Buddhism, brain science, and parenting: towards an integration

In the past week I had two profound yet seemingly polar opposite conversations about how to promote healthy development.

The first was among fellows and faculty of the UMass Boston Infant Parent Mental Health Post-Graduate Certificate program (IPMH) about a new study, The Effect of Poverty on Brain Development, published in the current issue of JAMA pediatrics. Using brain imaging techniques, researchers showed that the children raised in poverty had smaller volumes of specific areas of the brain. They describe how the "caregiver" can "mediate" against the effects of poverty. The effects on the brain were less in the setting of "caregiver support." The group was addressing the ways in which this study fit with the abundance of new research in developmental psychology, neuroscience and genetics.

In conversation with the IPMH group, made up of many brilliant and often like- minded colleagues, who I affectionately refer to as "my peeps," I expressed concern that the exclusive focus on "brain science," where parents are referred to as "mediators," the emotion is excluded. It can become a way to distance from, or even leave out, the passion inherent in these profound love relationships.

Perhaps even more worrisome, I said, is that by making the discussion primarily about poverty, there is a risk of creating a kind of "us-them" mentality.  Certainly there are plenty of well-off families raising children in an environment of high stress and emotional neglect. Similar to the focus on "brain science," it becomes another way of distancing from the problem. 

I shared with the IPMH group my recognition that pointing to the value of listening, of creating an environment of respect for all parents and children, is seen by many as "soft." For example, I felt very alone when one pediatrician referred to my work, in a none-too-kindly tone as, "that baby whisperer stuff."

I knew I was not alone when the second conversation occurred a few days later at  a workshop at Austen Riggs entitled The Interplay of Psychoanalysis and Buddhism: Partners in Liberation. It was all about emotion and interconnectedness.

In a post a number of years ago, I wrote about receiving a letter from a reader who had been "awakened by the tradition of Zen Buddhism" and found my that my work, as described in my book Keeping Your Child in Mind ( see excerpt below), resonated with his experience.

Being understood by a person we love is one of our most powerful yearnings, for adults and children alike. The need for understanding is part of what makes us human. When our feelings are validated, we know that we’re not alone. For a young child, this understanding helps develop his mind and sense of himself. When the people who care for him can reflect back his experience, he learns to recognize and manage his emotions, think more clearly, and adapt to his complex social world. 

When families come to see me in my pediatrics practice for “behavior problems,” both parents and children feel estranged and out of control. They are disconnected, angry, and sad. I help them recognize each other. Meaningful change happens when we share these moments of reconnection. 

While I do not know very much about about Buddhism, I have been greatly influenced by psychoanalysts D.W. Winnicott and Peter Fonagy. I attended the workshop because I was curious to learn more about the relationship between Buddhism and psychoanalysis. In particular I was interested in the place of mourning, for I have increasingly come to recognize that meaningful change, and with it the joy of connection, occur most often when parents move through moments of profound sadness.

Workshop leader Joseph Bobrow spoke with a kind, gentle manner while conveying a sense of quiet authority that was calming and containing. He described the Buddhist notion of "re-authoring our suffering" of "representing our suffering in safe circumstances without shame" so that the story can "take its place in a hierarchy." He described "riding the waves of affect" to "transmute them in to the waves of life." He spoke of "transmuting sorrow" so that it does not "hijack" us." He spoke of how the therapist's "presence of mind," is what  calms, regulates and heals the patient.

When parents are flooded with stress and feeling overwhelmed by their child's behavior, I may ask them to slow down and describe in great detail a specific moment of disruption. This can be very difficult to do. Listening to Bobrow speak about meditation and Zen Buddhism, I heard many links to this process. Meditation can be about noticing how we become derailed by patterns of  thought and behavior. Similarly, by slowing things down, parents become aware of how their child's behavior provokes them, and how they may unintentionally attribute meaning to their child's behavior that is markedly different from the child's true intention.

If a parent recognizes in his response to his child's behavior a surge of rage that is linked to a memory of his own father slapping him across the face, the tears may start to flow. Now we have an opportunity to, as Bobrow said "use the suffering to turn straw in to gold." For in the face of this realization, of this "riding the wave of affect" this father can "re-author the suffering" and in doing so separate his own experience from that of his child. It is just this slowing down that helps him to see his child as himself. In turn the child, himself feeling recognized and understood, becomes calm.  This "meditative" process can be what underlies the moments of profound joy and connection between parent and child that follow.

My two experiences this week seem at first glance to be worlds apart.  I wonder if a piece Bobrow wrote on his Huffington Post blog following the Newtown shooting might point in the direction of integration.

