Celebrating Fathers, Relationships, Being Present

In his beautifully illustrated children's book Magic Always Happens: My Daddy Loves Me; psychologist Neo Papaneophytou follows a father and son through the seemingly mundane events of the day. He shows the "magic in moments," or the value of simply being present in supporting a child's healthy growth and development. The book's introduction states:

To write “Magic Always Happens: My Daddy Loves Me!” the author drew from his experiences raising his own son. Seeing every day as a blessing, father and child find joy in all their daily activities, especially when their two-year-old therapy dog, Mya, joins in! While this father was born and raised on the Mediterranean island of Cyprus—a world away from his son’s upbringing in the New York City metropolitan area, the experience reflected in “Magic Always Happens: My Daddy Loves Me!” shows the impermeable bond between father and son spending quality time together, wherever in the world that may be. Such loving bonds are relevant to all dedicated fathers all around our global village!

Proceeds from sales of the book are going towards development of an international center for treatment of children with autism.

Neo is part of a community of colleagues who have all been educated in the latest developmental science as fellows in the U Mass Boston Infant Parent Post Graduate Certificate Program. Last week I had the pleasure of being reunited with the group (I graduated in 2011) at the conference I described in my previous post.

From conference speaker Stephen Porges I learned a new phrase, "connectedness as biological imperative." Listening, being present, is not just some "soft" extraneous concept (one pediatrician referred to it in a less than kind tone as "that baby whisperer stuff, " making me wonder if she herself did not feel heard.) Porges' work echoes John Bowlby, whose recognition of the central role of attachment relationships in survival drew from Charles Darwin's theories of evolution. Porges demonstrates how connectedness is necessary for regulation of physiologic and behavioral states. In other words, the way we learn to manage ourselves in a complex social world is through connectedness, through relationships. This is first learned in our primary caregiving relationships in our earliest years, and continues to be developed and supported in relationships throughout our lives.

In describing his book, Papaneophytou wisely identifies the need for a village to raise a child. Increasingly we offer parents "behavior management," "parent training," or even medication to address challenges in raising children.  The best science of our time tells us we should instead focus on protecting space and time for parents, for children and for each other. We need that space and time for listening, for "being with," for supporting that connectedness that is central to our very survival.

DSM, NIMH on mental illness: both miss relational, historical context of being human

It seems that the National Institute of Mental Health (NIMH) may have dealt a death blow to the recently published Diagnostic and Statistical Manual of Mental Disorders (DSM 5) when the organization declared they would no longer fund research based on the DSM system of diagnosis. The views of NIMH director Thomas Insel were referenced in the recent New York Times article on the subject.

His goal was to reshape the direction of psychiatric research to focus on biology, genetics and neuroscience so that scientists can define disorders by their causes, rather than their symptoms.

I am no fan of the DSM system, which reduces complex experience to lists of symptoms; focusing on the "what" rather than the "why."  However, the NIMH model has limits as well. There seems to be a wish to study mental illness in the same way we study cancer or diabetes. While I certainly have great respect for the complexity of the pancreas, or the process of malignant transformation of cells, trying to understand the brain/mind in an analogous way seems to be an unnecessary and even undesirable reduction of  human experience.

What is missing from both paradigms is recognition of the relational and historical context of being human. Fortunately there seems to be awareness that neither paradigm is complete. The Times article goes on to say:

Dr. Insel is one of a growing number of scientists who think that the field needs an entirely new paradigm for understanding mental disorders, though neither he nor anyone else knows exactly what it will look like.

The growing discipline of Infant Mental Health offers just such a paradigm. This discipline is characterized by four key components. First and foremost, it is relational, recognizing that humans (and that includes their genes and brains) develop in the context of caregiving relationships. Second, it is multidisciplinary. Experts in infant mental health offer different perspectives.  They come from many fields, including, among many others, developmental psychology, pediatrics, nursing, and occupational therapy.  Third, it encompasses research, clinical work and public policy.  The field looks at mental health within the context of culture and society. And last, it is reflective, looking at the meaning of behavior, not simply the behavior itself. The ability to attribute motivations and intentions to behavior is uniquely human, and research has shown that this capacity is closely linked with mental health.

Unfortunately when people hear the term infant mental health, they imagine babies lying on the couch.  In reality, the field offers a way of understanding all of human experience, well beyond infancy.  I recently taught a course on infant mental health to clinicians at the Austen Riggs Center, a hospital that offers intensive inpatient treatment for severely disturbed patients. None of them are infants- the youngest are in their late teens and most are well into adulthood.  My students found the insights from infant mental health very valuable for understanding and treating their patients.

The Center for Disease Control (CDC) Adverse Childhood Experience (ACES) study provides extensive evidence of the long-term effects of early exposure to a range of negative experience, including parental mental illness, divorce, abuse, and neglect, on mental health. The more severe the mental illness, the earlier in life disruptions to development probably occurred. Knowledge of infant mental health (that spans age 0-5) offers a textured understanding of this early experience.

Looking at an individual brain and/or genes, or listing the behavioral symptoms of an individual person, out of relational and historical context, how can one possibly understand the complexity of human experience? This complexity is represented by such things growing up in the home of a Holocaust survivor, a depressed parent,  in the setting of ongoing war trauma, with a physically and emotionally abusive parent, or some combination of all of these. A recent article on the blog ACES Too High,  "What motivated the Boston bombing suspects?" offers a fascinating look at the Tsarnaev brothers from an ACES perspective. The use of the word"motivation" in the title represents a curiosity about the meaning of behavior that is representative of an infant mental health perspective.

The ongoing research coming from the discipline of infant mental health offers growing knowledge about effective, primarily preventive, interventions. Not only do we need this research to continue, but we also need to grow a workforce trained in infant mental health to offer these interventions on a large scale. When the NIMH looks for a new paradigm towards which to direct funding, I hope they will look to the paradigm of infant mental health.

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