Welcome to my blog, which speaks to parents, professionals who work with children, and policy makers. Through stories from my behavioral pediatrics practice (with details changed to protect privacy) I will show how contemporary developmental science can be applied to support parents in their efforts to facilitate their children’s healthy emotional development. I will address factors that converge to obstruct such support. These include limited access to quality mental health care, influences of a powerful health insurance industry and intensive marketing efforts by the pharmaceutical industry.

Tuesday, January 11, 2011

An Epidemic of Uncontained Aggression

Josh Marshall, a guest of Keith Olberman's news program Countdown, made a brilliant analogy when discussing the recent assassination attempt on congresswoman Gabrielle Giffords. He compared the current climate of incitement and violent rhetoric to a flu epidemic in which, while many are affected, the weak and infirm are the most vulnerable. Similarly, the mentally ill, like Jared Loughner appears to be, are most vulnerable to act on the inflammatory and hateful words so rampant in our culture today. But what is the cause of this epidemic? What is the "virus" responsible for this "illness?" Many blame the political situation which has become increasingly polarized and divisive. Others point to the media and the talk show hosts who promote the free expression of rage and hate.

I propose that while these may be proximate causes, the true cause may have much deeper roots. Extensive research has shown that children learn to regulate emotions, including aggression, at a young age, in relationships with their caregivers. This learning takes place at the level of gene expression and biochemistry of the brain. The centers of our brain responsible for observing and monitoring our behavior actually grow fibers that control lower centers of the brain responsible for fear and the fight-flight response. This growth takes place in the context of attuned loving relationships in which children feel understood.

We as a society now seem to be failing at this task of regulating aggression. I wonder if this failure is in some way connected to our culture's failure to nurture and support early parent-child relationships, as exemplified by our maternity leave policy that lags so far behind other countries, as well as the rapid increase of prescribing of psychoactive medication to very young children. The second phenomenon is in turn inextricably linked with the very powerful health insurance industry and the lack of value placed on primary care and mental health care services.

Aggression is a normal healthy emotion, which, if all goes well, children learn to regulate and contain. It then may be transformed into assertiveness, which is considered a positive trait. When children lack close secure relationships that help them to think about and understand their feelings, these aggressive feelings don't go away. Without the ability to think about feelings, a person is more likely to impulsively act them out.

This weekend I will have the privilege, as part of the UMass Boston Infant Parent Mental Health Post Graduate Certificate Program
to hear leading researcher Peter Fonagy present the most current research demonstrating the critical role of understanding children's minds and helping them to contain intense feelings in promoting their healthy emotional development.

Public policy to support early parent-child relationships is essential. For example, postpartum depression can negatively impact a mother's ability to be present with her child in a way that teaches him to regulate intense feelings. Program leader Ed Tronick has been instrumental in calling attention to this very important issue, and this past summer a new law was passed that requires Massachusetts health insurers to submit annual reports on their efforts to screen for postpartum depression and calls for a special commission to come up with policy recommendations to prevent, detect and treat postpartum depression.

Certainly there are other angles for intervention in the aftermath of this horrific event, in the political realm as well as in the media. It may also inspire those strive to support these early relationships to, in the words of Dr. Tronick, "Press on with our work for children and families."

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