Emily brought her son Micheal to see me when he was 3 and 1/2 months old. He had been born one month premature, but it was clear from a first glance that he was doing well. I remember noticing that his mother was so close, physically close. She hovered over his carriage, reluctant to let me pick him up. She stood inches from him while I examined him.
He was robust little boy who gave a big smile as he intently followed his mother's face. Emily felt he was doing well. So well, in fact, that she was attributing qualities to him for which he seemed to young. "It's good for him to comfort himself, right? I should let him cry, right?" She seemed very anxious.
About a year earlier, Emily had lost a baby, Christopher she called him, in her ninth month of pregnancy, when she was in a car accident. She conceived again almost immediately. And here was this miracle baby. I watched Michael sleeping in his blue jumper. He seemed so small and vulnerable.
"He's doing great," I said. Emily continued to wear that uncertain look as I tried to reassure her. She asked about sleep. "Is it OK if he is still in our bed? Is it good for bonding?" she asked. I was puzzled by this question and paused, asking her to tell me what she meant.
"Is he bonded to me?" she asked. I started to attempt an answer when she interrupted me. "Can you bond in utero? I mean I bonded to Christopher, but he died. I didn't let myself bond to Michael when I was carrying him."
I felt a tingling in my arms and a clutching in my chest. Tears came to my eyes as I watched them run freely down her cheeks. We sat this way for a while, living in the unbearable pain of her loss.
I thought of this moment when listening to Francine Lapides, in her terrific course "Keeping the Brain in Mind," explain the neurophysiology of empathy. It was an "aha" moment for me. Empathy is a commonly used word in mental health, and I admit to having used it for years without really appreciating its meaning.
Empathy, she explained, is largely mediated by a structure called the insula. It is predominantly a right brain structure that connects to the visceral organs-the heart and intestine. It also connects the brain with the skin and mediates sensations of touch and temperature. It is responsible for what is commonly referred to as a "gut feeling." Empathy, then, in its truest form, means to literally feel what another person is feeling.
Daniel Siegel, in his paper Mindful Awareness, Mindsight, and Neural Integration defines empathy as "the capacity to put yourself in the mental perspective of another person." It is not an intellectual understanding, as in "I understand how you feel," which is primarily a left brain activity.
True empathy, an actual physical experience, is somewhat rare. Empathy has healing power, both for the listener and the person being heard. It represents a profound attunement between two human beings. It is something to strive for in all relationships.
With Emily I wondered aloud if getting pregnant so quickly had prevented her from doing the difficult work of grieving the loss of her first child. She said to me, "I feel like I can't give all of myself to Michael. I have to hold back to protect myself."
At that visit with me, perhaps fortified by our moment of connection, of true empathy, she found the courage to face this task of grieving. She recognized it was critically important not only for herself, but for her relationship with her infant son.
Minggu, 19 September 2010
Rabu, 15 September 2010
Advice to Parents: Remember to Breathe
There is a well know saying in medicine that before doing CPR you should first check your own pulse. This very important point was brought home to me several years ago. I was on my way to a meeting at Austen Riggs, a psychiatric hospital in Stockbridge MA, when I noticed a large commotion in the hall. As I came closer, I observed many panic stricken people standing outside an office where a woman was in dire straits, in fact taking her last breath. Many of them were psychiatrists with MDs after their names, yet they seemed paralyzed. Perhaps this was because they knew her well, perhaps because they were used to talking rather than taking action, or perhaps it was a combination of both.
A friend who knew I was a doctor asked if I would help. As a pediatrician, I had never done CPR on an adult, yet I immediately took over. I lowered her to the floor and began CPR while simultaneously giving tasks to the others in the room. People moved carefully and deliberately. There was no shouting, no throwing of objects. Not only did she live, but her brain survived completely intact. The statistics for this kind of survival are 2-3%.
I am convinced that her unlikely survival is due almost entirely to my ability to remain calm in the face of this crisis. This calm, in turn, allowed all the participants, each of whom performed an essential function in the resuscitation, to think clearly and to get past the panic that had paralyzed them to inaction.
This blog post, though, is not about CPR, but rather a response to a friend's comment on my facebook wall. I'm new to facebook and haven't been in touch with her for a while. She wrote: "Where were you last night when I needed the advice of a sane parent??? OY...11 and 8 plied with sugar (?) is NOT good...OK, breathe...!"
Those of you who regularly read my blog will know I'm not a great fan of giving advice. First of all, I can't really understand the situation without having an actual conversation. Second of all, I prefer helping parents find their way back to trust in their own natural instincts over telling them what to do.
Yet I didn't want to come across as cold or uninterested. So after giving it some thought, I replied, "breathing sounds like a good idea!"
Staying calm in the face of a stranger's medical crisis is one thing. I probably learned this skill in the course of my years attending deliveries and taking care of sick children. But staying calm in the face of your own child's distress is quite another.
In my experience, both as a parent and a pediatrician, I am convinced that seeing your child in distress, and particularly if that distress is directed at you, is the most dysregulating experience there is. Wild, out of control thoughts of epic disaster come unbidden. Rage, self doubt and other destructive feelings quickly cloud your thinking.
What if you could work to push those thoughts aside, and in a way analogous to meditation, concentrated on being in the moment, concentrated on remembering to breathe? It would help you focus on your child, and on the immediate task before you rather than its global implications.
This exchange led me to think about my experience saving that woman's life, and to the idea that just as taking your own pulse is the most important part of doing CPR, remembering to breathe is perhaps among the most important things to do as a parent when helping your child through a child size crisis, whatever it may be.
