Just before the interview with Ruth Feldman began, her research associate Orna Zagoory-Sharon knocked on the door to say goodbye before the holiday break.
“Wait! An oxytocin hug,” Feldman called out, and jumped off the couch. “At least 20 seconds.” The two had an extended hug (albeit less than 20 seconds). Haaretz, shrinking in embarrassment in the corner by the plant, could have gotten the impression that a touchy-feely, hippie-like atmosphere had gripped the Center for Developmental, Social and Relationship Neuroscience at Herzliya’s Interdisciplinary Center. However, the meetings with Prof. Feldman and the tour among her lab’s shiny devices showed that researchers there are trying very seriously to answer one of the biggest questions of all: how exactly do we become human beings.
“We’re studying the biological basis that allows us as humans to create social attachments,” explains Feldman, the center’s director. “To love, to be parents, to feel empathy, to be in a group, to have a reciprocal connection with another person, to identify another as friend or foe, to create social groups at the national level or even sports teams. What are the biological, hormonal, genetic, epigenetic and neurological systems enabling us to do this?” The short answer? Synchrony – the delicate bond created between mother and infant right after birth.
One of Feldman’s first experiments involved 73 preemies born in Israel in the 30th week of pregnancy and weighing 1,270 grams on average. Every day for two weeks, the preemies received one hour of “kangaroo,” or skin-to-skin, care. They were removed from their incubators and placed naked between their mother’s breasts. A control group of the same size and medical condition only received contact through the incubator.
Feldman and her staff tracked these children at seven junctures in time, over the next 10 years. The findings showed a dramatic impact on the children who had received the kangaroo care.
“They had a better connection with their mother, better adjustment abilities, lower cortisol (stress hormone) levels and lower ADD rates throughout their entire development,” says Feldman. “Small differences, created at the start, amplified over the years.”
The results of another study, from when the children were nearly 20 years old, are being released here for the first time. The two groups were asked to carry out a task requiring empathy while their brain was imaged. The researchers found that activity in several brain areas was about 50 percent higher in the participants who received kangaroo contact than among the youths who hadn’t received the contact.
“We saw more activity in the amygdala and in the prefrontal cortex and a greater connectivity between these regions,” explains Feldman. “Previous research showed that maternal deprivation, for example among children who grew up in institutions, suppresses activity precisely in these regions and the connection between them.” Additional preliminary findings demonstrate the real difference in the brain structure (and not just its function) between the two groups of preemies, in centers associated with emotional and motor functioning.
“We didn’t invent the kangaroo care method,” she stresses. “The method became renowned in wake of our research and today every neonatal unit encourages parents to provide kangaroo care. It impacts hundreds of thousands of babies annually, and we’re very proud of that.”
While Feldman discussed her research, I thought of my 3-month-old daughter and immediately felt guilty. “It’s worth synchronizing with her,” she advised after I mentioned her. “Was she a preemie?” No, I said, but it’s pretty amazing how much influence 14 hours of your life can have.
“You should understand that a preemie is born under specific conditions,” notes Feldman. When a baby is born, the mother can hold him or her, while preemies are separated from their mother during the period when their brain is not fully developed and they still need the mother’s physical contact. During this sensitive period, even a brief intervention is very significant. For example, songbird researchers showed that the bird needs to hear its song on a certain day, just two or three times, in order to learn to sing it. Specific neurons in the bird’s brain change when it learns its song during this exact timing. If you keep the bird from learning the song when it needs to do so, and play it for the bird 700 times a week later – nothing will help.
Mothers, zebrafish and cocaine
Feldman, born in Jerusalem, moved to the United States because of her parents’ jobs. Her academic career began when she was 15, studying music at New York’s Hunter College. She was enrolled at that age thanks to a program involving early college admission of students from low socioeconomic backgrounds. After receiving good grades her first semester, she was permitted to continue as a regular student, eventually graduating with high honors with a degree in music composition within three years. Her daughters still jokingly refer to their mother the professor as a “high-school dropout,” since she never finished high school.
She studied and played jazz on the piano and trombone, and was enchanted by the cooperation between the musicians when they improvise together. “I wasn’t much of a player, but old-time players are familiar with this experience of entering an altered, flowing and creative state,” she says. When she realized that a music career wasn’t in the cards, she decided she wanted to study this synchronized experience – “how we can be together with another person,” as she puts it.