We are helpless, we want it fixed, and become prone... to either-or thinking. But there is no silver bullet. Silver bullet, compartmentalized thinking is the problem. Cumulative trauma compromises the capacity for making connections, for holistic reflection. At it's extreme, the other becomes "not me," so I can eliminate him or her with impunity, Intellectually, it's like bubble living: psychology here, culture there, economics somewhere else. Climate? Fuhgetaboutit. We must grasp our fundamental interconnectedness, and with it the intimate and often unseen interplay of psychological and cultural forces and social and political action.

 I wonder if a third conversation, including both my IPMH colleagues and Bobrow, would lead to some real progress.

Towards a new (or return to an old) paradigm of finding meaning

I am fortunate that my father is my greatest fan, although, perhaps because his original language was German, it has taken me years of patient listening and translation to recognize this fact. Recently, after receiving a biography of Charles Darwin for his 89th birthday, he has taken to comparing me to Darwin.

 I would certainly be more modest, recognizing that the ideas I write about draw on the work of great thinkers and researchers, together with my own clinical experience.   One of these great minds is Sigmund Freud. His discovery of the unconscious, his greatest contribution, is so much a part of the way we think and behave that is difficult to appreciate the revolutionary nature of this idea.  Even before he used the term unconscious, in his work as a neurologist, his original discovery was that symptoms have meaning.

Freud did not write very much about development under age three, perhaps because there was only so much he could do. However we do know that when he was a toddler his younger brother died. I wonder how much this early experience, and his mother's concurrent grief over the loss of her child, influenced the development of Freud's theories, though perhaps in a way that he himself was not conscious of.

Fortunately the next wave of researchers, including such great minds as John Bowlby, Peter Fonagy and Ed Tronick, and many others in the growing discipline of infant mental health, have focused on early development, showing that not only does behavior have meaning, but also how that meaning is co-created in relationships.

Here is an example. I have written on this blog about my growing recognition of the significance of sensory processing challenges in development.  While such a trait may originate in the child, it immediately takes on meaning within relationships. A newborn that is not cuddly and does not like to be held may evoke feelings of shame and even depression in a mother. A father who himself had sensory processing challenges but was physically abused because of his difficulties may be overwhelmed with anxiety in the face of his child's similar problems. The child's behavior takes on meaning in the context of the parent-child relationship. When a child is a newborn, it may be relatively easy to identify the relational nature of these problems. But when a child is older, there are layers of complexities, such as learning difficulties and concurrent self esteem issues that may accompany sensory processing challenges, or marital conflict that may occur in the face of a child who is struggling.  These complexities are usually out of a parent's awareness, or, returning to Freud's term, unconscious.

 As a society we have come far from this idea of looking for the meaning of behavior. Instead we treat only the symptom. Thus a child who has sensory processing challenges, unless he is working with an occupational therapist trained in infant mental health, may be treated by brushing, or listening to tapes designed to "re-program" his brain. Many parents have told me that they are actively discouraged from participating in the therapy. Yet if parent and child are separated in this way, the meaning of a symptom within the context of relationships is never discovered.

In mental health care, this shift away from the search for meaning is due at least in part to the birth of "biological psychiatry" and the hope that complex emotional struggles have a simple chemical explanation that can be solved with a drug.

On the list serve of the American Psychoanalytic Association there is currently an active discussion about the issue of CPT codes. In order for a service to be covered by insurance, a clinician must provide both a diagnostic code and a code for the type of service. An underlying problem is that our system of diagnosis, largely based on the DSM (Diagnostic and Statistical Manual)  is organized by symptoms, not by meaning. Clinicians who are used to helping people to discover meaning are restricted by a system that reduces these complex meanings to a number that corresponds to a list of behaviors. It is a deeply entrenched issue related to the whole structure of the health insurance industry and of our health care system. It is further complicated by the rise of electronic medical records and concurrent implications for confidentiality. Helping people to discover meaning that may be unconscious often involves intimate and private conversations.

This brings me full circle to my father's flattering comparison. It is indeed true that I am motivated not only to help the individual children and families I work with, but also to promote a paradigm shift in how we as a society understand human development, and, in turn, support newborns, young children and families.

Though my father is a magazine publisher, he is not a big fan of social media. He told me that Darwin kept his discoveries to himself, partly in fear of upsetting the mainstream thinking, until he had it all written down in the Origin of Species. My father suggested that I concentrate my efforts on producing my own analogous work.

He has a point. However, I choose to embrace the age of social media, and so aim to move our thinking one blog post at a time (although another book will also be forthcoming.)