A friend who knew I was a doctor asked if I would help. As a pediatrician, I had never done CPR on an adult, yet I immediately took over. I lowered her to the floor and began CPR while simultaneously giving tasks to the others in the room. People moved carefully and deliberately. There was no shouting, no throwing of objects. Not only did she live, but her brain survived completely intact. The statistics for this kind of survival are 2-3%.
I am convinced that her unlikely survival is due almost entirely to my ability to remain calm in the face of this crisis. This calm, in turn, allowed all the participants, each of whom performed an essential function in the resuscitation, to think clearly and to get past the panic that had paralyzed them to inaction.
This blog post, though, is not about CPR, but rather a response to a friend's comment on my facebook wall. I'm new to facebook and haven't been in touch with her for a while. She wrote: "Where were you last night when I needed the advice of a sane parent??? OY...11 and 8 plied with sugar (?) is NOT good...OK, breathe...!"
Those of you who regularly read my blog will know I'm not a great fan of giving advice. First of all, I can't really understand the situation without having an actual conversation. Second of all, I prefer helping parents find their way back to trust in their own natural instincts over telling them what to do.
Yet I didn't want to come across as cold or uninterested. So after giving it some thought, I replied, "breathing sounds like a good idea!"
Staying calm in the face of a stranger's medical crisis is one thing. I probably learned this skill in the course of my years attending deliveries and taking care of sick children. But staying calm in the face of your own child's distress is quite another.
In my experience, both as a parent and a pediatrician, I am convinced that seeing your child in distress, and particularly if that distress is directed at you, is the most dysregulating experience there is. Wild, out of control thoughts of epic disaster come unbidden. Rage, self doubt and other destructive feelings quickly cloud your thinking.
What if you could work to push those thoughts aside, and in a way analogous to meditation, concentrated on being in the moment, concentrated on remembering to breathe? It would help you focus on your child, and on the immediate task before you rather than its global implications.
This exchange led me to think about my experience saving that woman's life, and to the idea that just as taking your own pulse is the most important part of doing CPR, remembering to breathe is perhaps among the most important things to do as a parent when helping your child through a child size crisis, whatever it may be.
Senin, 13 September 2010
Value Those Early Months of Parenting
Today in the Boston Globe I have an op ed entitled By the book, but breaking a bond, that is based on a previous blog post about the Massachusetts law enforcing 8 week maternity leave. Already at six am there are comments, and as is common when one puts ideas out into the world, some are none to friendly.
My aim in writing this piece, as well as one aim of my book (today I am sending the complete manuscript to my editor-thus the long absence from my blog) is to call attention to the critical importance of parent-child relationships in the early months of life.
When I see older children for consultation for behavior problems, I often hear stories from mothers who struggled terribly when their children were very young infants. Sometimes the memories are vague, but these mothers recall vividly the sense of being completely alone.
The most dramatic example of this was a mother with severe post partum depression whose father suddenly died when her baby was three months old. Much to my astonishment she described being relieved by this event. It wasn’t because she didn’t love her father. Rather, in sharing the grief with her siblings, mother and extended family, she no longer felt so terribly alone. In order for mothers to be available for the kind of preoccupation their newborns require for healthy development, it is essential that they not be left alone.
If I were to give one piece of advice to mothers, families and our culture as a whole, it would be to recognize that while what a mother does with her newborn may look ordinary, it is in fact extraordinary and deserves to be valued as such.
The relatively new field of Infant Mental Health has recognized this fact. The organization Zero to Three offers this definition if infant mental health, which is thought to be a characteristic of the child. “The young child’s capacity to experience, regulate and express emotions, form close and secure relationships, and explore the environment and learn. All of these capacities will be best accomplished within the context of the caregiving environment that includes family, community, and cultural expectations for young children. Developing these capacities is synonymous with healthy social and emotional development.” Research, clinical interventions and policy all aim to support parent-child relationships in the early months and years.
My aim is not to make parents feel bad for working, nor to imply that mothers need to stay home for years. Rather it is to bring readers inside those critical early months. My hope is that our culture as a whole will support, value and nurture parents of young children, parents who have the awesome responsibility for raising the next generation.
My aim in writing this piece, as well as one aim of my book (today I am sending the complete manuscript to my editor-thus the long absence from my blog) is to call attention to the critical importance of parent-child relationships in the early months of life.
When I see older children for consultation for behavior problems, I often hear stories from mothers who struggled terribly when their children were very young infants. Sometimes the memories are vague, but these mothers recall vividly the sense of being completely alone.
The most dramatic example of this was a mother with severe post partum depression whose father suddenly died when her baby was three months old. Much to my astonishment she described being relieved by this event. It wasn’t because she didn’t love her father. Rather, in sharing the grief with her siblings, mother and extended family, she no longer felt so terribly alone. In order for mothers to be available for the kind of preoccupation their newborns require for healthy development, it is essential that they not be left alone.
If I were to give one piece of advice to mothers, families and our culture as a whole, it would be to recognize that while what a mother does with her newborn may look ordinary, it is in fact extraordinary and deserves to be valued as such.
The relatively new field of Infant Mental Health has recognized this fact. The organization Zero to Three offers this definition if infant mental health, which is thought to be a characteristic of the child. “The young child’s capacity to experience, regulate and express emotions, form close and secure relationships, and explore the environment and learn. All of these capacities will be best accomplished within the context of the caregiving environment that includes family, community, and cultural expectations for young children. Developing these capacities is synonymous with healthy social and emotional development.” Research, clinical interventions and policy all aim to support parent-child relationships in the early months and years.
My aim is not to make parents feel bad for working, nor to imply that mothers need to stay home for years. Rather it is to bring readers inside those critical early months. My hope is that our culture as a whole will support, value and nurture parents of young children, parents who have the awesome responsibility for raising the next generation.
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