Josh Marshall, a guest of Keith Olberman's news program Countdown, made a brilliant analogy when discussing the recent assassination attempt on congresswoman Gabrielle Giffords. He compared the current climate of incitement and violent rhetoric to a flu epidemic in which, while many are affected, the weak and infirm are the most vulnerable. Similarly, the mentally ill, like Jared Loughner appears to be, are most vulnerable to act on the inflammatory and hateful words so rampant in our culture today. But what is the cause of this epidemic? What is the "virus" responsible for this "illness?" Many blame the political situation which has become increasingly polarized and divisive. Others point to the media and the talk show hosts who promote the free expression of rage and hate.
I propose that while these may be proximate causes, the true cause may have much deeper roots. Extensive research has shown that children learn to regulate emotions, including aggression, at a young age, in relationships with their caregivers. This learning takes place at the level of gene expression and biochemistry of the brain. The centers of our brain responsible for observing and monitoring our behavior actually grow fibers that control lower centers of the brain responsible for fear and the fight-flight response. This growth takes place in the context of attuned loving relationships in which children feel understood.
We as a society now seem to be failing at this task of regulating aggression. I wonder if this failure is in some way connected to our culture's failure to nurture and support early parent-child relationships, as exemplified by our maternity leave policy that lags so far behind other countries, as well as the rapid increase of prescribing of psychoactive medication to very young children. The second phenomenon is in turn inextricably linked with the very powerful health insurance industry and the lack of value placed on primary care and mental health care services.
Aggression is a normal healthy emotion, which, if all goes well, children learn to regulate and contain. It then may be transformed into assertiveness, which is considered a positive trait. When children lack close secure relationships that help them to think about and understand their feelings, these aggressive feelings don't go away. Without the ability to think about feelings, a person is more likely to impulsively act them out.
This weekend I will have the privilege, as part of the UMass Boston Infant Parent Mental Health Post Graduate Certificate Program
to hear leading researcher Peter Fonagy present the most current research demonstrating the critical role of understanding children's minds and helping them to contain intense feelings in promoting their healthy emotional development.
Public policy to support early parent-child relationships is essential. For example, postpartum depression can negatively impact a mother's ability to be present with her child in a way that teaches him to regulate intense feelings. Program leader Ed Tronick has been instrumental in calling attention to this very important issue, and this past summer a new law was passed that requires Massachusetts health insurers to submit annual reports on their efforts to screen for postpartum depression and calls for a special commission to come up with policy recommendations to prevent, detect and treat postpartum depression.
Certainly there are other angles for intervention in the aftermath of this horrific event, in the political realm as well as in the media. It may also inspire those strive to support these early relationships to, in the words of Dr. Tronick, "Press on with our work for children and families."
Selasa, 11 Januari 2011
Selasa, 28 Desember 2010
A Baby's Intuition
2-month old Max sat comfortably on his mother's lap and intently studied his hand. "He discovered them a few weeks ago. He's working hard to get his thumb in his mouth," Ellen told me." Ah ooh," Max cooed to me when I smiled at him and commented on his new skill. "He's talking a lot too," Ellen said proudly. We wore huge grins of delight with Max's obvious talents.
Our visit three weeks earlier, in contrast, was painful and difficult. Max slept the whole time, but Ellen wept as she spoke of debilitating anxiety and periods of inexplicable sadness. "I sometimes feel so lost, she had said." We spoke about her strained relationship with her husband, John. She described an intrusive ever present mother-in-law who always managed to make her feel bad. Arguments between her and John were escalating. She felt increasingly that he didn't support her when she was overwhelmed. I was worried about the degree of her emotional distress, and asked if she wanted the name of a therapist to talk with about her sadness and anxiety. She said yes. I gave her some names, and also made a follow up visit to see her with the baby.
Ellen hadn't called the therapist, and explained that she was having longer periods where she felt better. Max was becoming such a delight that he was pulling her along. "I have three or four good days, but then the bad feelings return." I followed Ellen's lead, focusing on all the positive changes she had made. She was learning to take care of herself and was excitedly thinking about going back to work. As she described these good feelings, Max's little body was relaxed and content in her arms. After the trauma of the last visit, she seemed to delight in telling me the good parts. I wanted to give her the space, yet wondered to myself if the anxiety had indeed passed.
