Monthly Archives: May 2014

“Heal trauma? Start with the body”

Bessel van der Kolk by Matthew Woodson, NYT 5-22-14“Bessel van der Kolk wants to change the way we heal a traumatized mind — by starting with the body,” reports Jeneen Interlandi in the New York Times Magazine May 22. (Dr. van der Kolk in session drawn by Matthew Woodson for the Times.)

It features Dr. van der Kolk’s new approaches to healing trauma by group therapy, yoga, meditation, EMDR, and “rhythmic regulation.”  I’ve reported on this in these recent posts: http://attachmentdisorderhealing.com/developmental-trauma/  and http://attachmentdisorderhealing.com/developmental-trauma-3/

“Trauma has nothing whatsoever to do with cognition,” van der Kolk says. “It has to do with your body being reset to interpret the world as a dangerous place.” That reset begins in the deep recesses of the brain with its most primitive structures (brain stem), regions that, he says, no cognitive therapy (frontal cortex) can access.

“It’s not something you can talk yourself out of.”

It’s a great Friday read: “A Revolutionary Approach to Treating PTSD” by Jeneen Interlandi, New York Times Magazine, May 22, 2014 at: http://www.nytimes.com/2014/05/25/magazine/a-revolutionary-approach-to-treating-ptsd.html?smid=tw-share&_r=2#permid=11865712

OK, it’s a bit off my topic. The Times doesn’t mention attachment trauma, although van der Kolk talks about that constantly. As to healing, it focuses on adult war PTSD. It only speaks to child trauma by debating what a child abuse victim can and can’t remember (not much of a call to heal child trauma).

But Ms. Interlandi does let van der Kolk speak to his charge that there is a lot more trauma than we think, and that standard “cognitive” treatments are not working. “Patients are still suffering, and so are their families. We need to do better,” van der Kolk says.

“Van der Kolk says he would love to do large-scale studies comparing some of his preferred methods of treatment with some of the more commonly accepted approaches,” she points out. “But funding is nearly impossible to come by for anything outside the mainstream. In the wake of the Sept. 11 terrorist attacks, he says, he was invited to sit on a handful of expert panels. Money had been designated for therapeutic interventions, and the people in charge of parceling it out wanted to know which treatments to back.

To van der Kolk, it was a golden opportunity. We really don’t know what would help people most, he told the panel members. Why not open it up and fund everything, and not be prejudiced about it? Then we could study the results and really learn something. Instead, the panels recommended two forms of treatment: psychoanalysis and cognitive behavioral therapy.

“So then we sat back and waited for all the patients to show up for analysis and C.B.T. And almost nobody did.” Spencer Eth, then medical director of behavioral health services at St. Vincent’s Hospital in Manhattan, (later) gathered data on the mental-health care provided to more than 10,000 Sept. 11 survivors.

The most popular service by far was acupuncture. Yoga and massage were also in high demand. “Nobody looks at acupuncture academically,” van der Kolk says. “But here are all these people saying that it’s helped them.”

Out of 208 reader comments to the Times, I only found two that weren’t deeply grateful for his approach, as I am.  These two didn’t mention healing either.

Enjoy reading about Dr. van der Kolk today, but read carefully – the Times, ever a bit arrogant, puts in some gnarly innuendos I didn’t like, which the two comments made worse. So I had to do further research on this one.  My results to come next week…

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Kathy’s news blogs expand on her book “DON’T TRY THIS AT HOME: The Silent Epidemic of Attachment Disorder—How I accidentally regressed myself back to infancy and healed it all.” Watch for the continuing series each Friday, as she explores her journey of recovery by learning the hard way about Attachment Disorder in adults, adult Attachment Theory, and the Adult Attachment Interview.

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Bruce Perry: No Empathy, No Survival

Dr. Bruce Perry, MD, “Born for Love:
“Why Empathy is Essential – and Endangered”
Address to The National Council for Behavioral Health
Washington, DC, May 4, 2014  – Click link or photo for video
https://www.youtube.com/watch?v=M6kDeBaJi0M

“Empathy is what makes us human,” says brain scientist Dr. Bruce Perry, MD  –  but this has not sunk in for Americans.  If simple kindness isn’t enough, what about the minor fact that it’s brain science?  Or that by ignoring this basic fact, we’re violating biology, so we’re dying as a species?

To let Dr. Perry make his point, today I’ve just got a few quotes from his May 4 Washington DC address, to provoke you to watch the video kindly posted by the National Council for Behavioral Health.

”From birth, we seek intimate connections, bonds made possible by empathy — the ability to love and to share the feelings of others,” Perry begins. But “our  policies routinely violate the biological reality of empathy, and that’s destructive…

“For example, we pass on to the next generation explicit choices that we’re going to teach math — but not music…We don’t care if everyone learns to read and perform music or not, but they’ve got to do arithmetic…  We have extensive rules for all the things everyone has to learn to drive a car… but we don’t do the same for raising a child!  We don’t make any systematic recommendations, or ensure that everybody who’s about to have a child has the fundamental knowledge of what’s necessary for the child…

“We’re exposing our children to levels of violence as a problem solving technique, at rates that are at least 50 times greater than alternate methods of problem-solving…

“We have invented ourselves into a corner with technology… into models of child rearing, education, and building communities that is fundamentally disrespectful of two of the greatest (biological) gifts our species has:  the fundamental malleability of the human brain in early life, and the fundamental relational (empathic) nature of human beings…. As a result we are much more vulnerable to mental health, social health, cognitive health, and physical  health  problems.

