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.

Wednesday, June 6, 2012

Childhood trauma: stories that must be told


My 51st birthday is approaching. My father is 87 years old. Yet it was not until this spring that I learned details of the story of his childhood in Nazi Germany, his escape to America as a teenager, and his dramatic rescue of his parents from the concentration camp Theresienstadt when he returned to Germany as a soldier with the United States army.  It took his grandson, my 13-year-old son, to get him to break this silence, when my son requested that his grandfather speak to his 8th grade class following their visit to the Holocaust museum in Washington, DC.

My father's story is one of not only survival, but of triumph in the midst of unimaginable horror. He would never use the word "trauma" to describe his experience.  Bits of the story had emerged at times, in part around my daughter's bat-mitzvah 4 years earlier. But in general he ascribed to Elie Weisel's notion that it was a horror so great it could not be spoken of.

French psychoanalysts Francoise Davoine and Jean-Max Gaudilliere have a different adage on the cover of their book, History Beyond Trauma; "Whereof one cannot speak, thereof one cannot stay silent." They argue that personal stories of war and societal trauma, if not told in words, emerge as symptoms, sometimes as mental illness, sometimes in subsequent generations.

Davoine offers a wonderful example in a story of her own family. She and her husband were on a trip with their young children when she discovered a growth in her abdomen. Despite a fear of cancer, they decided to say nothing to their children and finish the month-long trip. Shortly after the discovery, her son developed severe anxiety around bedtime and refused to go to sleep. It emerged that, being highly sensitive to his parents emotions, as children can be, he was worried, but didn't know what to be afraid of. When his parents explained about the lump, his sleep problem resolved. They write:
Let us imagine, for a moment, the following catastrophic scenario: continuing to play the admirable mother, Francoise keeps the secret. The child would find himself burdened by the cut out truth of the story. Rushing into a hyperactive exploration, or barricaded in a hyperpassive withdrawal, nowadays he might have been quickly diagnosed and chemically brought back to reason.
In my behavioral pediatrics practice, I often hear stories like this from parents, both of major trauma in the form of such things as abuse or death of a sibling, or subtler trauma of having an emotionally troubled parent. At first parents focus on the child's "behavior problem." But in a non-judgmental atmosphere where sufficient time is given,  parents are usually eager talk about their own history, and become curious about the effects of their experience on themselves as parents, and on their child.

For example, a 4-year-old girl  had severe separation anxiety. It emerged that her mother had a miscarriage when she was three, and had never had the opportunity to mourn the loss. Her daughter was worried about her, and so did not want to leave her either to go to school or go to sleep.  A father of another boy with "defiant behavior." had been abused by his own father, and found himself full of explosive rage that came out, against his will, in his relationship with his young son.

In recent posts I have been focusing on qualities a child brings to the relationship with his parents. In our quest to understand a child's experience, this is an essential piece. But equally important is to understand what parents bring to the relationship, in particular in terms of their own unique history. Parent-child relationships are a complex, intricate dance. At times they can be clumsy and full of stepped on toes. But with work and careful attention, they can be transformed back into a dance of joy and grace.

I am blessed by the fact that my father is alive and in good health. I am hopeful that we now have the opportunity to write a book together telling of both his remarkable life, and also how his experience came to be known by me and my children. It will serve as a dramatic example of a story that needs to be told.

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