Shortly after the 2016 election, as part of my effort to make sense of what had happened I read the book Hillbilly Elegy. In it author J.D. Vance generously offers his personal story to help us gain insight into why so many people in our country feel unheard and left out. When I was about two thirds of the way through, I noticed a kind of intergenerational transmission of trauma, with magnified effects in each successive generation who experienced domestic violence, substance abuse, and other forms of developmental disruption. I then discovered that Vance came to a similar conclusion.
Towards the end he references the Adverse Childhood Experiences (ACE) study, which provides abundant evidence of the long-term effects of early exposure to a range of negative experience, including not only abuse and neglect but also parental mental illness, substance abuse, divorce, and domestic violence. The effects are far-reaching, with significant increase in not only mental and physical illness, but also teen pregnancy, incarceration and other social problems. Vance writes: “ACEs happen everywhere, in every community. But studies have shown that ACEs are far more common in my corner of the demographic world.” Referring to people’s wish for a “magical public policy solution,” Vance offers a number of suggestions about how to address this problem. While he feels that there is no one solution, he recognizes that the problem has its origin in homes and in families.
The original ACEs study, as well as decades of subsequent research confirming the results, are epidemiological studies- observations of populations- and do not reveal how the experiences cause these outcomes. However, an abundance of research at the intersection of genetics, developmental psychology, and neuroscience demonstrates that disruptions in early caregiving relationships play a major role in how these experiences get into the body and brain. This developmental science guides us in applying the ACEs study to actually help people. New research shows the value of the term “early relational health.” Used alongside the language of adversity and trauma, it serves to focus our efforts on prevention. The ACE study offers evidence of the need to invest in our first relationships right from birth.
Coincidentally, the day before I finished Vance’s book I had participated in an extraordinary meeting via Zoom with researchers from all over the world who study the effects of the Newborn Behavioral Observations (NBO) System, a brief intervention designed to listen to baby and parents together.
The first days after the birth of a baby, when both a mother and father’s brain are bathed in oxytocin, present an opportune moment for intervention. The newborn’s brain makes as many as one million connections per second as they learn to adapt to the outside world. During this period new identities as parents take shape and relationships are transformed. The NBO is one offspring of the original work of pediatrician T. Berry Brazelton, who recognized both the tremendous capacity newborns have for connection and complex communication and the value of protecting time to listen to parent and baby together right around the time of birth. In our new book The Power of Discord, my co-author Ed Tronick describes going on rounds with Dr. Brazelton in the 1970’s.
“In his visits to the nursery Berry somehow could see the individual inside the baby—who the infant already was and who the infant might become. While current variations of these sets of observations typically include parents, at that time, parents were not present for the exam. However, even though it was not standard to examine babies with their parents present, Berry saw the value of sharing these observations with them. It wasn’t uncommon for him to handle a baby for a while and then go and chat with the parents. He would tell them what their baby was like to give them a sense of the baby as a unique individual. He recognized how important it was for parents to have protected time right from the start to learn about a baby’s way of communicating. He would give the parents a sense of what their babies were sensitive to, whether they were capable of self-soothing, and how they liked to be held. Sometimes he would tell them difficult things that he thought they should know, for instance that when their babies were upset, they had trouble calming down.”
We learn to listen by being listened to. Our ability to find our way into another person’s experience begins to develop in our earliest months of life when caregivers naturally respond to our wordless communication. Our ability to listen is enhanced in a setting of connection and communication. Alternatively, our ability to listen can atrophy in an environment that does not model or value listening. When we protect this time to listen to the baby’s unique voice and support parents at this transformative and often disorganizing time, we set babies and families on a healthy path right from the start.
So how does this idea related to the problem Vance identifies? Broad swaths of our population do not feel heard. Our current political climate suggests that we are all having difficulty listening to each other. We see people tenaciously holding rigid positions with fear dominating their social interactions. Empathy dissipates.
Brazelton traveled to a number of war-torn countries in the course of teaching about his work, and when the things he saw threatened to overwhelm him, he would visit with a new mother and her baby. Taking time to listen to them, he would find renewed hope. Dr. Brazelton’s original work provides a foundation for The Hello It’s Me Project in rural western Massachusetts, where maternity nurses, home visitors, pediatricians, early intervention workers, and others who work with parents and infants learn together about supporting these tender new relationships.
While clearly other supports need to follow in its wake, protecting time for nonjudgmental listening to a newborn and family can serve as a kind of birthplace of hope; a seed from which to restore empathy and grow a healthy world.