Music and mental health: a tribute to Pete Seeger

This morning while driving my son and two friends to practice for their high school singing group, we listened, as part of an NPR report on his death at age 94, to Pete Seeger tell the story of his song Where Have All the Flowers Gone. His voice, his message and his music together had a profound calming effect on me, and I suspect on my passengers as well. There was quiet, and perhaps even a tear shed by others besides me.

In my behavioral pediatrics practice I make a point of asking about a child's interest in music. Whether the presenting problem is one of anxiety, frequent meltdowns, inattention, hyperactivity, or a range of other concerns, I have found that music often has a calming effect.  One little girl, whose mother was under considerable pressure to have her diagnosed with ADHD and put on medication, stopped her scattered and frenetic play to sing me a song. Another, struggling with social anxiety, who for much of the visit refused to speak, at first with his back to me and then with increasing boldness, did the same. When parents see this effect of music on their child, they are moved to incorporate music in to our efforts to support development of emotional regulation. Problems with emotional regulation are central to all of these behavioral symptoms.

I was in need of emotional regulation myself this morning after spending the weekend embroiled in a difficult discussion about the subject of "ADHD." In a conversation on a list serve made up primarily of child psychiatrists, I pointed to a recent study about ADHD that showed very poor long-term outcome. I wondered if there might be an alternative explanation to that offered by the authors of the study, namely that ADHD is a chronic illness that requires lifelong treatment. Could it be, I asked, that the poor long-term outcome is because we are not properly treating the problem in the first place? That when we diagnose based on symptoms alone, and treat with behavior management and medication, we fail to address the full complexity of symptoms of dysregulation of attention, behavior, and emotion? I wondered how we would separate this issue from the possible long-term effects of stimulant medication itself.

I got a huge amount of push back, with a number of people implying that I was "unscientific," and that I might be affiliated with the church of Scientology. Given that there is extensive scientific evidence supporting an alternative paradigm for understanding symptoms of dysregulation of attention, behavior and emotion, this suggestion particularly got under my skin.

Not only music, but dance, martial arts, yoga and other activities have an important role to play in self-regulation. This is particularly true for children who have biological vulnerability to dysregulation, including those with problems of sensory processing. All of these activities occur in the context of important relationships, relationships that themselves are essential to development of emotional regulation. My little patients perform their songs in the context of a growing relationship with me.

But if we employ a purely medical model, diagnose ADHD, anxiety or any range of problems using the DSM ( Diagnostic and Statistical Manuel of Mental Disorders), we miss the relational and historical context of these symptoms. We need to offer room to hear the individual story of a child and his family in order to make sense of his symptoms. This story is itself can be a kind of music. Dar Williams incredible song "After All"  offers a beautiful example.

When children present with a range of behavioral symptoms, if we simply "manage behavior" and treat with medication, where is there room for the music?

Arlo Guthrie, who frequently performed with Seeger, in his song Alice's Restaurant, proposed that everyone being evaluated for the draft walk in singing the chorus of his song, and in doing so create an anti-war movement.

Borrowing the idea, espoused by both Arlo and Pete, of changing the world with music, what if every new evaluation of a child with a behavior problem included singing and/or listening to one of Pete's songs? It might help calm everyone down-parent, clinician, and child alike. If, in turn, the next generation were helped to develop in a healthy way, with an ability to think creatively and engage effectively in a complex social environment, it might change the world.

To MA Gubernatorial Candidates on Mental Health: What About Children?

At last night's MSPP ( Massachusetts School for Professional Psychology) sponsored Gubernatorial Forum on Mental Health there was much talk among all of the candidates about how devoting resources to mental health care is a wise investment. But there was virtually not one mention of prevention in the form of children's mental health care. This was striking, as Nobel prize winning economist James Heckman has offered extensive evidence of how devoting resources to prevention in early childhood leads to decreased long-term costs of physical and mental health care.

Investing in early childhood also leads to decreased spending on prisons, a topic all of the candidates addressed in terms of decreasing the number of people in prison for non-violent crimes and first time drug offenses. They all correctly identified the high rate of mental illness in prison and the need to offer treatment, particularly substance abuse treatment.

The whole night I was thinking, "what about the children?" This might have been due to the format, and the fact that moderator Tom Ashbrook did not ask a single question about children.
I was struck by the contrast between this discussion and last week's American Academy of Pediatrics sponsored symposium on Child Health, Resilience and Toxic Stress.

