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.

How Yoga Informs Parenting: Value in Not Knowing

In yoga, a pose referred to by my teacher as "how wonderful" involves a lifting of the head and chest, and opening of the arms out to the side, with a bend in the elbows.

In her introductory words of wisdom to a class in which that pose was to be the theme of the day, she asked us, "Do you ever make up stories?" She shared that she may in response to a distracted expression from a friend think, "She's mad at me," or from her 3-year-old child who refuses to put on his shoes, "He's trying to drive me crazy!" She identified how this ability to try to make sense of other's behavior has evolutionary significance. It helps us navigate a complex social world- otherwise, she said, we would have no idea what was going on. But sometimes this kind of assuming of meaning, this making up stories, can get us in to trouble.

What if instead, we employ the open stance of  "I don't know?"-words she demonstrated fit perfectly with the pose of "how wonderful."

In my behavioral pediatric practice, I find parents often driven by a  need to know. "Is there something wrong with him?" they ask. There are tremendous pressures -from teachers, from family, from insurance companies, to name the problem. There is a kind of certainty in this approach, a kind of professional declaring of "I know whats wrong with you."

What if, rather than being guided by diagnostic instruments, that ask questions with the aim of getting an answer, we approach the situation with a stance of curiosity, of inquiry, of "not knowing."

I find if, in a way not dissimilar to the hour-long yoga class, I offer space and time to let the story unfold, we uncover complex meaning in "problem" behavior. There may be a number of relatives with similar traits, suggesting a genetic component. There may have been significant stresses in a family that, even with parents' best efforts to shield a child from the effects, have been noticed and absorbed. A child may have a range of sensory sensitivities that he can manage, but under the stress of separation, often at bedtime or in the process of getting out the door, these sensitivities are magnified. "Problem" behavior may be both cause of and result of family conflict between parents, among siblings, between generations.

There is courage in a stance of not knowing. In yoga, we trust our teacher to guide us in the backbends that evolve out of the "how wonderful/I don't know" pose. The work is hard.  She challenges us while taking care to protect us from harm.

Perhaps professionals who care for children with "behavior problems" -pediatricians, psychiatrists, teachers- could learn a lesson from my yoga teacher (support from the health care system that decided what is and is not "covered" would be essential to this kind of approach.) Rather than being guided by a need to make a "diagnosis," we would support parents in a safe, holding environment through a time of not knowing, on a journey to find the true meaning of behavior.

This kind of journey might not only serve to decrease the number of children receiving psychiatric diagnoses, but also help us to discover creative solutions. We would have the opportunity to uncover both weaknesses and strengths, and to support development of resilience.  In the words of pediatrician turned psychoanalyst D.W. Winnicott, we would be promoting development of a child's "true self."

How wonderful.

Eliminate shame and blame from parenting: new study sheds light

In my behavioral pediatrics practice, it is not  uncommon for parents to go to great lengths to put up a good front. They feel terrible shame about moments of out-of-control behavior, and also fear that I will blame them for their child's troubles. They focus primarily on "what to do" about their child's difficult behavior. However with time, and the realization that I am interested in understanding, not shaming or blaming, they begin to open up about their own life and the enormous stress they experience in their parenting role. They acknowledge that this stress has often led them to yell at their kids or even remove themselves emotionally.

An important new study published in the current journal of the American Academy of Child and Adolescent Psychiatry provides evidence that a parent's early life stress, such as abuse, emotional neglect, or emotional abandonment, lives in the parent's body. The reactions mothers (the study is just about mothers, though fathers certainly face similar challenges) may have in the face of a child's aggressive or clingy behavior are biologically based. It is not simply that they are hitting because they were hit. The authors of the study draw on extensive animal research showing biological mechanisms for transmission of parenting behavior.

For example, when a child behaves aggressively in a way that is developmentally normal (though limits must be set) a parent with a history of early life trauma may have a surge of stress hormones that affect the functioning of his or her brain. Thinking is impaired. He or she may have a kind of fight-or-flight reaction, which may lead to aggression in return.  Another alternative is to shut down, or in psychological language to "dissociate." This leads to that sense of being emotionally disconnected. Neither are good for a child.

This study has major implications for understanding as well as treatment.  If a parent is frequently out-of-control, and is yelling at or hitting a child, or emotionally removing him or herself, it must be addressed. Focusing exclusively on the child's behavior will accomplish little in this situation. Repeated exposure to an angry, out-of-control or emotionally removed parent has significant impact on development.

If  parents can recognize that early life trauma has led to this kind of biological reaction, it may eliminate some of the guilt and shame. It may encourage them to acknowledge and address the problem. When children are young, there is ample opportunity to turn things in a better direction.

Second, if the problem is in the parents' body,  treatment needs to involve working with the parents body. Psychotherapy can be important as a way to develop insight into the impact early life experience. But this kind of work can take time. A more immediate intervention involves helping a parent to recognize the stress reaction and then to develop tools to combat it.

I am not talking about medication. While medication may calm a parent down, and may be necessary in  some cases, the hope is to identify the way a child's behavior provokes a parent, and develop strategies for remaining calm  in the moment. The mindfulness movement has much to offer in this regard. Deep breathing, yoga or simply a short walk can help to calm the body down. Music or art will work better for others.

When parents come to my office asking what to do about their child's "problem behavior," I don't think they expect that my answer will be "go for a walk." I am pleased that this current study will support me when in fact I do say something like that.