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 31, 2012

On Love and Healing

In yet another New York Times op ed, The DSM's Troubled Revision, on this controversial issue of diagnostic labeling, the author makes the argument that categories in the DSM (Diagnostic and Statistical Manual of Mental Disorders) are not actual diseases in the way that measles or hepatitis are, but rather offer a way of "categorizing suffering." I like this idea, in that it comes closer to trying to capture experience rather than pathologize. But, as he also goes on to say, our culture takes DSM too seriously, treating these categories as if they were "real." The health insurance industry contributes to this phenomenon by requiring a diagnosis in order to have treatment covered. While I agree with much of what he says, I was alarmed to find this statement:
The D.S.M. is the offspring of odd bedfellows: the medical industry, with its focus on germs and other biochemical causes of disease, and psychoanalysis, the now-largely-discredited discipline that attributes our psychological suffering to our individual and collective history (italics mine.)
While lying on the couch 5 days a week may not be a realistic treatment for most people, the discipline of psychoanalysis as a whole is most certainly not "discredited."

Most of the best ideas that I use in my work come from psychoanalysts-John Bowlby, D.W. Winnicott, Peter Fonagy -to name a few. I first learned about gene-environment interactions, expressed in my letter about ADHD published today in the New York Times , from another psychoanalyst, David Reiss, of the Yale Child Study Center, when he was the Erickson Scholar at Austen Riggs, a psychiatric hospital where intensive inpatient treatment is grounded in psychoanalytic thought. Reiss and his colleagues are on the forefront of collaborative research in neuroscience, child development and parenting. My recent piece, Mothers, Babies, Psychoanalysts, Pediatricians, shows how contemporary research in this discipline is making significant contributions to our understanding of how to promote healthy development in children at risk. Bruce Perry, a psychiatrist and psychoanalyst, is leader in the field of trauma research and treatment. In describing his model of intervention, he writes of the way brains develop in relationships. Healing from trauma must occur in the context of relationships.

Relationships between parents and children are among the most passionate. We fiercely love our children, though at moments are filled with unimaginable rage at them. Psychoanalytic literature that explores parent-child relationships, in my opinion, has poetry and feelings, in keeping with the subject matter. This is in contrast to much of the literature coming out of other disciplines that address this subject. Perhaps this is because, as Freud said in a letter to Jung, "psychoanalysis is in essence a cure through love."

There is an interesting discussion going on now on the list serve of the American Psychoanalytic Association about love. Because relationships between analyst and patient are so intense and intimate, much attention, rightfully so, is paid to the importance of maintaining boundaries. Boundary violations are destructive to patient, analyst and the therapy. Yet there must be a place for love. One analyst, Jane Hall, writes of the relationship:
It involves constancy, trust, compassion, patience, impatience, fury, empathy, consistency, amazement, attraction, disappointment, and regard among other things. This experience defines love for me.
Hypothesizing about the ability of love to change the brain, she writes "love is more powerful that we know. After all, it does make the world go round."

When I feel stressed, caught up in the whirlwind of intense controversy around how to best help young children develop in a healthy way, I return to these psychoanalytic roots. I find that they keep me grounded.

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