Anxiety and the Not-Knowing Stance: Lessons from Winnicott

Faced with overwhelming anxiety— both internal and external— people cling to certainty as a form of protection. But ironically this certainty only serves to make us more disconnected from each other. We miss the opportunity to grow and change by moving through misunderstanding to understanding.

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Listening for Ghosts and Angels in the Nursery

In my clinical experience I have found that far and away the most powerful agent of change is the process of grieving loss. When I open myself up to what I call “playing in the uncertainty” allowing the visit to unfold without setting an agenda, I’m consistently surprised and amazed that the process takes parents through feelings of profound sadness to powerful moments of connection with me, with their child, and with themselves.

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My Year of Dying: Lessons Learned

Not only with the glorious birth of my own two children, but also as a pediatrician who has attended many a middle of the night deliveries, I can attest to the profoundly transformative power of witnessing a new life enter the world. In what I have come to refer to as my year of dying— when in less than 9 months I saw my father, mother-in-law, and mother make the transition in the other direction —I learned the deep sense of love and connection that can come with the end of life. Or not.

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A Necessary Mourning

Our world today appears locked in the iron grip of what many refer to as generational trauma. I wonder if a more apt and descriptive term might be unprocessed and unintegrated loss. A psychoanalyst colleague often said, “All emotional suffering is about loss, and all healing is about mourning.”  The Persian poet Rumi expressed a similar sentiment in the aphorism “The cure for the pain is the pain.”

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My Father’s Story: Before the Holocaust

While I hadn’t yet mentioned the movie, my father told me of the radio announcers’ frequent refrain of “all quiet on the Western front” while “hundreds young men were slaughtered every day.” His voice trembled: his face contorted in an effort to contain the flood of emotion. He repeated the phrase in the original German.”Im Westen Nichts Neues” or “Nothing new in the West.” When I shared that we had just seen the movie, tears ran down his cheek. He opened himself to expression of feelings so deeply hidden for so long.

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Getting to Know You: Babies and the Origin of Negative Capability

Practicing in the time before hospitalists, my on-call duties included examining all babies shortly after birth. In the room with parents and their newborn time melted away: all the outside routine pressures of my life disappeared. The inconvenience of sleep disruption when called to a middle-of-the night c-section paled in comparison to the power of riding the elevator from the first floor OR of our small hospital to the third-floor nursery with a new father gazing in wonder at his baby in the isolette. I saw again and again how a newborn baby brings us into the present moment like nothing else. For them there is only “now.”

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Early Relational Health: Preventing Intergenerational Transmission of Shame

Guilt can be a normal and healthy emotional experience. “I’m guilty” can also mean “I’m responsible.” Shame, in contrast is always pathological, and can have destructive effects on emotional development. But without an opportunity to hear the family story, it is impossible to distinguish between the two. Knowing Paul’s story, we can understand it as a kind of intergenerational transmission of shame. Isabel’s sad feelings and expressions of low self-esteem were a communication of distress at an environment of rage, directed both at her and between her parents. One can understand her behavior not as an illness but as an adaptive effort to change the situation.

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Confronting Terror: The Power of Human Connection

In March of 2020, we were all collectively faced with an invisible yet terrifying threat. The group including fellows, faculty, and luminaries held each other over countless messy moments of uncertainty and loss. The result was a profound sense of connection and trust that fueled the explosion of creativity brought forth in their work. The impact will change the lives of infants and families throughout the world for years to come.

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Roots of Democracy Lie in Listening to Parents

Nelson Mandela famously said, “The true character of a society is revealed in how it treats Its children.” A more accurate revision might read: “how it treats its parents and other caregivers of infants.” As Winnicott wisely observed, “It should be noted that [caregivers] who have it in themselves to provide good-enough care can be enabled to do better by being cared for themselves in a way that acknowledges the essential nature of their task.”

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“Just Because It’s Hard, You’re Not Doing It Wrong:” Learning from Babies and Parents

For only by understanding what is “normal”- or the term I prefer “typical” -can we build a model of promotion and prevention. A frame of understanding rooted in healthy development can guide treatment of families when development has gone awry. This model has relevance for relationships throughout our lives. Simply taking time to carefully listen to parents with a young infant as they take us inside their moment-to-moment experience can be an important part of our collective learning.

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