Humans Need Humans Around to Live

Perry another headshot“Human beings are biological creatures with genetic gifts… The only way we survived was by forming relationships, collaborative relationships…  Human beings are neurobiologically meant to be connected to others: to live, work, hunt, play, invent, and die in groups.

“We use the word ‘independent’ a lot — but the truth is there’s not a single human on this planet, ever, that’s been independent.  All of our physiology is designed to connect to others, we have huge parts of our brain designed purely to respond to the non-verbal cues of others… it’s in the way our face is oriented, our facial configuration is forward, looking at people… We have sensory apparatus on our skin that’s meant to be touched… so that we can feel somebody caress us…

“Our brain is a social organ; we are social animals. We don’t have any natural body armor, camouflage, stinging other things. We form groups!  Human beings are ‘meat on feet’ to the natural world!  The only way we survive is by forming collaborative groups, by sharing what we hunted and what we gathered with everybody else in our group.  And the typical living group was a developmentally heterogeneous, multi-family, multi-generational group: 40 to 50 people.

“And in that group…  the ratio of developmentally more mature individuals who cared for you, protected you, nurtured you…  was four to one.  But now, we think it’s an incredibly enriched early child care environment if there’s one caregiver to six kids!  That’s 1/24  the relational density the brain benefits from…

“Today, the whole organization of society flies in the face of this… In the last census, one third of American households were one person.

“On top of which, now… the typical American spends 11 hours a day interacting with digital devices, and not with fleshy objects!  And I want to talk about the consequences of this for how we end up expressing our ability to be compassionate (or not)…. You see it all the time, complaints in the psychological literature about the disconnectedness of multi-tasking constantly with our phones… but we do it ourselves…  You’re talking to someone, then your phone will vibrate — and it pulls you away from them.

” It breaks the rhythm of social contact, of empathic engagement– and the truth is: those things are physiologically meaningful.”

Again, click here for video:
https://www.youtube.com/watch?v=M6kDeBaJi0M

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Kathy’s news blogs expand on her book “DON’T TRY THIS AT HOME: The Silent Epidemic of Attachment Disorder—How I accidentally regressed myself back to infancy and healed it all.” Watch for the continuing series each Friday, as she explores her journey of recovery by learning the hard way about Attachment Disorder in adults, adult Attachment Theory, and the Adult Attachment Interview.

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Allan Schore: What is the “Self”?

Allan Schore 2In March 2013, I was standing unknown in a crowd of professors and therapists at a UCLA conference, and noticed a quiet gentleman on my right.  I’d seen his photo online.  “Dr. Schore?” I asked.  “Yes,” said Allan Schore, turning calm eyes on me.

“I’m so grateful for all you’ve done to show that babies can’t control emotions, that’s the mother’s job to model, and emotions are ok,” I blurted,  suddenly in tears. “I’m writing a book on what it feels like on the inside, when we don’t get that as an infant.”

Dr. Schore didn’t flinch; his eyes grew wide with empathy. He got it.  He got a total stranger, right by the conference stage, got that I had walked through a hell of emotional pain to study this. He got that I was feeling love for him because he’s shown there’s a scientific reason for the pain.  He got that “emotions are ok” and only emotions from a caring other can heal this, so he gave me emotions: presence and compassion. On the spot. “We see it every day,” he said.

Just sayin’: he walks the walk.

UCLA professor Allan Schore is a world leader in Attachment Theory. He’s known as “the American Bowlby” after British psychiatrist John Bowlby who first wrote about attachment in the 1950s. [FN1]  Schore was among the first to put together the latest brain science on how an infant’s brain forms biologically (“developmental neuroscience”), with the early psychology of the infant mind (“developmental psychoanalysis”).

Dr. Schore’s 9-28-14 Oslo speech “The Most Important Years…the Right Brain and Its Importance” is a must-see to understand infant developmental trauma. He calls it  “trauma in the first 1000 days, conception to age two.”  Schore reviews how the theories he’s published since the 1990s are being proven to be hard science by today’s brain scan technologies (content starts minute 8): https://www.youtube.com/watch?v=KW-S4cyEFCc

Schore is known for documenting the “origin of the self”– what, scientifically, is the “Self”?  What is it that makes me, Me?

He calls it “the origin of the early forming subjective implicit self.” It’s entirely subjective; each infant has a different experience.  It’s “implicit memory” because the self forms in infancy when memory is only subconcious. It all happens years before we have thought and conscious “explicit memory” at age two or three.

This isn’t mere geek-speak; the mental, emotional, and physical health of all humans depends on it. We can’t remember what happened before age 3 when our self was formed, but the experience had massive impact. It’s all still “down there,” driving our feelings and behavior big time for the rest of our lives.

