I’m going to make an argument and a challenge today. I’ve spent a lot of my career trying to teach people about what it takes to make changes to old patterns of behavior. I was doing the best I could with the information available to me. When I announced my intention to go into counseling, my neuropsychology professor responded with, “it might be a good idea to know how things go wrong before trying to set them aright, though.” He was right about that. 50 years later I know he was right.
Our Mental Health System has Psychiatry at its core. A diagnosis is required before any service delivery can be scheduled or any medication prescribed. It is important to note, however, that the diagnostic categories spelled out in the Diagnostic and Statistical Manual of Mental Disorders, Volume 5 (DSM-5), are based exclusively on clinical observation rather than any set of clear empirical (scientific) foundations. This matters because these observations and the categories that get codified in the DSM-5 are ultimately determined free of any idea of causality. When one notices how many symptoms, e.g. impulsivity, emotional regulation, problems in interpersonal relationships, are shared by a myriad of diagnoses, it becomes inevitable that any two psychiatrists may disagree on the appropriate diagnosis for a given individual. The effect of medication for a particular diagnosis is too often similarly clinical in nature and often quite haphazard in spite of all the testing that precedes market availability. In a study published only in 2022 in Nature Genetics, Andrew Grotzinger and colleagues at the University of Texas at Austin, discovered common genetic architecture between pairs of a variety of mental disorders. How this understanding can help improve treatment and outcomes for people struggling with these disorders remains to be seen but it is a hopeful sign. In the meantime, parents and those diagnosed continue to try to “manage” behavior that just doesn’t work in the family or school as best they can. It is these efforts that I want to talk about today.
Most of us have intentionally or accidentally bought into Behaviorism as an explanation of how we learn. We seek to reward behavior we hope to see again and either ignore or punish behavior we hope to never see again. It is important to note that this sort of learning depends on two parts of the brain to work effectively for learning to happen: the hippocampus located in a lower/earlier part of the brain, the limbic system (an area free of our intentional control but responsible for both short and long term memory) and the cerebrum located in the highest part of the brain (an area generally under our intentional control responsible for voluntary actions and our thoughts). Most parenting assumes that the behavior of children is consistently intentional, even manipulative. This is the assumption that gets us into trouble, especially when considering the behavior of children with significant trauma histories.
It is important to realize that experiences influence neurological development in utero (those 9 months before birth). The consequences of these experiences, while not exactly “remembered” are nevertheless powerfully influential in what the developing child expects/predicts about the world they encounter daily once delivered into the world.
Those earliest “experiences” shape those predictions. If the quiet, warm, sea of amniotic fluid was blessed with conditions offered by a woman who feels safe and is well nourished and well cared for, then the developing fetus is born ready to receive the further blessings of existence. If the care the newborn then receives is equally responsive and loving, the child enters the world predicting that humans respond supportively. On the other hand, if that sea of amniotic fluid is regularly flush with stress hormones due to malnutrition, violence, or any other source of chronic fear, there is a risk for their entering the world primed to expect more stress. Our brains love patterns. We look for patterns. If delivered into a home poorly prepared to provide the necessary loving responsiveness, the newborn may “learn” to predict that the world, and the humans in it, are still in a pattern of not really interested and might even pose a threat to their continued existence. This is not a healthy worldview. It works against the child ever receiving anything that looks like what we might call love if it ever shows up.
This sort of “learning” is not happening in the parts of the brain we typically think of as responsible for learning, the hippocampus and cerebrum/neocortex (this is the part of the brain the school system relies on). This earlier “learning” is getting laid down in much lower, more primitive parts of the brain, e.g. the brain stem and diencephalon. New experiences have to pass through these primitive parts of the brain before they are ever considered in those higher, more voluntary parts of the neocortex. Responses out of these primitive parts of the brain cannot be called “decisions”. Decisions imply intentionality. When these lower parts of the brain are in control, the responses they generate are far from intentional. They are simply echoes of early, biased predictions based only on those super early experiences. For this reason, parenting strategies based on “good decisions”, rewards, or punishment, that rely on the functioning of the neocortex fail miserably when applied to children with this sort of early, chronic, trauma.
It is so hard to accept this. It is so hard to grasp that the brains of children with early trauma histories are truly and essentially different from the brains of people whose early development was free of this sort of distorting experience. Once we grasp it, however, we can adjust our own behavior because we have full access to our neocortex. We can employ strategies that can make a real difference in the life of these children. We can let go of reward and punishment and focus on regulating and relating. We can provide rhythmic activities throughout the day to rewire those lower brain regions letting the child truly experience what it feels like to get calm (rather than just exhausted) for the first time. Then, they have a chance to experience something else profoundly new: trust and safety with a human who cares enough to see things a little differently.
NEWS
- Check out the AZAFAP Event Calendar at https://azafap.gnosishosting.net/Events/Calendar.
- Our Friday night Happy Hour and Tuesday afternoon Coffee Chat continue. We’ve also added Wednesday R&R at 10 AM. Some find the facilitator (me or Michelle) and a single other participant; others find a conversation among 4 to 6 people. The topics range from the silly to what hobbies have us in their grip to what life has thrown in our path. If you ever find yourself wanting a bit of grown-up conversation, consider joining us (check your email for the unchanging link).
- Parent Mentor Partners: AZAFAP has trained volunteer parents as mentors who are ready to help support foster, kinship, and adoptive parents through one-to-one conversations. Interested? Fill out the form at https://www.azafap.org/family-support-services/
- Caring for Caregivers, funded by a grant from Blue Cross/Blue Shield, offers counseling services to AZAFAP members who don’t have insurance to cover such services. Apply at https://www.azafap.org/family-support-services
- I encourage you to check out what Dr. Bruce Perry has to offer. Find his thoughts at https://youtu.be/uOsgDkeH52o?t=3 and at https://www.childtrauma.org/trauma-ptsd
Thanks for listening. Take care of yourself so you can be there reliably for others.
Peace,
Cathy (cathyt@azafap.org)
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