I don’t remember exactly my “Eureka” moment. For sure, it was not in a bathtub like Archimedes. My “a-ha” came more recently while dry behind the ears. At the time I was in a private practice doing what pediatricians do. The discovery was that most everything I was doing in my office was wrong. The problem was not treating asthma or rashes. It was how I executed the time-honored well-child care (WCC) visit.
In the fleeting moments between the exam and the shots, my conversation with the parents usually was filled with platitudes and medical jargon. Well visits were boring. The monologue was stale. I said nothing lasting.
Further, I knew zero about the mother, father, or family. I had no clue about the person in the exam room with me. What kind of parents were they? How did they handle a screaming kid? What made them tick? Did they know love? Personally, knowing anxiety and depression, I worried about the parents in my practice. Were they equally struggling with their moods? How did it affect their parenting? Because I knew what a pain in the butt these conditions were, I wanted to help anyone with the same challenges.
“When the student is ready, the teacher will appear.” Perhaps it was the glowing embers of burnout. Whatever the igniting spark, I was ready. The teacher who appeared was Dr. Richard Ferre.
Proponents of “attachment”
Richard C. Ferre, MD, is the former chairman of the Department of Child Psychiatry at the University of Utah School of Medicine and Primary Children’s Hospital in Salt Lake City. He opened my mind to real pediatrics. The converting scripture was Daniel J. Siegel’s The Developing Mind.
Siegel’s book, one of many he has authored, introduced me to a brand-new world. It was as if I had followed the White Rabbit down the hole falling into an amazing wonderland. From its pages, I met Dr. John M. Bowlby, the godfather of child attachment theory. His work began with the millions of orphaned and displaced children after World War II. He continued to formulate his thinking, borrowing the studies of children forced to be alone by the British “stiff upper lip” policy during prolonged stays in the hospital. Bowlby was familiar with Konrad Lorenz and his imprinted gaggle of goslings. He added to his theory the behavioristic research of Harry F. Harlow of young primates clinging to the terry cloth “mother.” From this emerged the articulation of a secure base. Mary Ainsworth, Mary Main, and a pantheon of other thinkers and doers of the child and parent relationship became my heroes.
Attachment is the keystone
Archimedes by water displacement figured out the king’s crown was not pure gold. I discovered the gold. It is human attachment. The parent bonds to the child. The child attaches to the mother/father. The word “security” jumped out from the pages blinding me. It clarifies everything. The lack of security explains my own state of mind. Security and insecurity describe human behavior. Attachment’s propagation through the generations is the essence of parenting. Its absence in the pediatric WCC-visit curriculum is the missing keystone for caring for children.
The message to every new parent is their power to influence their child’s brain development. Nurturing is essentially the positive repetitive task of managing energy—in the vernacular, stress. It follows that it is critical to uncover his or her child’s mental model to handle tension. One of Dr. Ferre’s pearls was, “The job of the brain is to process information and manage energy.”
Attachment is now my practice and personal mantra. Mindfulness follows. My WCC agenda is to help every parent understand his/her mental model to deal with stress; ie, the child. To understand the parents’ intuitive behavior, I ask them to share their most frightful memories of childhood. Their brains draw from their nonverbal hemisphere stories that reveal a hidden clue to their stress energy management. It is the internal blueprint they use to deal with their child. A non–story is a story of avoidance.
The one question “What is the scariest thing you remember in your childhood?” is the revelatory key to open the mind. Over the years it has revealed a treasure trove of tales. The most ordinary parent sometimes has the most extraordinary story. There are the recollections of nightmares soothed by the sleepy parent. Another shared narrative is being lost but when found, being soothed with hugs. Tragically, quite a few stories do not have a happy beginning to the nearly 9.5 million minutes from birth to age 18 years. Sadly, there are repeated descriptions of violence or abandonment. Memories of dads pointing guns have been shared more than once. One patient told how her father put a gun to her head when she was about 6 years old. Her mother voiced her own craziness: “Go ahead and shoot. When the police come, they will know what idiot did it.”
Another patient remembered the night the mother said she was leaving, never to return. Today I learned a mother’s terrifying story recalling how at the age of 3 years she phoned the police because her parents were so violent. Imagine being 3 years old needing to know how, then calling the cops. One mother telling her personal history for a brief second transformed into her own alcoholic parent with a louder deeper voice and mean face leaned threateningly toward me.
Knowing the story plus how a parent tells it gives a glimpse into what he or she does when the child comes for succor. The memory prompts rapid, nonspecific, nonspoken reaction. If the parent’s tale is without a secure person, his or her spontaneous action will be more dismissive. “You are fine” is the automatic response. Decreased empathy is the result. The child is on its own. This by itself is not bad. Talk to the self-starters. It is a problem when the emotional skills run out. Avoidance of relationships, loneliness, procrastination, freezing, and fleeing take over.