Then in the middle of telling me about the holiday it happened. She started calmly enough to describe a visit to her in-laws. But quickly her distress escalated. Her voice became tense, her face contorted with anger. I tried to follow the details of the story, but noticed that Max had begun to squirm on Ellen's lap. He pushed his head back and his legs extended. She distractedly held him up against her shoulder, increasingly agitated by her rage at her husband's behavior. But Max would not be calmed, and soon his fussing escalated to an all out cry. I sensed that Ellen was asking me to validate her position in the argument with her husband. But this was not my role, and I took a different approach.
"This anger you experience seems to be making you feel bad." She paused. "Yes-I'm really a nice person and I don't like to feel so mean." "I bet if I took your blood pressure right now it would be sky high." She readily agreed. As she shifted her focus from her rage, Max's fussing decreased. Ever mindful of not wanting to make her feel blamed, I commented on how Max was reacting to her mood. Fortunately she did not respond defensively, but rather observed, "He's very intuitive. He can tell exactly what I'm feeling."
Extensive literature, much of which I have discussed on this blog, describes the negative effects of a mother's depression and anxiety on a baby's development. My visits with Max an Ellen offer a close up snapshot of what this can look like and what might be done to help.
Elizabeth Meins, PhD and colleagues have shown in their research that a mother's capacity to think about her baby's mind is a associated with secure attachment. Secure attachment, in turn, is linked to many positive outcomes including emotional regulation, cognitive resourcefulness and social adaptation. Ellen's noting of her son's intuitiveness represents a perfect example of thinking about her baby's mind. She showed a non-defensive willingness to reflect on his experience. She could think about what might be going on in is 2-month-old mind when her anxiety took over.
Ed Tronick,PhD and colleagues have shown that if parents and infants are attuned 30% of the time, but disruptions occur in up to 70% of interactions, as long as most of these disruptions are recognized and repaired, development proceeds in a healthy direction. Ellen was able to repair the disruption caused by her momentary agitation, and to help Max to calm down.
Ellen, Max and I will meet again in a few weeks. Perhaps Ellen will need more intensive treatment for depression and anxiety. She still has the number of the therapist. Perhaps she and John will need support for their marriage. But I feel hopeful about Max and Ellen. She has seen how Max thrives when she is feeling good. This knowledge I believe, will motivate her to take care of herself so that she can continue to be emotionally available for Max in the way he needs and loves.
Our visit three weeks earlier, in contrast, was painful and difficult. Max slept the whole time, but Ellen wept as she spoke of debilitating anxiety and periods of inexplicable sadness. "I sometimes feel so lost, she had said." We spoke about her strained relationship with her husband, John. She described an intrusive ever present mother-in-law who always managed to make her feel bad. Arguments between her and John were escalating. She felt increasingly that he didn't support her when she was overwhelmed. I was worried about the degree of her emotional distress, and asked if she wanted the name of a therapist to talk with about her sadness and anxiety. She said yes. I gave her some names, and also made a follow up visit to see her with the baby.
Ellen hadn't called the therapist, and explained that she was having longer periods where she felt better. Max was becoming such a delight that he was pulling her along. "I have three or four good days, but then the bad feelings return." I followed Ellen's lead, focusing on all the positive changes she had made. She was learning to take care of herself and was excitedly thinking about going back to work. As she described these good feelings, Max's little body was relaxed and content in her arms. After the trauma of the last visit, she seemed to delight in telling me the good parts. I wanted to give her the space, yet wondered to myself if the anxiety had indeed passed.
Then in the middle of telling me about the holiday it happened. She started calmly enough to describe a visit to her in-laws. But quickly her distress escalated. Her voice became tense, her face contorted with anger. I tried to follow the details of the story, but noticed that Max had begun to squirm on Ellen's lap. He pushed his head back and his legs extended. She distractedly held him up against her shoulder, increasingly agitated by her rage at her husband's behavior. But Max would not be calmed, and soon his fussing escalated to an all out cry. I sensed that Ellen was asking me to validate her position in the argument with her husband. But this was not my role, and I took a different approach.