When the self is damaged during formation in early infant and childhood, a person can feel miserable all their life. The ACE Study shows this often leads to biological disease and premature death.

The Self and Emotions : Secure Attachment

brousblog4c Claire+MosesBabies are born with a massive level of emotions. Schore reports that they are  overwhelmingly dependent on the mother to show them how to handle it all. An infant’s brain doubles in size “from the last trimester of pregnancy through the second year,” he says. “At birth, there are hardly any cortical (conscious thinking brain) areas that are myelinated and online… so it’s impossible for the baby to regulate its own emotions…

The mother is the regulator of that baby,” he says, and this shapes the development of its entire brain. “Over the first year… the mother’s interactions are shaping the very wiring of those higher regulatory centers… Attachment communications which are emotional are forging the connections in the early developing right brain… The right brain literally is imprinted by these attachment relationships while it is being created…”  FN2

It’s all subconscious. With “secure attachment,” when a baby cries, the mother “attunes” to it. An “attuned” mother doesn’t say “think” or “ought to.”  She feels a strong, emotional urge to comfort her baby; she subconsciously intuits whether her baby cries because it’s hungry, wet, or tired. “The mother is able to pick up the baby’s communications,” Schore says. “She is not doing this by language, there is no thinking or language before age two.  She is picking up bodily-based nonverbal communications:  facial gestures, auditory tone of voice, and tactile expressions.  The attachment communication is more than between the mother and the infant’s minds; it’s between their bodies…

“She is psychobiologically attuning to the internal rhythms… of the baby’s autonomic nervous system and central system arousal…  It’s an attunement of mind and body. In doing so, she is regulating the baby’s rhythms and allowing the baby to create different emotional states that are associated with these different rhythms. This is not a matching of behavior; it is more of an intuitive matching of the internal rhythms of the baby.

“The baby is expressing these internal rhythms through the emotional communications it is sending back to the mother, in the prosody of the baby’s voice, or in the cry, or in the expression on the baby’s face, or in the gesture.  They are matching each other’s subjective state. Now, when two people match their subjective states, there is a sense of empathy, there is a sense of a bond; a sense that ‘someone’s body is exactly resonating with my body.’  When that occurs there is an amplification of arousal, and this amplification of arousal leads to things like joy states.”

Infants also have no sense of self.  Instead, Schore adds, there’s a “mother-baby continuum” for at least the first six months of life where the “dyad” (mother and child) often don’t know (and don’t care) where one person ends and the other begins.

We begin life as a sea of emotions, and then mom models for us again and again, that she can comfort our wild emotions. Unconsciously we pick up that skill. After we cry and mom comforts us for the millionth time, one day we feel our way to stop crying because we’ve “internalized” mom’s comfort. We subconsciously learn to manage emotions, to both enjoy good emotions, and also–very important–to tolerate and be able to fully feel negative emotions. Without fearing or repressing them.

This is also called “Emotional Object Constancy.”  Mom was an external object, but now we’ve taken her image inside us, so we feel loved and emotionally secure 24×7, even when we’re alone.

Our “self” begins when we first start to “regulate” our own emotions (“affect”) this way. When we realize we can feel our emotions and also modulate them, without screaming for someone else to do it for us? That’s when we first realize that we are not merely part of mom. We’ve got some independent “self.” “Essentially, one’s self-concept is focused around a positive sense of emotionality in the self,” says Schore.

Insecure Attachment and Trauma

Still Face Experiment 2Or not.

Back to how all babies are born with a massive level of emotions. We’re all supposed to receive all that attuning above, then we’re fine.

Or not.

What if we’re an “Or Not” baby?  What if we cry but no one comes?  Or what if someone comes, but they don’t have the neural equipment to attune, or they’re too distressed to attune?  “That baby learns that there is no comfort, that emotions are terrifying, and the world is a scary place,” Dr. Schore says. His colleague Dr. Ed Tronick shows this graphically in the “Still Face Experiment”– click for video.  [FN3]

That baby often does not develop much of a self.  To the extent no one showed it how to manage emotions, the day could not come when it could “regulate like mom.” It can’t regulate, so it can’t individuate.

That is really uncomfortable; it’s what’s behind the feeling that “I have a hole in me.”

All the above leave deep damage, even just passively.

Plus, on top of that: what if we cry, someone comes, and then there’s active aggression; we’re yelled at or physically maltreated?

A whole lot can and does go wrong for a baby. I call that a lot of Adverse Infant Experiences (AIE). “Aaiiee!” Double ouch.

Schore says this is the root of developmental trauma.  “In trauma there is an intense negative state about the sense of self,” he says, with “extremely high states and low states of arousal, an inability to internally regulate their state or to use other people to help them regulate their state and bring them into a sense of comfort.”

With insecure attachment, he says, “there are problems that the caregiver is having emotionally…  There is anxious insecure attachment, where the mother is preoccupied or unpredictable… There is also avoidant insecure attachment, where the mother is mostly cold…

“And there is ‘mind blindness,’ so to speak. There are some mothers who cannot read the tone of the baby… depressive mothers have problems reading facial expressions, especially the facial expressions and gestures of the baby. You see inter-generational transmission of these deficits…”

Schore first showed this scientifically in his three blockbuster books Affect Regulation and the Origin of the Self (1994), Affect Dysregulation and Disorders of the Self, and Affect Regulation and the Repair of the Self.  FN4

“Affect regulation” means we can freely feel our emotions without being emotionally blocked, we can enjoy our emotions–yet also be “on top”of our emotions, so they don’t feel overwhelming, painful or frightening.  If not, we suffer “affect dysregulation ” i.e., some level of painful emotional chaos.

