Trauma, Brain and Relationship Helping Children Heal
From NEURONS TO NEIGHBORHOODS
Second Annual Conference
Interview with Marcy Axness, Ph.D.
DR. AXNESS, FOR REFERENCE CAN YOU STATE YOUR NAME, PROFESSION, AND WHERE YOU PRACTICE?
I'm Marcy Axness, and my specialty is early human development. I practice in the northern San Fernando Valley, Granada Hills, and in Los Angeles.
DR. AXNESS, FROM YOUR PERSPECTIVE, TELL ME ABOUT THE TERMS MALATTACHMENT AND SELF-STRUGGLING.
We know now that attachment is not just this sort of kind of nice, abstract, social, emotional construct that we have thought it was for so many years. That it's actually biological. That when a mother holds her baby and they coo at each other and they go back and forth that it's a highly precise and regulated dance, an interaction dance. The brain of the baby is shaped through this. So just like her mother's milk is nourishing the body and building the tissue and the bones, the attachment relationship is building this baby's brain, especially the portions of the brain that deal with emotional relationship.
The attachment relationship is literally building the sense of self of this child, to the extent that one of the most famous people in the field, Allan Schore, titled his landmark work "Affect Regulation and the Origin of the Self." That's where the idea of malattachment comes in. It's a form of nourishment. It is nourishment for the developing self. Anything less than the optimal is malattachment and then you're going to have a self-struggle, because you're seeking, the baby or the child, is seeking to find herself or himself in the eyes and in the dance between the mother and the child. There's a struggle there if it's not attuned right.
WHAT HAPPENS WITH ADOPTION? HOW DOES THAT INTERACTION GET DEALT WITH OR IS AFFECTED BY ADOPTION?
Adoption is a very complex issue. Let's just start with the basics. In adoption, you generally have prenatal relational trauma. You have usually a mistaken conception, which we are now beginning to understand carries its own legacy of self-struggle in the earliest days of creation. Then you have a very stressful pregnancy usually, which is absolutely shown in mounting literature to be negative impacting on the developing brain, the developing fetal brain and on pregnancy outcomes. Usually the mother is denying the pregnancy. Very often denying the pregnancy until later on. Sometimes there's abortion thoughts or abortion attempts. This is all falling under the rubric of prenatal trauma, which there's a growing field that is recognizing and mounting research is showing, that that is where the beginnings of malattachment happen.
In adoption you've got a baby who's suffered a stressful pregnancy already, and then at birth what happens? Separated from the mother at birth. Again, there's tremendous literature to show that this is a severe trauma. So in situations where there has been trauma at birth or after birth, very often if there's an awareness of that, we can deal with it. But in adoption, what complicates dealing with it is we have a societal attitude towards adoption that it's sort of the happy/happy, win/win situation for everyone. So we're pretty loathe acknowledging that this child comes with a whole series of losses, because there's also parents who come with a series of losses. Infertility, that's a tremendous trauma, a tremendous loss. There's often a lot of insecurity on the part of the adoptive parents, and they've got this traumatized baby, and the baby's crying, and then the mother feels, "oh, I'm not good enough", and it can go into a downward spiral of malattachment.
HOW, IN TERMS OF YOUR TREATMENT, DO SOME OF THE TREATMENTS CHARACTERIZE THEMSELVES, FOR INSTANCE, IN ADOPTION?
In adoption, one of the best things that can happen is pre-adoptive counseling. First of all, for the pre-adoptive parents to start to look at their infertility, to start to really understand adoption doesn't cure infertility, and you'll always be infertile. To start to educate them about the issues that this child is going to come with, that this child comes with a history, this child comes with a story. So that when that child is grieving and crying or maybe not crying at all, the mother can step out of her pain and say, "Ah, I know you miss your connection", "I know I don't smell right", "I know I don't heartbeat right", and "I know I don't just feel right in general, but I'm here for you and I'll hold you." To create a holding environment for that baby, it's about relationship.