"This anger you experience seems to be making you feel bad." She paused. "Yes-I'm really a nice person and I don't like to feel so mean." "I bet if I took your blood pressure right now it would be sky high." She readily agreed. As she shifted her focus from her rage, Max's fussing decreased. Ever mindful of not wanting to make her feel blamed, I commented on how Max was reacting to her mood. Fortunately she did not respond defensively, but rather observed, "He's very intuitive. He can tell exactly what I'm feeling."
Extensive literature, much of which I have discussed on this blog, describes the negative effects of a mother's depression and anxiety on a baby's development. My visits with Max an Ellen offer a close up snapshot of what this can look like and what might be done to help.
Elizabeth Meins, PhD and colleagues have shown in their research that a mother's capacity to think about her baby's mind is a associated with secure attachment. Secure attachment, in turn, is linked to many positive outcomes including emotional regulation, cognitive resourcefulness and social adaptation. Ellen's noting of her son's intuitiveness represents a perfect example of thinking about her baby's mind. She showed a non-defensive willingness to reflect on his experience. She could think about what might be going on in is 2-month-old mind when her anxiety took over.
Ed Tronick,PhD and colleagues have shown that if parents and infants are attuned 30% of the time, but disruptions occur in up to 70% of interactions, as long as most of these disruptions are recognized and repaired, development proceeds in a healthy direction. Ellen was able to repair the disruption caused by her momentary agitation, and to help Max to calm down.
Ellen, Max and I will meet again in a few weeks. Perhaps Ellen will need more intensive treatment for depression and anxiety. She still has the number of the therapist. Perhaps she and John will need support for their marriage. But I feel hopeful about Max and Ellen. She has seen how Max thrives when she is feeling good. This knowledge I believe, will motivate her to take care of herself so that she can continue to be emotionally available for Max in the way he needs and loves.
Minggu, 19 Desember 2010
Promoting children's healthy development: An inspirational poem
Below is a poem written and read by Chris Corrigan at the conclusion of a conference entitled "Applying the Science of Early Childhood Development to State Policy and Practice: a Case for Action and a Call for Innovation." The still face refers to Dr.Ed Tronick's paradigm that he articulates and demonstrates in this three minute video. The ACE in the poem refers to Adverse Childhood Events.
No more still face
a poetic harvest of the conference on science and early learning
by Chris Corrigan
November 4, 2010
Seattle, WA
Face it – relationships
language and emotion
700 synapses
babies are an ocean of potential for growth.
Reach out -
read and react
serve and return
the simplest skills for any parent to learn
ACEs are wild
don't poker face that child
ACEs are wild
don't poker face that child.
We need traction for action
no more funding for reactions
but positive interventions
systemic reinvention
health promotion and prevention
well placed intention.
Founders and funders
get this under your skin
When society is the still face
we create the ACE
When society is the still face
we create the ACE
So what do we do?
We partner early and often
And surely that softens
the hard blows of a cold world
a banner unfurled
a revolution of solutions
of iLabs and Head Start
exposure to the reading arts
bring parents together
to talk and train each other
raise kids in community
and pursue a unity of purpose
and hope and inspiration
for this nation can be
the demonstration project of population in relation
and information dissemination.
For a world of compassion
can fashion its future
synapse by synapse
and not relapse into a state
of comatose siloitis.
Because you know what?
We are the ACE
when society is the still face
we are the ACE
when society is the still face.
So let's get on the continuum
and at a minimum
shout out for Thrive by Five
Bring partnerships to life
Reach out and read
Everywhere plant seeds
Base policy on science
increase community self-reliance
reach parents where they are
at home and in their cars
at salons in Central Park
on the streets after dark
supporting healthy choices
hearing a diversity of voices.
Bring it to schools
deposit all the tools that every family needs
common methods that lead us
to children at the center
parents as mentors
resilience enters through doors
pried open by relationships
the community is the trajectory
the way to connectivity
cafés and conversation and new forms of evaluation
spark the realization
that T.X.T 4 B.A.B
Educare, P3 and all the rest we see
is about relationality.