We all know people who either can’t or won’t access their emotions, or others whose emotions go out of control to where they and those around them feel miserable.  Others  swing to both extremes, but never simply enjoy their emotions without freaking out or hurting people.

The good news is: there is repair, as Dr. Schore’s third book lays out in detail. At a support group, Al Anon meeting, therapist’s office, or with friends, repair means we find other humans to do exactly what Schore did for me on the floor of that conference: be present emotionally with another emotionally-attuned human being.

If we can sit for an hour and attune to another human willing to share our emotion state and help us learn to gradually shift and modulate it, we learn to “regulate.”  Brain scans now show that we can literally repair the neural circuits which remained painfully out of tune when we didn’t receive human attunement as kids.

It takes time, perseverance, courage, and real human beings like Allan Schore.  I’ve met them–they’re out there.  Find them.

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Kathy’s news blogs expand on her book “DON’T TRY THIS AT HOME: The Silent Epidemic of Attachment Disorder—How I accidentally regressed myself back to infancy and healed it all.” Watch for the continuing series each Friday, as she explores her journey of recovery by learning the hard way about Attachment Disorder in adults, adult Attachment Theory, and the Adult Attachment Interview.

Footnotes

FN1  Bowlby, John, “The Nature of a Child’s Tie to His Mother,” British Psychoanalytical Society, London, 1958; “Attachment and Loss,” New York, Basic Books, 1969

FN2  Schore, Allan N., PhD, “Affect Regulation and Mind- Brain-Body Healing of Trauma,”   National Institute for the Clinical Application of Behavioral Medicine (NICABM), June 15, 2011
Schore, Allan N., “The right brain implicit self lies at the core of psychoanalysis,” Psychoanalytic Dialogues  21:75–100, 2011 www.lifespanlearn.org/documents/2011Handouts/Schore/Schore%20Psych%20Dialogues%2011.pdf
Interview with Allan Schore – ‘the American Bowlby,’  by Roz Carroll, UK ;  The Psychotherapist, Autumn 2001, www.thinkbody.co.uk/papers/interview-with-allan-s.htm

FN3  Dr. Ed Tronick of the U Mass Boston’s Infant-Parent Mental Health Program did his first “Still Face Experiment” work in 1975; his 2007 video  has over 1.3 million hits.  First a mother and child play in a responsive, attuned way, so the baby learns to interact with the world. Then she suddenly stops attuning. Video at: www.youtube.com/watch?v=apzXGEbZht0&feature=youtu.be

FN4  Norton Textbook Series on Interpersonal Neurobiology:
Schore, Allan N., “The Science of the Art of Psychotherapy,” April 2012; 480 pages
Schore, Allan N., “Affect Regulation and the Origin of the Self,” Norton textbook May 2003; first edition 1994; 432 pages

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What Trauma-Informed Care Means to Me

IMAG3258 James, kid, bike“Rider for Change” James Encinas arrived by mountain bike at San Diego’s Cherokee Point Elementary May 2 to the delight of some hundred students, and visitors from around southern California. James, a career LA school teacher, is riding 3,000 miles from Sacramento to Philadelphia. He’ll take the southern route through Texas and Louisiana, then follow the Underground Railway by which African Americans escaping slavery crossed north to freedom.

James is riding to draw national attention to the need for “trauma-informed schools,” key to the movement for “Trauma-Informed Care (TIC)” in education, health, and all public systems. But what is Trauma-Informed Care, and what’s a trauma-informed school ?  (Hint: all the pix in this blog are from Cherokee Point).

“In medicine, a patient is sent to hospice when all medical procedures have failed, and they’re going to die. That says: we give care and comfort only when nothing else works,”notes Dr. Christopher Germer, psychology prof at Harvard Medical School and co-editor of Mindfulness and Psychotherapy.  Pretty crazy right there, if you consider. Been in a hospital lately? Often you’re a widget; they take your clothes away, don’t tell you what’s happening, and so on. [FN1]

IMAG3250 James, Dana Mom w. FoodBut when treating the real human being, “Care Equals Cure,” says Dr. Germer. If a therapist doesn’t care, he’s not going to cure his client. But it’s also true in any dealings with humans. “Care IS the practice of non-resistance to suffering which dismantles emotional suffering,” says Germer. “It means opening to emotional pain more fully, instead of trying to bypass it. Compassion opens the heart, reveals inner suffering, and makes the suffering available for transformation.” (Above: James and activists carry food donated for kids.)

“So the message is:  Stop fixing,and start caring,” Dr. Germer concludes. In fact, it’s brain science. Comfort, care, compassion reduce so much of a human’s fight-flight reflex, even in major medical pain, that this has been shown to heal surgeries faster. Pain and bodily trauma create enough fight-flight that the brain stem often shuts down the immune system, for one.  Compassion helps it come back online. “Let a wounded soldier talk to his mom and he’ll require 50% less pain meds,” says Dr. Bruce Perry, MD.