The importance of being seen can't be overestimated. It's really what the attachment relationship is built on. I believe it was Rilke, the poet, who said, "Face to face with you I am born in the eye." That's what happens in the attachment relationship. The baby is mirrored back. Donald Winnicott wrote about mirroring. It's Winnicott who said, "The baby's first mirror is the mother's face." It's through the mother's face that the baby sees, "Ah, I'm delightful, I'm wonderful, I'm worthy of love." When that's missing, and it is missing a lot of times due to maybe the mother's own developmental history, maybe she wasn't seen. You get sort of a generational effect of not being seen. Then we go through life trying to be seen in admiring looks from others or from our bosses. It's really the power of being seen.
The invisibility issue begins also in the womb: An unacknowledged pregnancy, a denied pregnancy, saying, "I will not be pregnant." A dear friend of mine, she was just getting her acting career going again when she got pregnant with her second child. She denied the pregnancy. She was tiny, so she could. She thought, "I will not be pregnant." This little girl, although loved and everything, the mother came to accept the pregnancy and embrace her. This little girl has flaming red hair and she is loud, and she will not be overlooked. These early experiences weave themselves into our personality.
YOU REFER TO DEVELOPMENTAL ISSUES. WHAT DO YOU MEAN BY THAT?
I like to apply an adaptive lens when we look at let's say attachment disorder or personality disorder. When you have a situation where there is malattachment, where that nourishment of the attachment relationship has been lacking in one way or another, it can be one of a million ways. What happens is you'll end up with something that may, down the line, be diagnosed by the DSM4 as narcissistic personality disorder or borderline schizoid, or whatever. If you look at the literature, it's tremendously ambiguous. There is no area as rife with ambiguities and imprecision as personality disorders. So to me it's helpful to just look at it in an adaptive way. I mean these are brilliant psychic adaptive mechanisms for dealing with the rejection, the abandonment, and the abuse that is inherent in malattachment. I call them defensive personality styles.
Rather than personality disorders, I like to use the term personality styles or defensive personality styles. This is a scheme, a psychic scheme. It's brilliant what this developing being came up with to cope with the lack of attachment, to cope with the malattachment that they were experiencing. Alice Miller, the famous psychiatrist, I guess it was she who said, "I view personality disorders less as a disorder and more as a tragedy." That brings a more compassionate, and I think more helpful, way to look at it. We go back and say, "Well, what were they adapting to?" It leads us back to what needs to be changed, rather than applying a label.
IN THE MATERIAL THAT YOU HEARD TODAY, OR IN THIS KIND OF CONFERENCE THAT FOCUSES ON CHILDHOOD TRAUMA AND NEUROBIOLOGY, HAS IT AFFECTED YOUR WORK? WHAT DID YOU THINK OF THE MATERIAL, IN RELATIONSHIP TO YOUR WORK?
I think one of the most exciting things that I heard Bruce Perry talk about was the therapeutic web, that one hour with a clinician is not going to make a significant dent in what has been a lifetime of sort of malattachment or relational trauma. Instead let's educate the important people in this person's life so that they can be there for that person, child, and teen, in a more connected, healing way. I'm really excited about the idea of life, daily life becoming more healing, as opposed to a compartmentalized adjunct to what we do.
Another really exciting thing that I heard, because I am a real believer in Waldorf education, is that what Bruce Perry was describing as therapy, sort of from the ground up, beginning with these very basic brain stem base experiences, he was describing a Waldorf education.
YOU TALKED ABOUT ADOPTIVE PARENTING. IS THERE SOMETHING YOU WANT TO SAY ABOUT THAT IN TERMS OF PRENATAL HEALING?
The most important thing that I think I can say for prenatal healing is the single most important thing that parents can do to optimize the development and success of their child is to decide to have a child and want that child. There's research to show that planned conceptions have a list of better outcomes than mistaken conceptions. I mean that's the first and foremost. We need to educate and support pregnant women. Our society will change when we change our attitudes towards mothers, when we support them, when we provide them beauty and inspiration for their pregnancies. The ancient spiritual traditions knew this, and the most cutting edge science is now bearing it out. We just need to bring this to the people.
GREAT. THANK YOU MS. AXNESS.
(END OF INTERVIEW)
Stan Tatkin, Psy.D. - Psychotherapist
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