital, New York, unexpectedly led him elsewhere.

“So many of the cases--50% and possibly 60%--were behavioral, developmental or emotional difficulties,” Call says. “This seemed to me to be where the greatest challenge was: identifying the earliest phases of a problem and figuring out what is the best kind of intervention. When they are identified later, it is so much more difficult to deal with them. Things are very settled and set.”

Call says the prospect of research at the outer edge of scientific knowledge appealed to a pioneering spirit he had acquired in childhood. His family was proud of the fact that ancestors had come from England to New England in 1640 and to Utah in 1847. “I saw myself as a pioneer in the unknown with science as the guide.”

In 1956 Call completed his residency in child psychiatry at UCLA, the first resident to graduate from the fledgling Department of Psychiatry. He taught and researched there a total of 15 years, then transferred to UC Irvine’s College of Medicine in 1968, eventually becoming its chief of child and adolescent psychiatry. He retired from that post in July but continues his research and teaching there as an emeritus professor of pediatrics and psychiatry.

Call conducts a part-time private practice at his home overlooking Upper Newport Bay, a home he shares with his wife, Barbara, two cats, two Irish wolfhounds and occasionally some of his immense extended family, which includes three daughters (a designer, a teacher and an artist) and two grandchildren.

*

Call concedes the irony: All his research into infancy didn’t really make him a better father. That’s partly because his research has shown that being a parent is, or ought to be, largely a matter of intuition and adaptation, not “going by the book.”

He approves of the baby books of Benjamin Spock and T. Barry Brazleton, noting that they are pediatricians, not psychiatrists. Most consumer books offering psychological advice are “ill-founded,” he says. Most do not sufficiently take into account differences among even newborns.

Assuming there is only one correct way to raise a child is wrong, he says. Children’s inherent differences take effect from the moment of birth, “so you can’t know what kind of a kid you’re going to get until he’s there on the site.” Some are more active, more sensitive to light and noises, more adaptable to their parents, more communicative. There are many ways to be a good parent, he says.

“People believe you can solve any problem if you have enough knowledge and leverage. What hasn’t been acknowledged is that people have the capacity to grow into parenthood with their children. They often don’t look at it as something they can learn from their children. Many go about it as if they’re supposed to know everything about how a child grows without looking inside themselves and learning from their own experiences and using their own feelings and intellect.”

Babies are born with differing needs, but most are also born able to communicate them to a parent who’s paying attention, Call says. Crying is the most powerful means of communication, and soon the newborn’s cry has been changed into a repertory of cries, each recognized by the parent as a different signal. But there are many, more subtle signals.

“If they can’t learn from their own experience with their own child, they grow up believing there’s somebody else who knows more about it than they do, like an authority in a book or a pediatrician. Pediatricians don’t know all of this. Neither do psychiatrists. We have to support parents in their capacity to get to know their own individual children, not just from what they do but (through) what thought processes they have.

“Parents actually do grow by deciphering and responding to their babies’ signals, responding to the kind of kid they have. And that’s really more important than ‘knowing the right way.’ ”

After discovering that newborn babies had the mental ability to anticipate feeding, Call began observing more of the interaction between mother and newborn. He discovered that after feeding, with the stress of hunger allayed, the baby was most receptive to play.

“That’s when playful activities between parents and their children develop. I realized that play was a rich, interactional experience that involved communication. So I began studying typical games that parents play with their children.”

*

This led to Call’s major interest since the 1970s: how the ultimate communication, language, develops in infants.

He remembers what piqued his interest. A father and his 13-month-old daughter had come to Call’s class as subjects. The girl spotted a penny on the floor, pointed to it, turned to her father and said, “Ush!” When he father ignored her, she doubled her efforts; she pointed with both hands and said “Ush, ush!”

“I hadn’t been aware of how important pointing was as a precursor to language,” Call says. “I think this was a major landmark in my own scientific development.”

Call postulated that pointing is a primitive form of language; it can act as a multi-word statement or question. A child pointing may be asking the name of an object, informing a parent of a desire or just remarking on something interesting. Adults, when deprived of their language in a foreign country, resort to pointing.

Soon the child attaches contrived words like ush to the action of pointing. These words take on the meaning meant by pointing and become rudimentary spoken language. To the child, the one word represents an organized thought--”Look at that” or “I want that.” Linguists call that one word a holophrase, and the technique persists into adulthood. Adults often use one word in place of a sentence.

“I began researching, looking at the evolution of words, and I found myself absolutely fascinated,” Call says. “I found also there were very significant gaps in the literature--that frontier I was always looking for.”

There were competing theories in the field, one that babies develop language because they are rewarded for using words and sounds, another that babies’ central nervous systems are pre-wired for language.

Call’s observations led him to publish his own hypothesis, which he calls the “grammar of experience.” It is a transition phase in which the child begins organizing his actions into sequences, a sort of nonverbal syntax. Eventually that leads to word sequencing, Call maintains.

A simple example, Call says, would be a mother attending to the child when the telephone rings. The child has had enough experience to know that the telephone may draw her away.

The child wants to say, “Forget the phone and stay here with me.” He will say it with calculated action, however. He may fuss or cry in anticipation of the mother’s departure. He may grab and hold on. When she goes to the phone, he may try to call her back with cries. If he can walk, he may pick up a toy and take it to her. The meaning is obvious: Hang up and let’s play with this.

While eating, the child may finish the finger food, then pick up his spoon and bang it on the tray of the highchair. His mother understands what he’s “saying”: He wants the spoon food now.

“The child knows where he or she is going, knows what needs to be done. There is a goal,” Call says. “It’s just like uttering a three-word phrase--’Bring the food.’ It’s meant to produce a result.”