But could it be necessary or work well in schools?

History of Trauma-Informed Care (TIC)

IMAG3253 Dana w. Youth LeadersTIC goes back to 1994 when the federal Substance Abuse and Mental Health Services Administration (SAMHSA) began to study the remarkably high rate of women in the mental health system with histories of physical and sexual abuse trauma. It became clear that, since such clients came in already pre-traumatized, providers should be mindful lest their own practices and policies put the women in danger, physically or emotionally, or lead to re-traumatization. (Activist Dana Brown with youth leaders.)

These and related studies next showed high rates of earlier life trauma in clients seeking services for substance abuse, domestic violence, child welfare and many other areas. In 2005 SAMSHA created the National Center for Trauma-Informed Care (NCTIC) to assist all public programs to implement Trauma-Informed Care, not only in mental health, but in all services including criminal justice and the education system. [FN 2]

“NCTIC seeks to change the paradigm from one that asks, “What’s wrong with you?” to one that asks, “What has happened to you?” says SAMHSA. “Trauma includes physical, sexual and institutional abuse, neglect, inter-generational trauma, and disasters that induce powerlessness, fear, hopelessness, and a constant state of alert…often resulting in recurring feelings of shame, guilt, rage, isolation, and disconnection.”

It’s impossible to successfully  treat human beings in that condition without recognizing this and at least following the principle of “Do No Harm.”  “When a program becomes trauma-informed, every part of its organization and service delivery system is assessed… to include a basic understanding of how trauma affects the life of an individual,”  SAMHSA notes.

IMAG3271 Kids Raise HandsSchools are key, since all Americans are supposed to spend 13 years there. “If fixing school discipline were a political campaign, the slogan would be ‘It’s the Adults, Stupid!’,” says Jane Stevens, founder of ACEsConnection;  “More than three million kids are suspended or expelled each year” in the U.S., 3.4  million in 2006 according to the National Center for Education.  “But punishment doesn’t change behavior; it just drops hundreds of thousands of  kids into a school to prison pipeline.” (Above: Kids ask James questions.)

“Instead of waiting for kids to behave badly then punishing them,  trauma-informed schools are creating environments in which kids can succeed,” she says. It’s about re-training the adults to drop their fears and assume that kids are basically good, but something traumatized them, so they act out. Bad behavior isn’t accepted and it is corrected – by a dialog with kids to hear what’s hurting inside, and show them how to address it. “Focus on altering behavior of teachers and administrators, and kids stop fighting and acting out in class. They’re more interested in school, they’re happier and feel safer,” Stevens says. [FN3]

See the Grade or see the Person?

As SAMHSA began trauma studies in 1994, the Adverse Childhood Experiences (ACE) Study (1994-98) documented a shocker:  about 50% of Americans have significant child trauma. The 17,421 HMO clients studied were privileged to be mostly college-educated, have jobs and good health care. Yet more than half had two of ten types of childhood trauma: physical abuse; sexual abuse; alcoholic or drug addict parent; family member in jail; battered mother; parent with mental illness; loss of a parent; physical neglect, emotional neglect;  or verbal/emotional abuse.

The ACE Study compared their childhoods, to whether they later developed life-threatening physical conditions and/or addictions.  “It found that those 10 types of severe and chronic childhood traumas up the risk of adult onset of major diseases. But it also  increases the chances of being violent, a victim of violence and becoming chronically depressed,” Stevens reports in a terrific post on  Cherokee Point El.  “Brain research revealed one reason: the toxic stress of trauma damages the structure and function of a child’s brain. Kids get anxious and can’t sit still; get depressed and withdraw; get angry and fight; can’t focus and stop learning. They cope with anxiety, depression, anger by drinking, smoking, drugs, fighting, stealing, overeating,  and/or becoming overachievers on their way to being workaholics.”

What about not-so-privileged kids?  Child trauma and its mortal results must affect a far higher percentage of kids in low-income areas with less access to nutrition, health care, and on and on.  A huge percentage of American children suffer trauma, bigger than 50% if we knew the real national average.

IMAG3293 Big GroupMeanwhile many of us privileged middle class kids grow up to be teachers,  administrators, and so on. If we’re traumatized ourselves, we can’t feel our feelings– so we believe that considering “feelings” is idiotic.  Instead, we set up schools as a place to tell kids things.  Because adults talked at us, we think it’s adult to talk at kids. We tell kids they are there to listen to information and repeat it back as we want it, ie. “get the grade,” or face trouble. Enough to put anyone into fight-flight. (James Encinas, left, with students, Principal Godwin Higa, activists.)

I’m from that privileged middle class. I often say, “Nobody beat me or raped me; what’s wrong with me?”

