Last week I took an amazing course at the Cape Cod Institute. The course, taught by Francine Lapides, was entitled "Keeping the Brain in Mind." Over the week, extensive evidence was offered to show how a parent's attunement with her child's emotional experience, or her ability to, as I have referred to elsewhere in this blog as "holding her child's mind in mind," leads to a capacity for emotional regulation and healthy emotional development at the level of structure and biochemistry of the brain.
At the end of the course, I rewrote a clinical vignette from an earlier blog post, Holding a Child in Mind, incorporating the language from the course. A very brief discussion of the structures of the brain responsible for regulating emotions will be necessary to make sense of the new piece, which follows below.
The medial prefrontal cortex(MPC), which is made up of the orbitofrontal cortex and anterior cingulate gyrus, is primarily responsible for emotional regulation. When a person has a well developed MPC he experiences a sense of emotional balance. He can feel things strongly without being thrown into a state of chaos.
The amygdala, the structure referred to by trauma researcher Bessel van der Kolk as the “smoke alarm of the brain,”, connects directly to the hypothalamus, which in turn connects directly with the parts of the body, like the adrenals, responsible for the release of these stress hormones, the hormones that lead us to experience the physical sensations of stress. Lapides describes how the medial prefrontal cortex, by virtue of its location, wrapped around the amygdala, literally hugs the amygdala. It serves to regulate and control the smoke alarm.
When these connections are not well developed, intense emotions are not regulated. In the face of difficult feelings a person may be flooded with stress hormones. He may become completely overwhelmed and unable to function. Thus in the face of fear, for example, with a well developed MPC, a person will experience the feeling, but his hormonal response will be turned down by the MPC so that he is not overwhelmed or paralyzed.
If, on the other hand, he does not have a well developed MPC, the amygdala will go off and he will be flooded with fear that he cannot manage. When the amygdala acts unopposed in this way, it impairs a person’s ability to make use of the higher cortical centers of the brain, meaning that he cannot think clearly in the face of overwhelming distress. In fact, the amygdala is overactive in PTSD and all anxiety disorders.
When a parent gazes into her baby’s eyes, she literally promotes the growth of her baby’s brain, helping it to be wired for a secure sense of self. The MPC has been referred to as the “observing brain.” It is where our sense of self lies. When a mother looks at a baby in a way that communicates with him, not with words but with feelings, “I understand you,” he begins to recognize himself, both physically and psychologically. This mutual gaze, literally and figuratively being “seen,” actually facilitates the development of the baby’s brain. As the MPC matures in this kind of secure loving relationship, the brain is wired in a way that will serve him well for the rest of his life. He will be able to think clearly and to regulate feelings in the face of stressful experiences.
The story of Sam and Jane illustrates the way in which supporting a parent’s efforts to hold her child in mind may actually promote the healthy development and growth of her child's brain.
Sam burst into the office, a two year old wild little bundle of energy. Squealing with delight, or was it distress-it was hard to tell- he ran from toy to toy not looking at me or his mother, and seemingly unable to engage with anything. His mother had brought him to see me in my pediatric practice because “he hits me, has explosive tantrums and I can’t take him anywhere.”
Jane sank into the couch in a way that suggested she was feeling discouraged and dejected in her role as mother. She needed to be heard. I sat on the floor, wanting to listen to Jane, but also to include Sam in the visit. At first, I focused my attention on her story, while Sam continued his frantic exploration of the room. Things had not been easy for her. Sam’s father had abused her and was no longer involved in thier lives. Jane was afraid when she felt Sam’s anger that he would turn out like his father. Of her own mother she said, “She was never there for me”. Jane was frustrated and bewildered by the fact that Sam could relate to other people, but seemed to reserve all his difficult behavior for her.
At the beginning of the visit, Jane made several awkward attempts to interact with Sam, but without success. She was anxious and her body language felt intrusive, which seemed to cause Sam to withdraw. However, as she opened up and shared more of these difficult, painful feelings with me, an interesting transformation occurred. Jane’s whole body relaxed and she leaned forward on the couch toward Sam. Sam, in turn, began to engage in more focused play. Jane and I talked about what Sam was doing, observing together how he was calming down. At first he talked to me, bringing me toys and naming them and describing what he was doing. But then he spontaneously ran over and gave his mother a hug. Her pleasure and relief were palpable in the room.
Sam began to engage her in his play, and to communicate with her. It seemed as if the very act of being held in mind by his mother served to calm him down. He could feel her thinking about him. She looked directly into his face, speaking with him in a soft intimate way. They were engaged in a private dance. As I observed this scene, I literally felt as if I was watching Jane growing Sam’s brain. By holding him in a loving way that reflected her recognition of him, I thought that I could see the projections forming from the MPC and reaching down to hug his amygdala.
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 research in child development 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.