Feldman earned no fewer than three master’s degrees, starting with music therapy in New York. After meeting the man who became her husband in the United States and returning with him to Israel, she completed degrees in neuroscience and clinical psychology. She wrote her doctoral dissertation in developmental psychology on synchrony in mother-infant relations. While studying, the couple had four girls and a boy.
Upon return from a post-doc at Yale University in 1995, she joined the Bar-Ilan University faculty as a researcher. About 20 years later, she moved to the IDC. The neuroscience center she runs there includes the Loralee West Laboratory for Brain Research and Human Development, and the Simms-Mann chair. Feldman also heads a public clinic for young children and their families.
Feldman’s impressive lab, which she moved into a year ago, is the pride of IDC. Costing over a million dollars and set up according to her detailed requirements, it takes up an entire floor of the library building. The lab includes a large observation room where subjects can interact with each other more or less naturally, while researchers record their brain activity, and film and observe them behind a one-way mirror. Researchers use computers to analyze video clips with micro-second precision and to generate data on the synchrony of gaze, affect, vocal signals and body movements between interacting partners.
In the hormonal and molecular biology lab, Zagoory-Sharon and her staff use robots in analyzing blood, saliva, urine, breast-milk, sweat and hair samples. In yet another room, with special ventilation equipment, they recently began to analyze feces samples, in order to try and measure the synchrony of gut bacteria between youths who live in Sderot (the town near the Gaza Strip that has been the target of Hamas rockets in recent years) and their mothers. According to Feldman’s long-term research, half of the children in Sderot develop psychiatric disorders and half do not. Her goal is to discover what characterizes the gut bacteria that is associated with resilience in the face of chronic trauma.
Could the treatment that develops be fecal transplant of the “resilient” into the bodies of the “non-resilient”?
“Nice. Do you want to work here?”
In an era when print journalism is dying and stool research is flourishing, perhaps I’d better not reject such an offer out of hand, I thought.
In any event, one of Feldman’s starting points is the classic study conducted in 1958 by Harry Harlow and his wife and colleague Margaret Kuenne with rhesus macaques. The monkeys were separated from their mothers and placed in cages with two inanimate surrogate mothers – one made of bare wire holding a bottle with food, and another clothed but with no food. When they were hungry, they went to the wire mother, ate, and immediately returned to the mother giving them softness and contact. The picture of the little monkeys clinging like a leaf blowing in the wind to the creepy, clothed doll with a frightened look on their faces, is one of the images that is never forgotten by psychology students.
Feldman: “Harlow’s insight was that it wasn’t about the food but the contact. However, ‘contact’ is a very general word, like ‘motherhood.’ It is a word that consists of many components. Contact involves the oxytocin system, the stress system and the immune system. It entails behavioral and neural synchrony. It activates the brain basis of attachment, the connection of dopamine and oxytocin.”
In order to decipher this observation, let’s start with oxytocin – a neurotransmitter, sometimes referred to as the “love hormone,” which is secreted by the hypothalamus. It constitutes the basis of Feldman’s theory. From an evolutionary standpoint, the body’s oxytocin system is ancient, and can be found in thousands of species of vertebrates. Its role – whether for a person or a zebrafish – is to connect individuals. In humans, oxytocin is released in response to contact (hence the “oxytocin hug”), eye contact, sex, breast-feeding and a variety of social activities.
One question Feldman and her colleagues have tried to answer is what causes the human connection to be enjoyable, pleasant – something we desire and pursue. Indeed, hugs or eye contact aren’t necessarily so enjoyable. Why do we derive such pleasure from sniffing our baby? From an evolutionary standpoint, the brain must create a reward mechanism, otherwise we wouldn’t. The answer is dopamine.
The oxytocin-dopamine connection in animals was known, but the research by Feldman and her team demonstrated the connection between the bonding system (oxytocin) and reward system (dopamine) in humans as well, at the newborn stage.
“Dopamine gives this connection the energy because oxytocin is a system without much energy,” says Feldman. “The connection of dopamine with oxytocin makes it that the strongest reward you have stems from taking care of your baby.”