IMAG3306 Higa & Crane AOn Feb. 25 this year, I heard Ruth Beaglehole, founder of Echo Parenting and Education, address Echo’s annual Los Angeles meeting. Urging the 150 professionals present to get passionate about raising awareness of child trauma, she said,  “Kids have to live in the real world? Make the real world non-violent and trauma-sensitive!  What about creating places where children can seek safety, where children can come home to people who open their arms, attune to them, and say ‘Tell me what happened today’. ” (Above: Principal Higa helps Cherokee students make origami cranes for charity.)

“Some people define that as a report card and demand, ‘I want to see your grades.’  Enough of these bloody grades!” Ruth said, to audience laughter, including mine. “Why do we accept this?  Why do we accept that that’s the definition of a person — their grades?”

Suddenly out of nowhere I began violently sobbing at my table full of therapists, about 20 feet from the podium.  “I see you,” Ruth said, looking straight at me. “You don’t have to hold it back.” She saw the real person I am, she didn’t need me to fake anything. She was willing to simply be with me in the pain, as Chris Germer said: “Stop fixing, start caring.” Boy did that feel good. [FN4]

I knew I always hated having to go out and get that grade, and it better be above 90 “or else.”  So I did it, but I lived in fear.  They didn’t see me.  I was a widget who had to produce results or there’d be trouble.

Back story? On Feb. 8, 2011, I’d just heard I might have a thing called “attachment disorder.” Late one night I dragged myself to the sink to wash, listening to a CD by Dr. Henry Cloud. He joked about a lady who didn’t like her husband to go bowling: “She’s not old enough to be dropped off at school.”  But it wasn’t funny.  [FN5]

“That’s it: I wasn’t old enough to be dropped off at school,” I journaled, “I was just dumped off.”  Terrified, I slumped in a heap sobbing, clutching a stuffed dog and a soggy toothbrush.  Rising an hour later, I couldn’t even brush my teeth without holding the dog. “I’m really frightened because I don’t know if this hole under my feet ever ends,” I muttered into my pocket recorder.

I didn’t know last February but read later that Ruth was born in New Zealand to prestigious academic parents who didn’t see Ruth, either.  “I baby-sat since age 12, trying to give to vulnerable children what I didn’t get,” she says.  So she took a BA in early childhood ed, moved to LA, got a Masters in family therapy, and grew Echo Parenting into an agency of 23 staff that trains 100 professionals a year in service.

IMAG3308 Trauma SignWhat if Ruth’s right? What if a school’s whole mission were to look at each child and say “I see you”?  “I see you as a human being, I care how you’re feeling today, and I care what feelings and fears you’re bringing in the door.  I care if you feel threatened even before you walk in the door.  I want to get to know you, the real you who is.  That way we can make you feel safe to be here in school.  And then, you’ll really want to learn!”  (One of many posters students did for James Encinas.)

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Kathy’s news blogs expand on her book “DON’T TRY THIS AT HOME: The Silent Epidemic of Attachment Disorder—How I accidentally regressed myself back to infancy and healed it all.” Watch for the continuing series each Friday, as she explores her journey of recovery by learning the hard way about Attachment Disorder in adults, adult Attachment Theory, and the Adult Attachment Interview.

Footnotes

FN1  Christopher Germer, PhD, “Open Heart, Open Eyes: Self-Compassion,” speech to 20th Annual Conference on Psychology of Health, Immunity and Disease, National Institute for the Clinical Application of Behavioral Medicine (NICABM), Hilton Head SC, Dec.2008
Dr. Germer [http://www.mindfulselfcompassion.org/ and http://www.centerformsc.org/ ] is a founding member of the Institute for Meditation and Psychotherapy, a clinical instructor in psychology at Harvard Medical School, author of The Mindful Path to Self-Compassion, and co-editor of Mindfulness and Psychotherapy. His meditation MP3 are here: http://www.mindfulselfcompassion.org/meditations_downloads.php   “Why Self-Compassion is Becoming a Psychotherapist’s Best Between-Sessions Tool,” Dr. Chris Germer interview by  Dr. Ruth Buczynski, Sept 13, 2009 is at http://www.nicabm.com/nicabmblog/can-self-compassion-become-a-portable-between-session-tool/

FN2  The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. Websites on TIC:  http://www.samhsa.gov/nctic/ ; http://www.samhsa.gov/nctic/trauma.asp

FN3  Jane Stevens, ACEsConnection.com and ACEsTooHigh.com:  http://blogs.psychcentral.com/organizations/2014/04/5-reasons-we-struggle-to-be-trauma-responsive-and-why-the-struggle-should-continue/
http://acestoohigh.com/2012/05/31/massachusetts-washington-state-lead-u-s-trauma-sensitive-school-movement/
http://acestoohigh.com/2013/03/20/secret-to-fixing-school-discipline/

FN4 Ruth Beaglehole, founder of Echo Parenting and Education, address to Echo’s annual Los Angeles meeting “Developmental Trauma: Changing the Paradigm,” Feb. 25, 2014

FN5  Dr. Henry Cloud, PhD, “Character Discernment for Dummies, Part 2,” CD, Dec. 6, 2010, www.CloudTownsendResources.com

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Music Therapy and Child Trauma

Vienna Boys ChoirWant to heal developmental trauma in kids?  Create children’s choirs, I wrote last week.   Dr. Bruce Perry says “patterned, repetitive, rhythmic regulation” is what regulates the brain stem, and when it’s not regulated, we can’t truly reach the rest of a child’s brain.