All the best science of our time, in the form of research at the interface of neuroscience, genetics and developmental psychology, tells us that to invest in prevention means to invest in parents and children.

I was disappointed by Martha Coakley in a sense towing the NIMH party line, whose great shortcomings I describe in a previous post, by saying that mental illness is like any physical illness, such as diabetes. I am one hundred percent in favor of parity for mental health care, and decreasing the stigma of mental illness. But the only way to achieve this parity is to recognize that mental illness is not like diabetes.

Resilience and emotional wellbeing develop in the context of relationships. To both prevent and treat mental illness the focus of intervention needs to be on relationships. What makes us human is our historical and relational context. We need to value space and time to listen to each other.

The most important point of the evening, that was made in some form by all three democratic candidates, is that reimbursement for mental health care needs to increase significantly. When we place value, both cultural and monetary, on taking the time to listen, whether to parents of young children, teens struggling with substance abuse, or adults with a range of diagnostic labels, then we will be making meaningful steps not only towards mental health care parity, but also towards promotion of health and resilience.

To CDC on childrens mental health: consider office of homeland attachment security

Change is in the air for children's mental health care. The latest CDC (Center for Disease Control) special supplement to the MMWR (morbidity and mortality weekly report) is titled Mental Health Surveilance Among Children-United States 2005-2011. The report overview states:

Approximately $247 billion is spent each year on children’s mental health.  The mental health of children is critical to their overall health as children and as they grow into adults.

The report summary concludes:

More comprehensive surveillance is needed to develop a public health approach that will both help prevent mental disorders and promote mental health among children.

This report coincides with both the release of DSM (Diagnostic and Statistical Manual of Mental Disorders) 5, and a statement by the director of the NIMH (National Institute of Mental Health) that research funding would not be guided by DSM diagnoses, and that a new paradigm of mental health care is needed.

The time has come to recognize the overwhelming evidence regarding the importance of early relationships in healthy emotional development. The answer to the problem posed in the CDC report is in: invest in early childhood -from newborn to three- to prevent mental health disorders and promote mental health.

A huge part of this evidence comes from the CDC itself, with the ACES study, showing long-term negative impact on both physical and emotional health of a range of adverse childhood experiences.  An abundance of research coming from the discipline of infant mental health provides a more nuanced view of this issue. 

 When parents are supported and valued by society, they are able to be fully present with their children, in turn helping to grow healthy brains. Children who grow up in an attuned caregiving environment are flexible, resilient, and empathic.  In contrast, when children experience toxic stress, or stress in the absence of a safe, secure caregiving relationship, the parts of their brains responsible for emotional regulation do not develop normally. What results are symptoms that are then labeled "mental illness." 

I heard this phrase "office of homeland security of attachment" from Gerard Costa, director of the Center for Autism and Early Childhood Mental Health at Montclair State University. I was speaking at the 2nd annual Todd Ouida Children's Foundation Conference with the wonderful title: The Magic in Moments: Patterns of Early Relationships that Create Resilient Individuals and Peaceful Societies. While the phrase is meant to be humorous, the idea behind it is very serious.  

Our country is seriously lagging behind other countries in the care and attention we give to young children and their parents, with potentially devastating effects. A special government organization to take on this task would address this problem with the attention it deserves. This does not mean that the government has a role in parenting, which is a private, individual experience. Rather, such an organization could address such things as:

- parental leave policy

- comprehensive screening and treatment for perinatal emotional complications including 

depression and anxiety

- education of a workforce trained in working with young children and families

-  high quality child care, including supervision for child care workers 

Attending to early caregiving relationships will move us toward the goal of creating peaceful societies. Given that $247 billion is spent a year on children's mental health, focusing on early childhood is not only the right thing to do, it is also a worthwhile investment. 

  

HEALTH: Mother warns pregnant women about resuscitation of premature babies in hospital

Essex: Godwin interview SOT Wide shot Godwin talking to reporter on bench in park (not heard)

HEALTH: Mother warns pregnant women about resuscitation of premature babies in hospital

ENGLAND: Essex: EXT Tracy Godwin (Mother) along with reporter talking (not heard) before sitting on bench in park Tracy Godwin (Mother) interview SOT