Fusion makes change
the core is rearranged
fusion makes change
the core is rearranged
So people in this State
we can no longer wait for fate to have its day
here are the ways
we get traction for action:
One science fits all
So tear down the walls
that keep parents from all
the riches that help them call
the future to their kids
open up learning, cultivate a yearning
for society's embrace
A bill of rights that rights political will
that allocates the resources to relationships
This is STILL public health – why the stealth
approach to early learning? Let's be turning
this science to common sense
and then let's invest this sense to finance a dense campaign
to build better brains
better babies
break the chains that hold us back
keep us from conceiving
of new tender maybes...
Because in every single case
There is only this to chase:
No more ACE
No more still face
No more ACE
No more still face
No more ACE
No more
still
face.
This poem offers a hopeful antidote to the depressing yet powerful Boston Globe piece about the SSI system that I wrote about in my previous post. That post concluded with the words "this piece demonstrates with disturbing clarity how much we need to intervene early to support parents and their young children, before they get to such a point of desperation that they are willing to label a child as disabled in order to survive." The website of the Harvard University Center on the Developing Child offers a wealth of information about why and how to intervene early to promote healthy development.
No more still face
a poetic harvest of the conference on science and early learning
by Chris Corrigan
November 4, 2010
Seattle, WA
Face it – relationships
language and emotion
700 synapses
babies are an ocean of potential for growth.
Reach out -
read and react
serve and return
the simplest skills for any parent to learn
ACEs are wild
don't poker face that child
ACEs are wild
don't poker face that child.
We need traction for action
no more funding for reactions
but positive interventions
systemic reinvention
health promotion and prevention
well placed intention.
Founders and funders
get this under your skin
When society is the still face
we create the ACE
When society is the still face
we create the ACE
So what do we do?
We partner early and often
And surely that softens
the hard blows of a cold world
a banner unfurled
a revolution of solutions
of iLabs and Head Start
exposure to the reading arts
bring parents together
to talk and train each other
raise kids in community
and pursue a unity of purpose
and hope and inspiration
for this nation can be
the demonstration project of population in relation
and information dissemination.
For a world of compassion
can fashion its future
synapse by synapse
and not relapse into a state
of comatose siloitis.
Because you know what?
We are the ACE
when society is the still face
we are the ACE
when society is the still face.
So let's get on the continuum
and at a minimum
shout out for Thrive by Five
Bring partnerships to life
Reach out and read
Everywhere plant seeds
Base policy on science
increase community self-reliance
reach parents where they are
at home and in their cars
at salons in Central Park
on the streets after dark
supporting healthy choices
hearing a diversity of voices.
Bring it to schools
deposit all the tools that every family needs
common methods that lead us
to children at the center
parents as mentors
resilience enters through doors
pried open by relationships
the community is the trajectory
the way to connectivity
cafés and conversation and new forms of evaluation
spark the realization
that T.X.T 4 B.A.B
Educare, P3 and all the rest we see
is about relationality.
Fusion makes change
the core is rearranged
fusion makes change
the core is rearranged
So people in this State
we can no longer wait for fate to have its day
here are the ways
we get traction for action:
One science fits all
So tear down the walls
that keep parents from all
the riches that help them call
the future to their kids
open up learning, cultivate a yearning
for society's embrace
A bill of rights that rights political will
that allocates the resources to relationships
This is STILL public health – why the stealth
approach to early learning? Let's be turning
this science to common sense
and then let's invest this sense to finance a dense campaign
to build better brains
better babies
break the chains that hold us back
keep us from conceiving
of new tender maybes...
Because in every single case
There is only this to chase:
No more ACE
No more still face
No more ACE
No more still face
No more ACE
No more
still
face.
This poem offers a hopeful antidote to the depressing yet powerful Boston Globe piece about the SSI system that I wrote about in my previous post. That post concluded with the words "this piece demonstrates with disturbing clarity how much we need to intervene early to support parents and their young children, before they get to such a point of desperation that they are willing to label a child as disabled in order to survive." The website of the Harvard University Center on the Developing Child offers a wealth of information about why and how to intervene early to promote healthy development.
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