When a parent plays and makes eye contact with the baby, behavioral synchrony is created between them, according to the research model. Both sides are on the same wavelength. Consequently, their brains literally switch to the same wavelength. “You have one developed brain, one not, one connected, one not,” Feldman explains. “This synchrony is critical for the child because it introduces him to the social world.”
Both brains activate the same areas, release the same hormones, and the heartbeats are also synchronized. The connection between the oxytocin and dopamine systems is created in the baby and strengthened in the parent. Thus, infants learn during early childhood to enjoy another person’s company, to want to be in contact with other people. Anyone who didn’t experience this synchrony with their parent at the right time will have more difficulty creating the valuable connection between the bonding system and the reward system later in life. His whole life journey may be one of hardship. He’s liable to seek his dopamine in other sources, like cocaine, which floods the brain with this neurotransmitter.
“We believe that behavioral and biological synchronous processes are the ones allowing us to form personal bonds,” Feldman explains. “When you and I synchronize our gaze or laugh together, or do any other synchronized act together, it also allows our brain activity to synchronize and to release hormones, and for our heartbeats to synchronize. We learn all this within our early bond with the mother.”
When the child is parented well and his abilities develop properly, synchrony develops and expands over time. “Initially, gaze, affective states, vocal signals and body position synchronize. Later, as the child’s mental abilities develop, synchrony with the parent also includes more complex actions and brain systems, like mutually recognizing the needs and viewpoint of the Other, the ability to feel empathy and to solve problems mutually,” the professor explains.
“The more we researched, [the more] we saw how the experience of synchrony precedes and shapes all social skills. It determines the nature of the bonds you will have with friends in kindergarten, and later how much empathy you’ll be able to express, how much you can cooperate, how much understanding you’ll have for others’ troubles.”
Only in moments when behavior is synchronized is synchrony also created in brain activity, in hormones and in the heartbeat, which is the process that allows proper emotional development. One of the many studies being conducted now in the Feldman’s lab examines whether such synchrony is created when parent and child correspond remotely (like on WhatsApp), as compared to face-to-face communication.
The effects of stress
Feldman has for many years followed three groups of children and mothers. Each of them represents another aspect of risk to the proper development of synchrony. Besides the group of preemies and their mothers, there is a group of mothers and children from Sderot, who live under high levels of stress because of the security situation there, and another group of children born to mothers suffering chronic depression. The findings were published this summer.
Feldman: “We recruited them when the children were two days old, from hospitals in central Israel. We examined the child’s interaction with the mother several times from childhood to adolescence, checked the hormonal levels of the child, mother and father, the child’s adjustment, his emotion-regulation skills and his mental health. At age 12, we imaged the child’s brain. We found that throughout childhood, the depressed mothers were less synchronized with the child than the healthy mothers. This is expressed nonverbally during breast-feeding, like a smile or by touch, and later you see less verbal synchrony.”
The reduced synchrony in behavior led, as expected, to disruptions in biological synchrony. These children did not show the expected elevations in oxytocin in the blood and urine after interaction with their mother, which can be seen among children of healthy mothers. The saliva in these children contained elevated levels of cortisol and immunoglobulin A – a sign of weakness of the immune system and chronic stress. The brain-imaging findings provided additional evidence of difficulties in the mother-child bond: It showed no special activation in their response to a video of themselves with their mothers, which is typically observed in children’s brains. Starting at age 6, these children were four times as likely to exhibit a full-blown psychiatric disorder.
During childhood, these problems included anxiety disorders or behavioral problems, says Feldman, offering another not-yet-published observation: “Today, we see more depression among the children, who are now 16 years old.”
Although this particular study involved observation of women with chronic depression, even postpartum depression, which tends to be shorter in duration, may lead to long-term difficulties because of the critical juncture at which it occurs, she notes. Thus, it’s very important to be aware and to seek treatment in such a case, Feldman adds: “Some 15 to 18 percent of mothers suffer from postpartum depression. It’s nothing to be ashamed of.”
Gay fathers’ magic
The mother is usually the main “attachment” figure for the development of synchrony. However, one of the studies by Feldman and her colleagues shows that, the brain basis of attachment in gay fathers who are the primary caregivers is no less active than that of mothers. That study looked at three groups of parents: straight mothers who were the primary caregivers, straight fathers who were the secondary caregivers, and gay fathers who were the primary caregivers. The researchers filmed the parents interacting with their infants at home. Later, the parents watched these films while undergoing a brain scan with an fMRI. Additionally, their oxytocin levels were measured before and after playing with their children.