The brain science studies have been done on yoga, meditation, EMDR and so on — not on Bach.  But is that only because those scientists were never given the chance to sing Bach?  Chalk it up to the decline of education.  What if Bessel van der Kolk had sung in the Vienna Boys’ Choir?  (Ok, so he’s from Holland…)  Or haven’t I seen the brain science studies on choirs?  Please leave me a comment!

Plus: there’s a lot of science that shows music helps shape babies in the womb — and keeps them alive when they need it.  Science shows this “medical music therapy” helps people of all ages.  Put this with the fact that children’s choirs have been a keystone of civilization since at least 700BC  [FNO] and we start to see a pattern.

The Music in Your Cells

What we do know is that everybody loves music because every body loves music.  Music is literally built into the human cells, especially brain cells from the hour of conception.  Our bodies physically need it. Infants and children know that instinctively.  “The first music encoded deep within your memory are the earliest vibrations that made you – the rhythms and tempos of your first cells,” writes Galina Mindlin, MD, Columbia University Professor of Psychiatry. [FN1]

“As your cells began to develop with the comforting rhythms of your mother’s heartbeat and the whooshing low frequency sounds vibrating through her placenta and your umbilical cord, these first musical scores began entrainment (two or more rhythms synchronizing into one) in your brain and orchestrating the essence of music for your entire being.  So from your first spark of life, your brain was already establishing the relationship for how music affects you today…

“Newborns can almost immediately show some memory of sounds they encountered in the womb… Before any of us is capable of speaking words, we can recognize changes in notes and rhythmic patterns… Throughout all this development, lyrical and comforting ‘motherese,’ the singsong way in which parents speak to their children, plays a significant role in instilling feelings of calm, safety, and love…

“By only their 14th week, children can distinguish their mother’s footsteps from anyone else’s, and discriminate between their mother’s voice and a stranger’s… At the beach on any given day, we can see a man or woman lying in the sand… listening to the whoosh of waves and the easy hush of wind, smiling like a baby…”

“Music in its most primodial form links our brain to vibrations we experienced as babies that have both long- and short-term effect on our brains’ circuitry.  The core characteristics of music – rhythm, harmony, synchrony, resonance, and dissonance – can affect frequencies in our brain and extend their influence on our hormones, neurotransmitters, and essential enzymes, and can ultimately affect our focus, feelings, moods, motivation” and more. [FN2]

Music Therapy Saves Preemies

Joanne Loewy Sings to BabyDr. Joanne Loewy, Director of the Louis Armstrong Center for Music and Medicine at New York’s Beth Israel Hospital, saves lives of premature babies (and other patients) using music to replicate the auditory environment in the womb. I haven’t asked Dr. Loewy about choirs, but to me this work says worlds about what singing can do to regulate the physiology and thus the brains of kids.   Dr. Loewy sings to a newborn, above. [FN 3]

I first met Dr. Loewy by email shortly after the Beth Israel team she heads published a major study on medical music therapy for preemies  on  April 15, 2013.  First off, I was blown away to learn there exists a Louis Armstrong Center for Music and Medicine  at the top hospital in New York City.  It’s official: music is essential to humans!  [FN4]

I was also delighted when she invited me to see her for music therapy to heal my pre-concious anxieties from being an unwanted pregnancy.  Gosh, she trains music therapists worldwide and teaches  at the Albert Einstein College of Medicine. It was too long a commute from California.  But I started music therapy anyway and it sure works for me.

“By re-creating a womb-like environment through sound and music, music therapy has been shown to deepen infant sleep-state, support infant self-regulation, assist in the stabilization of breathing and heart rates, enhance parent/infant bonding, sooth irritability, re-enforce feeding/sucking rhythms and weight gain, and promote a sense of safety during painful procedures” faced by many preemies,” she wrote.

“Historically, we thought premature infants were best left alone in a quiet, closed incubator with no stimulation,” she told the press when the study came out. “But more recently, we’re seeing that the right kind of stimulation — particularly live, interactive music — can enhance babies’ neurological function and increase their quiet-alert state. . . . the more we can regulate the sound environment, the better they’re going to fare.”  [FN 5]

Dr. Loewy’s team studied  272 infants in 11 hospital neonatal intensive care units (NICUs). They found that live music matched to babies’ breathing and heart rates enhanced feeding and sleeping patterns. Parent-selected lullabies also seemed to promote bonding between parents and babies, easing the stress of the chaotic NICU environment.

The music also lowered parental stress, the study found — which is key, because anxious, fearful, clueless parents produce developmental trauma in their kids.  Parent-preferred melodies and entrained live rhythm and breath sounds enhanced quiet alert and sleep states, suck response, and oxygen saturation in premature infants and also  significantly reduce fear and anxiety perception in parents, they found.

