In
his extraordinary book Hillbilly Elegy, J.D. Vance generously offers
his personal story to help us gain insight into why so many people in our
country feel unheard and left out. When I was about two thirds of the way
through the book, in conversation with my millennial daughter, I said that it
seemed there was a kind of intergenerational transmission of trauma, with
magnified effects in each successive generation who experienced domestic
violence, substance abuse, and other forms of developmental disruption.
Thus
I was surprised when later that day I got to the end of the book and found
Vance came to a similar conclusion. He references the Adverse Childhood Experiences (ACE) study. I
describe the study in my new book where I show how these
experiences get into the body and brain (and how to help when they do.)
The ACE study provides abundant evidence of the long-term effects of early exposure to a range of negative experience, including not only abuse and neglect but also parental mental illness, substance abuse, divorce, and domestic violence.
The
effects are far-reaching, with significant increase in not only mental and
physical illness, but also teen pregnancy, incarceration and other social
problems. Vance writes:
ACEs happen everywhere, in every community. But studies have shown that ACEs are far more common in my corner of the demographic world.
Referring
to people’s wish for a “magical public policy solution,” Vance offers a number
of suggestions about how to address this problem. While he feels that there is
no one solution, he recognizes that the problem has its origin in homes and in families.
Coincidentally,
the day before I finished the book I had participated in an extraordinary
meeting via Zoom with researchers from all over the world
who are studying the effects of the Newborn Behavioral Observations (NBO) System,
which offers one possible solution. It is a brief intervention designed to
listen to baby and parents together.
The
first days after the birth of a baby, when both a mother and father’s brain are bathed in oxytocin,
present an opportune moment for intervention. The newborn’s brain makes as many
as 700 connections per second as he or she learns to adapt to the outside
world. During this period new identities as parents take shape and
relationships are transformed.
At
the meeting I “met” a colleague from Australia, Susan Nicolson, who has
succeeded in implementing this intervention at a hospital with 8,000 deliveries
a year. In an article she describes this process. Prior
to presenting their idea to the hospital board, they had conducted a small study with teen mothers using a brief
intervention with elements of the NBO added to routine hospital maternity care.
The study showed significant differences in the way these mothers interacted
with their babies, with more positive engagement and joyful play.
The intervention seemed to open their minds to being curious about their baby’s
experience. This stance of curiosity has been demonstrated in extensive research to be
associated with emotional regulation, flexible thinking, empathy, and overall
mental health.
They
shared their findings at the hospital board meeting. Nicolson writes:
With the consent of a small number of study participants, some video snippets of mother–infant interaction were shown to board members at that meeting. The videos of young mothers and their babies interacting with each other at home proved as much of a call to action as the study findings did. As one board member put it, “We don’t usually see what happens to families after we help them get through pregnancy and birth safely. I was so moved, I had to ring my mother and talk about it.”
Nicolson
offers a public health perspective on her work, suggesting that universal
integration of the NBO would support parent-infant relationships in a way
similar to the World Health Organization/UNICEF-accredited “Baby-Friendly”
hospitals support of breastfeeding.
A
growing body of evidence from NBO research worldwide suggests that large scale
implementation could have a significant impact on postpartum depression,
parenting stress, and a range of other factors that have potential to derail
healthy development.
In
our small rural community in western MA, we have trained a range of people who
interface with infants and parents in the NBO, including maternity nurses, home
visitors, pediatricians and early intervention workers. Our hope is to build a
model that can be applied to rural communities throughout our country.
So
how does this idea related to the problem Vance identifies? Broad swaths of our
population do not feel heard. Our current political climate suggests that we
are all having difficulty listening to each other. While clearly other supports
would need to follow in its wake, starting all lives with 30 minutes of focused
attention on listening might just be the thing that helps lead us on a path to
healing.