The researchers found that while synchronizing with the infant, exceptionally high activity was observed in the mother’s brain – five times higher than among the straight fathers – in the center responsible for emotional processing. When the straight fathers synchronized with their offspring, brain activity in the mentalization center, which enables social understanding and empathy, and provides cognitive representation of the intentions of the infant, were measured as being four times higher than among the mothers. The gay fathers beat them both, with high activity in the emotional center, like the mothers, and high activity in the mentalization center, as among the straight fathers.
Feldman rejected out of hand my provocative attempt to characterize gay fathers as “super parents.”
“Our findings show, in my opinion, not the superiority but rather the plasticity of the parental brain,” she says. “Until 1850, one out of three mothers died in childbirth. Who raised the children? Neighbors and aunts; women who hadn’t given birth took in the children. Suddenly, the entire network responsible for attachment in their brains started to activate. This network is very flexible because it is critical for survival.”
Feldman adds that when a father spends a lot of time raising his child, the father’s emotional brain center becomes more active. “Gay fathers are the heralds of the ‘new dads’: When you are more involved raising your child, these two brain systems will activate and connect.” We’ll get back to this.
That study is just one of hundreds that Feldman and her colleagues have published, most of them in leading scientific journals. She is considered a leading, influential and very productive researcher in Israeli circles and abroad. Besides her work at the IDC, she is an adjunct professor at the Yale Child Study Center, and is a former editor of the prestigious Journal of the American Academy of Child and Adolescent Psychiatry. Her global reputation helped attract several leading researchers from abroad to the inaugural developmental social neuroscience conference at the IDC a few weeks ago, which she hosted.
Still, Feldman’s successes have also drawn criticism. One of the claims against her work is that the concept of synchrony, upon which she has built much of her career, is too similar to another psychological concept – sensitivity theory, which has been widely studied for decades. Another claim is that the measurement of oxytocin in body fluids (blood, saliva, urine, etc.), which are main findings in her studies, don’t reflect sufficiently the oxytocin in the brain – which is the one that’s important.
At this stage of the interview, Feldman’s body language suggested a certain drop in the level of synchrony between us. To her credit, however, she quickly recovered, and responded matter-of-factly to the claims.
“Our research is at another level, built on the study of ‘maternal sensitivity,’ whose source is [John] Bowlby and [Mary] Ainsworth (who developed attachment theory), to whom we have given much credit in our studies,” she says. “Even if I were to check the neural basis of ‘sensitivity’ and not ‘synchrony,’ our studies would be unique.”
Still, it is important for Feldman to stress that it is no coincidence that she chose to research the biological basis of synchrony, because in contrast to sensitivity it is a dyadic concept. “Synchrony is built online from the interaction of two people,” she says. “We call this ‘a lived social experience.’ Thus, it is much more similar to jazz. You can’t create a jazz band with yourself.”
As for the method of measuring oxytocin, Feldman acknowledges that there is disagreement on this issue, but there is also support for it. She explains that among other things, a connection has been found in animal research between the hormone level in body fluids and its level in the brain. The combination of that finding with additional evidence she has regarding people – such as genetic tests and brain imaging, which reflect activity in areas rich in oxytocin receptors – helps build a case for the studies, she says.
The nature and character of the synchrony created in the bond with a parent influences not only your mental and physical health but also the attachments you make in life – socially, romantically and when you yourself become a parent. “Nature is thrifty,” says Feldman. “The same systems that come to fruition in the initial bond are the building blocks of your romantic bond when the time comes.”
A 2012 study showed that one can predict the success of a romantic relationship by measuring oxytocin levels. Feldman and her colleagues found a significant correlation between oxytocin levels in the blood of the lovers and the level of synchrony between them with respect to positive affect and the way they touched each other in the lab. The couples with higher oxytocin levels were the ones who were still together six months later.
