Is Disorder Healthy? Rethinking the Language of Mental Illness

“But it’s genetic” or “these are brain diseases,” are frequent response to this reframing of our concepts of mental wellness and illness. Once we recognize that our genes, brains, and bodies develop in relationships, the false duality of biology and experience, of nature and nurture collapses. Expression of our genes and wiring of our brains occurs in the interactive process of mismatch and repair in our closest relationships starting from birth. It used to be thought that brain wiring was pre-determined; that our brains had a fixed wiring plan. But now we know this is not true. Formation of new neural connections- the “wires” that make up the brain- is flexible not only in early development, but throughout our lifespan.

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The Allure (and Danger) of Certainty: A Developmental View

Stress and adversity are ubiquitous. Adversity becomes “trauma” when it is compounded by a sense that one’s mind is alone. When children grow up in an environment characterized by lack of curiosity about their experience, where they do not feel listened to by their primary caregivers, epistemic mistrust, or hypervigilence, along with a sense of social isolation, develops. An individual then faces what Fonagy terms an “epistemic dilemma, “ characterized by cycling between hypervigilence and excessive credulity
For a person facing this dilemma, a leader who speaks with absolute certainty, leaving no doubt that he or she is the one to whom we should listen, has power to protect against the emotionally intolerable experience of being alone. In this state, feelings can override facts. This developmental model helps to make sense of our current political situation. In a democracy, when a large population feels fundamentally disconnected and unheard, filled with mistrust yet also vulnerable to emotionally driven messages, it makes all of us vulnerable.

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Mind-Altering Drugs and the Toddler

Behavior is a form of communication. Medication can silence that communication. Until we place a renewed value on protecting time for listening, we will continue to see an increase in this kind of prescribing. In effect we will be silencing the voices of the youngest members of our society.

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Postpartum Depression:Bringing in the Baby

A baby may be sensitive to touch or sound, or struggle going from awake to asleep, or any of a range of qualities that may make negotiating the big, loud, complex world more challenging. If, in addition, his caregiver is struggling with depression, the dance may be further disrupted. Or the problems in the baby may cause depression in the mother, as when the baby cries all the time and the mother never sleeps. When these disruption are not addressed early, significant problems may develop.

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Parenting and Empathy: An Essential Partnership

Last week I had the privilege of reconnecting with Anna Ornstein, a brilliant child psychiatrist and one of my original mentors. In preparation for our meeting, I re-read a paper she had given me back in 2004* (written with her husband Paul Ornstein, MD about 20 years before that), when I was just beginning to develop the ideas now described in my book, Keeping Your Child in Mind. While I do not reference the paper in my book, it is filled with such wisdom that I felt compelled to quote large segments of it in this blog post. Interestingly, much of what she says is similar to what in the current world of developmental psychology is referred to as “reflective functioning, ” or what I refer to in my book as “holding a child’s mind in mind.” While in that language, empathy is included as one component of the more complex task of reflective functioning, in Dr. Ornstein’s language “empathy” encompasses the many components of reflective functioning

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