This nonverbal language is evident in play, says Call, so he is conducting experiments, observing children in simple play with their parents using blocks, dolls and clay. “We’re using it as a basis for predicting later language ability in children.”

*

This sort of research will have more effect than satisfying curiosity, Call says. His long-term studies observing newborns as they mature--some of the babies are now over 30 years old--is leading toward knowing the effects on adults of events in their infancies.

“One of the things I have learned is that the period of infancy is more, not less, important than I thought when I started out.

“Trauma in infancy often is completely neglected. Psychological trauma--desertion, deprivation, disruption of the family, violence between the parents--very few people can remember what happened in their lives before the age of 3.”

But the long-term studies will lead to recognizing the signs of brewing problems in an infant and what to do about them at that time. Sometimes very serious ailments can be reversed when treated very early, he says.

“Will these (ailments) last forever? Some do, but some don’t. Human beings have a chance to make up very critical phases of growth that have not occurred earlier. And there are many different pathways to maturity, not just one. So a kid who has certain handicaps, even to the central nervous system, under a favorable environment can compensate for them.

“Actual organic brain damage at infancy does not always give a prediction of how a kid is going to be at age 3. What does predict is the adequacy of his social environment.”

Call concedes that information about the ills of infancy make some people fearful of having children.

But take the risk, he says. Trust yourself.

Just be open to surprises “and to the mysteries and to the almost magical transforming experience they can have as they assume responsibility for a child.”

Hone your intuition and be ready to learn from the child. Acknowledge your mistakes. “Everyone makes mistakes. The difference between people is how they correct their mistakes,” he says.

“One of my subjects has a history of the worse things that can ever happen to a human being. But when she had her baby after two miscarriages, it had an enormously transforming influence on her.

“To me, it’s a dramatic example of what being a parent can do. I think it can change a person’s conception of themselves as people and can widen their horizons of humanity in general. It can deepen the questions they might even have about existence itself.

“I really don’t think anyone can predict how they’re going to be when they have a child the first time. I don’t think it’s possible,” he says.

You can’t avoid making plans when the child is in the womb, but make no assumptions until the child is in your arms, he says. Maybe you won’t really want to go back to work after all.

“There’s easy going and tough going, but the experience of being a parent will affect their perspectives on life. Not experiencing that is a deprivation--that’s the way I feel. People who miss the experience of caring for children are to some extent incomplete human beings.”

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Spotting Psychological Problems in Infants

AGE: BIRTH TO 1 MONTH

* Probably not a problem: Wants to eat every two hours; not satisfied with feeding; sucks fingers or thumb; grunting and red face during bowel movements; wants to be held “all the time”; prickly heat rash; normal “spitting up”

* May indicate problem: Doesn’t gain weight; vomiting; no eye contact; doesn’t hold head up; doesn’t grip with hands; no feeding anticipation, that is, does not open mouth and turn head toward proffered bottle or breast; head or facial tics

AGE: 2 TO 3 MONTHS

* Probably not a problem: Irritable crying; colic; constipation; waking during night; sucking fingers or thumb

* May indicate problem: Doesn’t gain weight; indifferent to human face, voice and invitations to play; persistent hyperactivity and sleep disturbance; vomiting and diarrhea without physical illness; unusually high or low response to stimulation such as light and sound

AGE: 4 TO 6 MONTHS

* Probably not a problem: Constipation; demands for attention; wants to be propped up; is “spoiled”; biting while teething; sucking fingers or thumb

* May indicate problem: Sleep problems every night; hyperactive; unusually high distress from stimulation such as light, sound and movement; wheezing without infection; lack of interest in people within view; objects to upright position; excessive rocking (except at night or when alone)

AGE: 7 TO 9 MONTHS

* Probably not a problem: Dropping things; messy eating; sleep pattern disturbed by teething, illness or moving to new home; “temper”

* May indicate problem: Persistent sleep problems; eating problems such as refusing to hold cup or rejecting all but a few foods; irregular sleep and eating patterns; doesn’t imitate simple sounds, gestures or facial expressions; shows no emotion; strange, incomprehensible “play” with inanimate objects (such as biting on sharp objects); lacks interest in others; is not distressed by strangers; withholds bowel movements; regurgitates and reswallows food or liquids; excessive self-destructive behavior; apathetic; depression (anxiety, sadness, no new abilities, loss of established abilities)

AGE: 10 TO 15 MONTHS

* Probably not a problem: “Getting into things”; climbing; constipation; declining appetite; insistence on feeding oneself; occasional screaming; mild tantrums; attachment to a favorite blanket or toy

* May indicate problem: Speaks no words or has lost words previously used; sleep problems; withdrawn behavior; excessive rocking or posturing; strange, incomprehensible “play”; not distressed by separation from parents; night wandering; easily distracted; bowel disturbances

AGE: 16 MONTHS TO 2 YEARS

* Probably not a problem: “Getting into things”; climbing; stubbornness; temper outbursts; easily upset; “stuttering”; sibling rivalry; strong likes and dislikes

* May indicate problem: No speech; excessive body rocking; inappropriate play; bowel problems; sleep disturbance; retarded development or regression lasting more than a week

AGE: 25 MONTHS TO 3 YEARS

* Probably not a problem: Messy play; stuttering; won’t put things away; aggressive and possessive play; occasional soiling or wetting; stubbornness; won’t try new foods; regressive behavior during illness or stress; wants own way and fusses; occasional temper tantrums; unreasonable fears that subside after a week

* May indicate problem: Disturbed sleep; animal dreams; persistent soiling and wetting; persistent eating problems; inappropriate play; excessive fear of ghosts, burglars lasting more than a few weeks; shyness lasting more than a few weeks; excessive body rocking, finger sucking, tics or masturbation.

Source: Justin D. Call, MD