Another study, published last year, discovered that among romantic, long-term couples, as in the case of the mother-baby bond, synchrony of the brain took place between them when they synchronized their behavior, specifically with warm feelings and looks. Feldman explains that romantic love of the synchronized kind, just as with a close bond between parent and child, “has a component that lowers the stress level and improves the immune system.” She notes: “Geriatric studies also show that when one member of a couple dies, the second one often gets sick or dies immediately thereafter. Something about relationships keeps us healthy.”
Feldman repeatedly returns to the triangle she finds in her research: oxytocin-cortisol-immunoglobin A: Good synchrony raises oxytocin levels, lowers stress levels and improves the immune system.
On the neural level, she stresses, romantic love may be based on the foundations created during infancy, but not solely on them. “Romantic love is not just a look and a hug,” she explains. “True, you clearly need to look each other in the eye and not spend most of your time on your smartphone,” but a good relationship needs also to be expressed through more complex elements, which are learned during childhood – thanks to good synchrony with one’s parents, of course.
She says you need “to be able to detect when your partner is in pain, to be accurate in understanding his empathy, to know how to interpret what disturbs him, to be able to anticipate what causes him joy or anger, what will bring you together and what will drive you apart.” These higher cognitive skills, which are based on higher cortical neural networks, function in concert with the more ancient subcortical systems.
Feldman believes it’s important to put her research in a historical context. Darwin’s evolutionary arena is a place of a "war of all against all,” she said at the conference she hosted a few weeks ago. “Freud’s world is painted in similar colors, of the principle of pleasure and sexual libido.” In contrast, social neuroscience holds that social skills – mutuality, care, parenting, empathy – are not a “second floor” built upon the foundation of such drives, but are just as fundamental. “Social neuroscience is taking a stand; we choose to examine the neurobiological basis of human nature through the lens of mutuality and concern.”
She says her findings indicate that mothers are biologically prepared to parent, while fathers have to invest. “The more a father invests in caregiving – feeding, bathing, playing – the better,” she observes. “The more you do earlier, the more your parental brain will be consolidated. Parenting can completely reorganize your brain. I had my first daughter at 22. I remember getting up in the morning, taking her for a walk and saying, ‘Wow, the whole world is colored differently.’ It has been that way ever since, and my daughter is grown up. Mothers get it for free. Fathers have to work for it. If you don’t do it, parenthood will pass you by.”
Feldman warns of “intrusiveness” – “a very damaging and prevalent component in relations between parents and children, and between people in general.” It is expressed in overstimulation of babies and lack of attention to moments when they avert their gaze or are tired. “Babies and mothers synchronize only a third of the time when they are in face-to-face communication,” she warns. “They are floating in space most of the time. To be in sync all the time is too intrusive, like a jazz band that plays in forte for two hours. It’s intolerable.”
Such overstimulation may negatively impact a baby’s neural development, adjustment and stress levels. By the same token, forcing your agenda on your partner, dominating the conversation and not paying attention are also forms of intrusiveness, which is problematic and damaging.
Good synchrony with the child is a necessary but insufficient condition for social development. The relationship between the parents themselves is also important.
“Our studies show that starting from the age of 4 months, babies also react within fractions of a second, to nonverbal signals between parents,” Feldman says. “If your wife makes a comment about you and you make a dismissive face, your daughter will notice.”
The oxytocin system is flexible “and it depends on your behavior,” she adds. “Hug, hug hug. When you leave home, hug your child, hug your partner. It will lower both side’s stress level, and raise the feeling of wellbeing and the ability to enjoy what you encounter during the day. It will also boost your immune system.”
The Jewish-Palestinian problem
The work of Feldman and her colleagues also has a political dimension. “We are a state living with trauma,” she observes. “We have followed mothers and children in Sderot for 16 years. Their situation may be extreme, but we all live this to a certain degree. Our studies show that extended exposure to a situation of war and uncertainty has a long-term impact on physiological systems related to stress and immunity. I’ve studied the topic of war-related trauma since 1996. I didn’t prevent any war with my research, but these are the tools I have. It’s impossible to ignore its long-term effects on the developing brain. This needs to be taken into account.”
When she returned from her post-doc in the United States in 1995, Feldman began research with Dr. Shafik Masalha on young families from Tel Aviv and Ramallah. “We thought if we’d understood the code of how children are programmed in their first experiences in both societies, perhaps we could contribute something to resolving the conflict,” Feldman recalled in a recent lecture.
