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, August 3, 2015

Is Listening a Science or an Art?

According to pediatrician turned psychoanalyst D.W. Winnicott, the "true self" in its original form develops when the mother meets the infant's "spontaneous gesture." She sees the baby as himself, without projecting her own expectations, fears, or needs. But as Winnicott identified, the mother is not perfect. Inevitably she fails in this process. Sometimes the failures are small; disruptions can easily be repaired. The true self continues to take shape and grow.  But more significant disruptions may occur.  Postpartum depression, a highly dysregulated baby, her own unresolved conflicts and losses, among other things, may obstruct a mother's view to her child's true self. That child may become an adult in search of his true self.

Winnicott understood this search on a profound level. He saw it in its original form in his work as a pediatrician with mothers and their babies. Then he saw it again, when his adult patients in analysis "regressed to dependence." They used him to discover, or re-discover, their own true self. Winnicott was able to support this process with his full presence, using the predictable space and time of the therapy session to provide a "holding environment" analogous to that offered by the mother in infancy. 

Psychoanalysis is sometimes described as the "talking cure." One might more accurately call it the "listening cure." In infancy the mother reflects the baby's experience, holds him with her body, her words, the sound of her voice. She helps him to give words to his feelings. When our emotions get the better of us, we have lost this ability to give words to feelings. When a therapist listens to our words, mirroring our experience in a way that echoes that original experience of being seen and understood, we can discover, or re-discover, that true self, that either never fully formed or got lost along the way. 

At the recent International Psychoanalytic Association Congress in Boston, a speaker at a panel on Winnicott (whose collected works will be published by Oxford University Press in 2016) addressed Winnicott's use of language. At the time he was developing his unique contributions to our understanding of human experience, adherence to Freud's original discoveries was considered paramount. Freud had developed his own language to describe his discoveries, and in part in an effort to make the field "scientific" there was pressure to use that same language. But Winnicott resisted. 

Using his own words was integral to his theories. By using his own language to describe his highly personal experience, he stayed true to himself. Thus it is the very lack of adherence to Freud's language that gives power to his ideas. But as Professor Scarfone articulated at this presentation, the ideas themselves are perhaps most true to Freud's discoveries. 

 We take its existence so much for granted, that we may forget that Freud's greatest original discovery was the unconscious. The unconscious is that part of the mind made up of feelings, thoughts, and memories that are out of our awareness but exert influence on our conscious thoughts and behaviors. The "talking cure" or "listening cure" connects those thoughts and feelings, which may maintain a grip on us in unhealthy and maladaptive ways, to conscious thoughts and words. When a therapist listens to a patient, she to performs a kind of mirroring function.  She parallels that original experience of connecting thoughts and feelings with words, when the mother recognizes the infant's true self. She offers the patient space and time to say what he means, to connect words with feelings, and so make the unconscious conscious.  In other words, she gives the patient the space and time to discover his true self.  

In the current age of "evidence-based" medicine, I question the necessity of scientific evidence of the healing power of listening.  For Winnicott, the search for the true self precludes a common language; thus it is in a sense by definition unscientific. Attempts to design controlled studies inevitably call for a common language, and for a reduction of human experience to quantifiable measures. When I offer space and time to listen parents whose children are struggling with a range of "behavior problems, I always hear a story that gives meaning to the behavior.  The stories themselves are the evidence. 

When I read Winnicott, I have the calming, centering experience of recognition and understanding. I feel that if he were here today he would "get" what I find troubling about this age of "evidence-based" medicine. Listening to parents and children,  facilitating development of a child's true self, is by definition unscientific. It is creative and original. Creativity emerges in the "play space" of the therapy setting. Telling of the story is itself a creative act. As Winnicott writes in Playing and Reality:
It is in playing and only in playing that the individual child or adult is able to be creative and to use the whole personality, and it is only in being creative that the individual discovers the self. 
In conclusion, I playfully offer an articulation of the connection between language and the true self from another creative thinker, Dr. Seuss:

          I meant what I said and I said what I meant
         An elephant's faithful one-hundred percent                          
                                                Dr Seuss, Horton Hatches the Egg

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