In 2006-2008, years I hope will turn out to have been the peak of the bipolar diagnosis in young children, it was not uncommon for parents to bring a child as young as 18 months to my behavioral pediatrics practice asking if he had the disorder. During the same time period, I had the good fortune to be a scholar with the Berkshire Psychoanalytic Institute. There I was exposed to a wealth of research and knowledge at the interface of developmental psychology, genetics and neuroscience, coming out of the growing discipline referred to as infant mental health (in this discipline "infant" refers to age zero to five.)*
The research I was learning about, particularly the work of Peter Fonagy, offered me the tools to help families in dramatic and meaningful ways. He and his colleagues have shown how children develop a healthy sense of self, and with that a capacity for empathy, emotional regulation and resourceful thinking, when the people who care for them respond to the meaning of their behavior, that is, motivations and intentions, rather than the behavior itself. This kind of reflection, referred to as holding a child's mind in mind, actually promotes healthy development of the regulatory centers of the brain.
Being a responsive caregiver in this way, particularly in the face of a biologically vulnerable child, is very hard work.
In my office, guided by this model, I aim to listen to the whole of caregiver’s experience in order to fortify their efforts to be fully present with their child. In doing so, I aim not only to change behavior but also to support relationships and to get the rapidly moving train of development back on track.
I longed to communicate to my pediatric colleagues, who are on the front lines with young children and families, not only this new knowledge, but also the way I was able to use these ideas everyday in my pediatric practice with such powerful results. The model of psychiatric diagnosis, often followed by psychiatric medication, needed to be counterbalanced by this alternative paradigm. But I felt that I was living in two completely separate worlds. How could I bring them together? This is where social media comes in.
At first my plan was to develop a curriculum for pediatricians in training. But as a small town doc with no academic appointment, it was hard to break in to this world. Then in June of 2008 the story broke about leading psychiatrists receiving, but failing to disclose, large amounts of money from the drug companies who manufacture the medications used to treat childhood bipolar disorder(they were subsequently found to have violated conflict of interest rules.) I was moved to write an op ed for the Boston Globe entitled Mind Altering Drugs and the Problem Child. The overwhelmingly positive response led to the decision to write a book (That book Keeping Your Child in Mind was released August 30th.) My thinking was that writing for a general audience, important in its own right, might also give me a way in to the world of academic medicine. In addition to embarking on the book project, I started writing this blog.
This past March, a follower of my blog emailed me a link to an article in the New Yorker. The article The Poverty Clinic, described the practice of Nadine Burke, a pediatrician who was incorporating principles of Infant Mental Health in her inner city clinic. I was thrilled to find another like minded pediatrician, particularly one who was so successful, and I subsequently wrote a blog post, Early Relationships and Brain Development as the Core of Medical Practice, about Dr. Burke and her work.
Shortly after this post went up, a pediatrician in Seattle, doing a search for information about Dr. Burke, found my blog. She emailed me to say that she had been up all night reading it. She too had discovered the wealth of knowledge in the world of Infant Mental Health and she too was overjoyed to find a like minded pediatrician. She told me how these ideas, as I describe above, had completely transformed her practice. Rather than "giving advice" and telling parents "what to do" from the stance of an "expert" she found herself listening to parents in a new way. By shifting her task from "fixing problems" to "supporting relationships," she had seen dramatic changes in her her ability to help young children and families. She invited me to speak this coming April at a conference she was organizing for general pediatricians on Infant Mental Health.
About a month later I received an email from a new fellow in Developmental and Behavioral Pediatrics at Boston Medical Center. She was from Seattle, and had worked with the same pediatrician who had discovered my blog via Dr. Burke. That pediatrician had suggested to this new fellow that she seek me out. She, in turn, approached the director of her program, with the suggestion that they read my book and invite me to come and speak about it. So here is my foot in the door of academic medicine in the Boston community, thanks to social media, via San Francisco and Seattle. (I will soon have an opportunity for both practice and teaching in the Boston area-stay tuned to my blog for news about this in the coming months!)
So here I am writing about what I am doing, namely using social media to bring new knowledge to a larger community. As a country doc, I fully embrace this model of shared information as a powerful tool to make the world a better place for children and families.
* Note to my regular readers: this is an introductory post for the new direct feed of my blog posts on the Boston.com website