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.

Monday, February 2, 2015

Vaccination, Parenting, and the Specter of Unbearable Loss

As the measles outbreak gathers worrisome steam in parallel to the explosion of passionate rants both pro and anti-vaccination, I find myself wondering; what is this really about? Rather than get bogged down in the myriad of issues on either side- though at the outset I will say that as a pediatrician I unequivocally recommend vaccination- I will aim to look at the bigger picture.

Is this issue really about trying to have control in a situation where we as parents do not have control? Is it an effort to deny the fact that when we become parents, we make ourselves vulnerable to the unlikely but real possibility of unbearable loss?

The intensity of the rage, strikingly evident in a blog post by a cardiologist opposing vaccination, makes me wonder if this is really all about something else. Perhaps beneath all the vitriol is really fear of loss. 

As a culture, we are not good at dealing with loss.  The myriad of baby monitoring devices exploding on to the market, offer a kind of illusion of control, are an example of this phenomenon. Putting a baby to sleep on his back will do more to insure his safety than any commercial monitoring device, none of which are indicated for medical reasons. 

The defining of grief as an illness offers yet another example. The latest version of the DSM eliminated what is called the "bereavement exclusion." What this translates to clinically is that if a person has depressive symptoms for over two weeks following a loss, he can be diagnosed with major depressive disorder. 

In contrast to this cultural denial of loss, Buddhism embraces suffering and loss as a normal part of living. Buddhist Thich Nhat Hahn writes
If there is someone capable of sitting calmly and listening with his or her heart for one hour, the other person will feel great relief from his suffering. If you suffer so much and no one has been able to listen to your suffering, your suffering will remain there. But if someone is able to listen to you and understand you, you will feel relief after one hour of being together…. That is called compassionate listening. 
I wonder if the mess we are in is in part due to our devaluing of space and time for listening, for holding through pain and loss. 

There is deep fear on the part of parents on both sides of the vaccine argument. Those against vaccination fear harm by the vaccine. Those in favor fear for their child's exposure to disease.

Science is clearly on the side of vaccination. Measles is a highly contagious illness. Before vaccination became widespread in the early 1960’s, hundreds died every year from the disease. There is massive scientific evidence discrediting the claim that MMR vaccine causes autism. Yet here we are, on the cusp of what may prove to be a major public health crisis.

Could making space for loss have averted this crisis? Loss is an inevitable part of parenting- when we put our child to bed in his own crib for the first time, when he gets on the bus to go to Kindergarten, when he gets his license and takes that first drive on his own out the driveway. If as parents we felt safe enough, held enough, to acknowledge this idea, would we let go of a desperate need for control in a situation where we really don’t have control?

If so, perhaps we could recognize that vaccination is not about our individual child. It is about being a responsible citizen.






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