Trust: A Book Review

Why is trust vulnerable in America today? Pete Buttigieg asks this question midway through his brilliant new book Trust: America’s Best Chance. In it he lays out a clear, concise, and compelling argument for the urgent need to rebuild trust in order for our country to heal and grow. Not only his extraordinary wisdom but also his unrelenting sense of hope make his voice one we must listen to at this time of unprecedented polarization and uncertainty.

As a pediatrician and infant mental health specialist I read his book from the perspective of developmental science, with the knowledge that trust has its roots in our earliest relationships starting from birth. What relevance does this knowledge have, I wondered, to Buttigieg’s core thesis? Does it help us to understand why trust is vulnerable? And if so does that knowledge guide us to any specific form of action?

I met Pete on a sunny day in August 2019 when he spoke in an idyllic setting on a farm in Cornish, New Hampshire. A 2020 presidential candidate at the time, he had just released his plan to address healthcare in rural America that included a white paper on mental health and addiction. Never in my life had I heard a politician speak with such profound insight on the subject. As a clinician working with families struggling with opioid use disorders in rural Western Massachusetts, I felt that his unusual yet deeply meaningful focus on the concept of belonging as central to physical and emotional wellbeing resonated with both my knowledge and experience. In this book he connects the path to restoring trust with the need to build a sense of belonging, which he describes as “a basic human need.”

I did not expect his book to cover a developmental perspective on trust. Buttigieg states in the introduction that he does not intend to survey the vast literature on the subject, describing his approach as “more personal, and political.” He addresses the need to rebuild trust in order to address urgent the challenges of the COVID-19 pandemic, income inequality, systemic racism, and climate change. His only mention of children comes in a reference to the high levels of trust of Scandinavian countries who invest heavily in education and childcare. He cites Finland as an example, with the United States having nearly five times the rate of maternal mortality. He references parents as one of “the original forms of established authority among human beings.”

Towards the end of the book he writes “It is precisely because we are flawed, biased, sure to make mistakes, and let others down, that we grapple with trusting one another, ” concluding that, “Trust isn’t about perfection. It’s not about certainty. Trust only arises, is only needed, because we are so often less-than-credible beings.” Here Buttigieg- perhaps unwittingly- exactly expresses the developmental roots of trust.

Decades of developmental science research reveal that our core sense of trust and belonging emerge exactly because of imperfections in our ability to understand each other. As beings with a unique sense of self, humans inevitably misread each other’s communications. Moving from misunderstanding to understanding with the people we love starting from birth is the developmental process by which we come to have a sense of ourselves as hopeful, curious, and capable of trust and intimacy. In contrast, repeated failures in efforts to feel understood by people who care for us can make us anxious, filled with mistrust, and closed off from others.

It may be that the developmental roots of mistrust in our world today lie in our neglect of these tender new relationships. Parents are stressed and overwhelmed. Generations of trauma- both historical and within families- undermine caregivers capacities to wonder about the meaning of their infants’ wordless communication. When we do not feel heard and understood, we grow mistrustful. We lose access to growth promoting interaction in our social world. The flip side of belonging-exclusion- can bring with it dark feelings of rage and shame.

Connection to others is central to our humanity. It regulates our physiology and protects against the harmful effects of stress. Its absence, the profound aloneness that accompanies difficulty in communicating with others is the common factor underlying all forms of mental distress. The foundations of connection are laid in early childhood, when caregivers respond to us as individuals with motivations and desires. Rather than simply controlling our behavior, they listen to us and reflect on the meaning of our communication. This process, known in common language as being held in mind, exploded into the world of developmental psychology and neuroscience after researchers identified its significance in the early 1990’s.

In the United States we are failing terribly in listening to parents and children. In a book published shortly after her untimely death in 2011 deprived us of opportunity to wrestle with her thesis, Elizabeth Young-Bruehl identified a worrisome level of prejudice against children- what she named “childism.” A political theorist and biographer, she argues that prejudice exists against children as a group in a way that it is comparable to racism, sexism, and homophobia. This prejudice legitimates and rationalizes acts that are not “in the best interests of children.” She compares the situation in our country with that of comparably developed countries that have lower rates of child abuse and neglect. There, “children have a range of preventative and development-oriented services: universal health care, health services, and parent support services in homes after the birth of a child; maternal and parental leaves for infant care; developmental preschool programs; after-school programs; and economic supports of various kinds.”

We are one of two developed countries without government supported parental leave. Childcare workers are among the lowest paid, with little support or training in child development. We have an epidemic of expulsion from preschool. Primary care clinicians are more likely to diagnose psychiatric disorders in young children than to take time to listen, as I describe in my book The Silenced Child.

It is refreshingly hopeful to hear a politician speak eloquently about trust and belonging, both of which are central to our humanity. Development is a lifelong process starting from birth of engaging in moment-to-moment interactions through which we learn to belong to a wide variety of different groups. These include, but certainly are not limited to, ethnic, professional, religious, geographic — even the changing culture of a growing family as its members marry and have children. Trust develops when we move through inevitable moments of disconnection to reconnection. When we listen to one another with curiosity, we create communities of connection.

Renowned pediatrician T. Berry 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. An understanding of the developmental roots of trust and belonging can offer guidance to address the current levels of mistrust while helping to design a preventive model of investment in children and parents. Perhaps childism needs to be added as a fifth issue to the four Buttigieg names as the main challenges of our time. With trust and belonging identified as the core tasks of building a healthier world, a focus on children and parents seems a logical next step.

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