The best talk I have ever heard. She presented her investigative reporting about a boy named Enrique who fought incredible odds to find his mother in the United States. He traveled through five countries, as a twelve-year old, in search of his mother. As Ms. Nazario says, storytelling is the best way to help people understand, and indeed, she told an amazing story. What was gripping and sad about her tale was that she mirrored his journey, herself, so that she could convey the determination and the tenacity that these children, these young people, who cross multiple borders in search of a parent. Her emphasis on wanting to tell Enrique’s story, mirrors my daily attempt to understand my patient’s story. It is through understanding the narrative, the tale, that we connect as human beings, and we reach out to each other. If we do not take the time to understand the story, then we miss out on understanding the common humanity. I cried and cried as she illustrated the danger that Enrique faced, day after day, and yet he persevered, and yet she persevered in parallel. Sonia first told her own immigrant story, and then told Enrique’s story, and at the end she tied them together, as if they were one tale, as if there were more commonalities than differences. She was right. The deeper you dig, the more the differences drift apart. Rarely, am I that moved by one speaker. Sonia Nazario did that for me.
“Toxic stress response can occur when a child experiences strong, frequent, and/or prolonged adversity—such as physical or emotional abuse, chronic neglect, caregiver substance abuse or mental illness, exposure to violence, and/or the accumulated burdens of family economic hardship—without adequate adult support. This kind of prolonged activation of the stress response systems can disrupt the development of brain architecture and other organ systems, and increase the risk for stress-related disease and cognitive impairment, well into the adult years.”
Parents may facilitate development, but more likely they need to “get out-of-the-way,” as I like to say. Getting out-of-the-way means protecting kids from what is now labeled as “toxic stress”. Children are biologically programmed to develop and mature, and with a basic environment of positive affirmations, good attachments, and provisions for food, sleep, friends, and education, most children and grow and flourish and reach their biological potential. However, in the face of tension, violence, or deprivation, then the child must go into what I call “brain freeze” and this stunts the development of the brain, in terms of understanding and knowing how to please oneself. Psychotherapy steps into to deal with toxic stress, but this requires many hours of trying to understand what happened in the preverbal period, where most memories are implicit and not explicit, Uncovering the trauma, so the adult can return to the developmental train where they learn to love themselves is a lengthy process, involving struggle and psychological pain.
Emily, fifty-six, youngest of eight children, always felt like she was a “burden” and consequently, never experienced love from her mom. As a result, Emily spends her time feeling angry, at little things and big things. She is angry with her husband, her children, her friends and her co-workers. She collects all of their misdeeds and she stew over them, simmering with ill feelings day in and day out. By Emily’s account, all of these people in her life are trying to make her feel better. I suggest an alternative viewpoint that Emily is really angry at her mom, for depriving her of a loving environment, and now that anger is transferred on to the meaningful people in her life. “It is a struggle for me to see that,” she says, as she cries. “The struggle is a good one,” I say, highlighting that understanding projection is a struggle, and it is hard to see when a feeling is being displaced. “The struggle implies that you are trying to see another point of view, and in that angst, there will be growth and understanding. Emily’s toxic stress hit her pretty hard, such that the only way she can handle a feeling is to throw it out to someone else and then feel victimized by that feeling, rather than owning that feeling and then trying to metabolize it. The toxin is the neglect. The anti-toxin is her awareness of it.
“He told me he was sorry for what he was doing. He was willing to die,” Tuff told ABC. Antoinette Tuff demonstrates the power of human connection in preventing antisocial behavior. She approached Michael Hill, an almost school shooter, with dignity and compassion, thereby preventing an enormous tragedy. Ms. Tuff gave Mr. Hill and ear, a compassionate audience, allowing Mr. Hill to reflect on his behavior before he proceeded to hurt innocent children. This story illustrates the value of human kindness in the prevention of serious human destruction. It parallels the work of psychotherapy, where human to human understanding helps people think about their behavior, rather than act impulsively. There is no checklist, or automated treatment, but rather a sense of understanding human suffering, because, as Ms. Tuff, explained to Mr. Hill, she too, has gone through hard times. This remarkable empathy led to heroism that was celebrated by President Obama. I imagine that instinctively, Ms. Tuff knew, that if she could see this 20 year old gentleman, as a man in pain, and not a horrible murderer, then she had a chance to help him. Her instincts proved right, as she was a compassionate person, believing that with a little self-revelation, she could change the course of history. It seems to me that she saw Mr. Hill as a man looking for help, but not knowing how to ask for it, and so she supplied an ear, giving him the intervention he needed, but did not know how to elicit. This story should be our model for how to help the mentally ill. They need understanding and caring, and sometimes, not all the time, this simple modality, will prevent violent behavior.
Accidents at home, leading to children dying keep happening, despite media attention and legal action. Cords are dangerous for children. Even cords within the blinds hurt and kill children. As a Child Psychiatrist, as a human being, I want to use this media to encourage folks to be mindful of household dangers. Prevention goes a long way.
Shirah Vollmer MD 