Over two weeks, the 272 premature babies underwent several sessions of two instruments, singing and no music at all.  The instruments and lullaby singing style were intended to approximate womb sounds, said Dr. Loewy.  Two-tone heartbeat rhythms were played on a “gato box,” a rectangular wooden drum.  [Bruce Perry and Bessel van der Kolk speak  extensively on the primacy of the mother’s heart rate in determining fetal brain development. Dr. van der Kolk strongly recommends heart-rate variability regulating therapies for trauma. -kb]

Whooshing sounds [like those in the womb referenced by Dr. Mindlin and I suspect by numerous researchers] were produced by an “ocean disc,” a cylinder containing shifting metal beads.

For melody, parents were asked for a favorite song.  If it wasn’t a lullaby (one chose “I Heard It Through the Grapevine”; another, “Pick Up the Pieces”), therapists slowed it, changed meters to lullaby-like waltzes and adjusted lyrics.

“Lots of times you see parents bopping the baby up and down on their lap, and there’s no purpose to it,” Dr. Loewy said. “You don’t feel the music intention as much as if you have a song that a parent has chosen.”  If parents did not specify, researchers used “Twinkle, Twinkle, Little Star.”  Tempos were coordinated with babies’ vital signs, indicated not only by monitors but also by baby  eye movements and its chest’s rise and fall.

Researchers found that the heart beat gato box, the whooshing ocean disc and the  singing, all slowed a baby’s heart rate, though singing seemed most effective.  Singing also increased the time babies stayed quietly alert.  Sucking behavior improved most with the gato box. Breathing rate slowed most and sleeping was best with the ocean disc. Babies hearing songs their parents chose had better feeding behavior and gained more calories than those who heard “Twinkle, Twinkle, Little Star.” But the “Twinkle” babies had slightly more oxygen saturation in their blood.

“Many NICUs are noisy, or people put on random lullabies that are recorded,” Loewy said. “But it’s not just any recorded lullaby, it’s the power of the parent’s voice synchronized therapeutically . . . and the other two sounds can have a therapeutic benefit.”

———————————
Kathy’s news blogs expand on her book “DON’T TRY THIS AT HOME: The Silent Epidemic of Attachment Disorder—How I accidentally regressed myself back to infancy and healed it all.” Watch for the continuing series each Friday, as she explores her journey of recovery by learning the hard way about Attachment Disorder in adults, adult Attachment Theory, and the Adult Attachment Interview.

Footnotes

FNO  Chorus members in Greek theater were trained in childhood from around 700 BC.  Greek theater always included a chorus, whose members also danced and spoke, but also sang: http://en.wikipedia.org/wiki/Greek_chorus   Both boys and girls were trained to sing: http://www.amazon.com/Choruses-Young-Women-Ancient-Greece/dp/0742515249
Greece and Rome founded many children’s singing schools: http://www.boychoirs.org/library/history/hist014.html
The Schola Cantorum in Rome was formed in the seventh century to train boys in reading and singing.

FN1  Galina Mindlin, M.D., Ph.D is Assistant Clinical Professor of Psychiatry at Columbia University College of Physicians and Surgeons, and Supervising Attending Physician at the Department of Psychiatry in St. Luke’s Roosevelt Hospital Center.  She is Board Certified in psychiatry and neurology.  See also: www.nicabm.com/nicabmblog/what-healthy-brains-sound-like-how-brain-music-therapy-is-helping-first-responders/

FN2  Mindlin, Galina MD, PhD, “Your Playlist Can Change Your Life: 10 Proven Ways Your Favorite Music Can Revolutionize Your Health, Memory, Organization, Alertness,”  Sourcebooks, Inc., Naperville, IL, 2012

FN3  Joanne V. Loewy, DA, LCAT, MT-BC,  is Director,
Louis Armstrong Center for Music & Medicine,
Beth Israel Medical Center, New York, NY  Websites:
http://www.musicandmedicine.org/ and http://www.facebook.com/ArmstrongMusicandMedicine
She is also Co-Editor-in-Chief, “Music and Medicine” www.sagepub.com/journals/Journal201929

FN4  “The Effects of Music Therapy on Vital Signs, Feeding, and Sleep in Premature Infants,” Joanne Loewy,  Kristen Stewart, Ann-Marie Dassler,  Aimee Telsey,  Peter Homel
Online April 15, 2013; hard copy in May 2013 Pediatrics.
Abstract: http://pediatrics.aappublications.org/content/early/2013/04/10/peds.2012-1367.abstract
Full Text in PDF: http://pediatrics.aappublications.org/content/131/5/902.full.pdf+html
SUMMARY:
What’s Known on This Subject:
Recorded music, parent voices, and sung lullabies have been shown to increase oxygen saturation, nonnutritive sucking, and weight gain in premature infants.
What This Study Adds:
Parent-preferred melodies and entrained live rhythm and breath sounds can enhance quiet alert and sleep states, suck response, and oxygen saturation in premature infants and significantly reduce fear and anxiety perception in parents.

FN5  Pam Belluck, “Live Music’s Charms, Soothing Premature Hearts – Preemies and Sound,” New York Times, April 15, 2013, www.nytimes.com/2013/04/15/health/live-music-soothes-premature-babies-a-new-study-finds.html?_r=0
Maureen Salamon,  “Lullabies Soothe Preemies, Parents Alike,” Philadelphia Inquirer, April 15, 2013 [webpage removed]

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