Until the border was closed in 2000, when the intifada erupted, they filmed the parents with their children and discovered a substantial difference in their interactions. Israeli babies were raised with an emphasis on energetic communication based on eye-contact and verbal exchanges, while Palestinian babies were left more to sit on their parents’ laps, looking in the same direction, and the interaction between them was more regulated and subdued. When the babies became toddlers, the Israeli parents tended to negotiate more with them (for example, over TV time), while Palestinian parents tended to let children watch an extra few minutes and then sit next to them and ask them to come eat without too much discussion.
To Feldman and Masalha, it was clear that anyone wanting to understand why there are problems in dialogue between Israelis and Palestinians should return to the sandbox, where he can detect the differences in how the children from the two societies learn to create contact with other people. Oxytocin levels rise in parents and in children both in Tel Aviv and Ramallah after a successful interaction – but “successful interaction” means different things in the two cultures.
“The interesting thing in the oxytocin system is that it is very ancient,” Feldman explains. “It’s not a smart system because it allows us to immediately identify who is like us and to connect to him, but it also automatically identifies foreign patterns, and then our brain immediately activates all of its alarm systems.” When Jews and Arabs meet, so do their oxytocin systems, which warn them of the other because they have each learned that a personal connection means different things.
The good news is that Feldman and her colleagues showed, in a study published in June, that an intervention of just eight meetings at least partly helped a group of Israeli and Palestinian youths deal with the barrier between them. “The moment each teen talked about himself, his family and home experiences, and they engaged in one-on-one synchronized activity – oxytocin levels rose, cortisol levels dropped and empathic behavior among them strengthened,” she says.
Based on their research of depressed mothers, Feldman and her colleagues have developed another intervention method.
“I’ve researched maternal depression for 15 years,” she says. “I put everything we learned into eight sessions, but at the right time, at the critical age between three and eight months, before the children start to use language, when they enter the stage of nonverbal synchronistic communication with their parents: shared smiles and enjoyment, looks, social vocalizing. It’s a critical time for orienting the brain toward social interactions. If you didn’t experience this then, it’s going to be much harder later. We turn to depressed mothers [when their children were] at this age and teach them to do everything they don’t do: touch the baby, don’t be intrusive, don’t look at toys or their WhatsApps. It’s truly amazing. They learn to synchronize, and within a few meetings you see their oxytocin reach a normal level.
“We also have really beautiful research on autistic children [in which we showed] that after 20 minutes of full interaction with their parents, their oxytocin normalized, and it remained normal as long as they were interacting with their parents,” she notes. “The moment the interaction stopped, the levels dropped back because the child’s oxytocin system was disrupted. But it means there is something to this [interaction] that can jumpstart oxytocin secretion, even when levels are low.”
“The bonding system works from bottom-up. It’s ancient, and behavior activates it. So, you can stimulate it with behavior,” the professor concludes.
My conversation with Feldman strayed from topic to topic and kept going. I accompanied her to a kiosk at the IDC for a sugar fix before her trip to Jerusalem, where she had a patient to see in her clinic at 9 P.M. The professor, who rains terror on her neuroscientist colleagues around the world, stood there, embarrassed by all the abundance. I was prepared to offer some insight that I’d gleaned from my other job, as a critic of snacks. It was clear that both of us were a bit stressed out by the interview: I was concerned that I wouldn’t be able to process all of this into a coherent article. And I understood her, too: Researchers are used to being published, but in professional journals and on their own conditions. It was possible to see her first, wide-ranging interview with the media as a psychological challenge – to succeed to loosen up.
“I understand your apprehension,” I told her. “If and when I am interviewed, I always insist on anonymity.” I’m not sure that calmed her down.
“Biology isn’t destiny,” she says as we walk to her car. “Our study from 2014 shows you can predict a coming breakup of a new couple, if they have high cortisol levels in their blood. But the interesting thing is that this prediction was only valid if the interaction between them in the lab was hostile. In other words, even if you are stressed and your cortisol is sky-high, you can fight respectfully with your partner and thus prevent destructive influences of stress on your relationship. Moreover, the brain is a flexible organ, and a good partner can fix somewhat the damages of bad parenting.”