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 research in child development 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, May 22, 2012

Is big pharma's grip on children's mental health care loosening?

Is it possible that our culture's over-reliance on the quick fix of medication to treat complex problems is waning? That alternative models of care offering meaningful support for early parent-child relationships are gaining increased recognition? My inspiring weekend with the current group of fellows in the UMass Boston Infant-Parent Mental Health Post-Graduate Certificate Program gives me hope that this is in fact the case.

One person in the group, an experienced neonatologist, has in the course of her clinical work increasingly recognized that what makes some premature babies do well and others not lies in the quality of their early caregiving relationships. She sent the group an article as evidence of the above trend, writing: 
I am attaching a very short paper from this month's Journal of Perinatology that describes incorporation of relaxation techniques into perinatal counseling. It uses terms such as "being with," "connections," and "compassionate presence." Ten years ago, this paper would have been flatly rejected by a prestigious journal as being anecdotal and merely descriptive. 
Peter Fonagy, the weekend's featured speaker, a great mind who has been likened to a modern-day Freud in terms of the transformative nature of his ideas, offers an alternative model from that presented by the pharmaceutical industry. Relationships can change the brain in more specific ways than drugs.

Fonagy identifies the quality that makes us uniquely human, different from animals. It is the ability to interpret other's behavior as having meaning. Humans alone understand that behavior is driven by motivations, intentions, desires and beliefs.

But the thing is, babies are not born knowing how to make sense of their own and other's behavior. They learn it from the people who care for them. When a parent is attuned with her baby in such a way that says, "I understand you," that child learns to understand not only his own mind, but also the minds of others. This learning takes place at the level of structure and biochemistry of the brain. This ability to interpret other's behavior in turn allows that child to make sense of the wider social world.

 Attuned early relationships of what Fonagy called "epistemic trust" are critical because they are "the superhighway for transmitting cultural knowledge." They are the means by which we learn about the world: how we learn to engage with others in a healthy and productive way.

Where does the motivation come from to shift from a quick-fix model of disease to one that promotes healthy relationships? The ACE study, which I have written about in previous posts, offers a kind of negative motivation. If we do not do something to change direction, there will be lots of bad outcomes in the form of such things as mental illness, violent crime, diabetes and heart disease. Fonagy offers more positive motivation. If we intervene early to promote secure safe relationships, we give children the tools to go out into the world, think creatively and move our society forward.

Fonagy points to three trends offering hope that things are changing in the way we as a society care for children and families. One is the increasing evidence of the impact of stressed early relationships on such long-term health outcomes as heart disease and obesity. The second is the decreasing influence of big pharma on mental health care, as evidenced by the marked decrease in development of new drugs to treat mental illness.  And third is the role of the Internet in disseminating new information. I am hopeful that this blog is one small part of that trend.

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