Healing Transgenerational Cascades of Distress in Disadvantaged Indigenous Communities; Challenges, Opportunities, and a Case Study.

Here is the abstract for a paper that will be published over the next few months. A copy of the full text is available if  you e-mail me at <leon.petchkovsky@gmail.com>

Healing Transgenerational Cascades of Distress in Disadvantaged Indigenous Communities; Challenges, Opportunities, and a Case Study.

Leon Petchkovsky 1 , Rachel Johns 2

 1 Associate Professor Psychiatry,  Department of Psychiatry University of Queensland, Brisbane, QLD, Australia, 2 Mental Health Worker, Community Mental Health Services, Lismore, NSW, Australia

ABSTRACT:  Aboriginal Australians especially in disadvantaged communities suffer disproportionately; with reduced life expectancy, high suicide, violence, and imprisonment rates, and a range of illnesses (Metabolic Syndrome) associated with Hypophyseal Pituitary Adrenal (HPA) Axis damage resulting from high maternal and infantile stress.  Foetal Alcohol Spectrum Disorders, Attention Deficit Hyperactivity Disorders, Conduct Disorders and Learning Disorders are prevalent in the child population.

A substantive developmental neuro-psycho-biology research literature points to the centrality of early nurturance processes in facilitating the development of physical and psychological health and resilience.

The larger Australian community has failed to provide adequate repair despite interventionist programs deployed over many years.  The authors argue that this rests in part on a lack of mindfulness (awareness of one’s own processes) and empathy (tuning into others), at every level: cultural, political, organisational, and individual.

Dan Siegel’s neuro-developmental insights into individual and organisational function are used to explore these concerns, and identify early (peri-natal) supportive intervention (nurturing the nurturers) as the most central strategy of repair.

But damaged nurturers are very sensitive. Attempts to nurture them can be counterproductive if political programmes, organisational cultures, and individual case workers themselves have not developed sufficient mindfulness and empathy to address these sensitivities. Recent advances in developmental neuroscience help fine-tune this process. Guidelines are offered, with an illustrative Case Study.

 KEYWORDS: nurturance, attachment, disadvantaged, developmental neuroscience.

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Some change at last,

In conversation with Bev  Allen and Mel Watson at the August 2014 Child Trauma Conference in Melbourne, we learned about Babes to Bumps and Beyond  and listened to their presentation (Allen and Watson 2014).  This program has been going for 2 years, was initiated and maintained by local Aboriginal communities in the Mallee region of Victoria,  and informed by the latest understanding of attachment theory and developmental neuroscience. This is precisely what is needed nationally to begin the transgenerational healing process we support so strongly.

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a fractal view of nurturance

Empathy and mindfulness facilitate impulse control and make for both kindness and good limit setting.
A range of interventions (meditation, psychotherapy) can boost these, but they involve much hard work, essentially because of our ingrained resistances, which have much to do with the core unsatisfactoriness of human existence (the Buddhist “First Noble Truth”). If it were easier, we would all Dalai Lamas.
However, a good start in life helps a lot. As I have said so often before, developmental neuroscience tells us that “good enough” early nurturance makes for more mindful and compassionate beings. Babies and children find it hard enough to begin this developmental work, even with good nurturers. But various forms of nurturance failure, reactive attachment disorders, make things so much more difficult. Many of our interventions, no matter how well meaning, no matter how necessary, thus come too late.

But one of the lovely things about empathy is that it has a reverberating effect, a fractal “similarity across scale” property.

We recently treated a severely abused young Indigenous woman who was pregnant. A “reflective listening” engagement helped her develop a useful therapeutic alliance, and allowed us in turn to extend this to interactions between her and her new born baby girl. The successful bonding in turn gave the mother further vicarious repair.
We ourselves received support from regular videolinks with a tertiary perinatal service (SWOPS…Google it). This spread across the various members of the team…..midwives, obstetrician, post-natal workers, mental health workers, who could thus “sing from the same page” in their empathic care of the mother and baby.
The mother stopped drinking and using cannabis early on. HER mother, who had a severe drink problem, also gave up (without ANY prompting on our part) so as to be a better supporter for her daughter and grand-daughter. The relatives who used to come to the house and get drunk and violent also moderated themselves, again, without ANY prompting.
Fractal patterns everywhere. Now if ONLY this could spread further. Our politicians perhaps?

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Dr John Boulton is a pediatrician who has been working in Aboriginal communities for many many years. An article by Nicholas Rothwell in the Weekend Australian (June 1-2, 2013) reviews some of this work. 

In essence , (and I quote from Nicholas’ article), “if an unborn child is malnourished in the womb “….( but also if the mother is subject to high stress levels, and also if she overdoes alcohol and drugs because she feels so miserable)…..”blood is directed as the first priority  to the brain, leaving the kidneys and other organs insufficiently developed……the child will grow up with a degree of insulin resistance”….(but  also more broadly, with HPA Axis dysfunction…AND Metabolic Syndrome, which are explained in detail in earlier posts on this blog)……”This in turn leads to early-onset diabetes……..(and) the child will have a propensity to high blood pressure, heart disease, stroke and eventual kidney failure”.

Key signs in young kids are a combination of poor growth plus a tendency to put fat on in the middle of the body. 

But the psychological effects are also dreadful…ADHD, poor impulse control, chronic dysthymia (feeling miserable), learning difficulties  etc…again, I have detailed this in earlier blogs. 

 

The whole point is, IF WE COULD ONLY GET IN EARLIER, and protect and nurture the mothers, we would spare each generation from the dreadful consequences.

 

WE NEED TO DEVELOP WAYS OF NURTURING THE NURTURERS. 

 

 

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what relevance does the fMRI study have for nurturance?
Well, the things that light up are the so-called “resonance circuitry” or the “shared circuitry”. This is the mirror neuron/self-awareness/self-monitoring circuitry, that mediates mindfulness and empathy……..the very stuff that develops properly if you get good enough nurturing…..and that doesn’t do so well otherwise.

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nurturance deniers

Climate change deniers are unwilling to concede that human activities are affecting the planet, despite all the research.
Even if the research were overly pessimistic, this is still such a big issue that we can’t really afford to take a complacent attitude.
Most of us would not let our 5 year old children cross the road unsupervised, even though the risk of them being killed may only be 1 in 100 per crossing. The stakes are just too high.
Ditto with climate warming. If the research is wrong, we haven’t lost much. If it proves right, we’ll eventually lose the planet.

The nurturance issue faces a similar denial process. The science is convincing, but the politicians (and the media) behave even WORSE than the climate deniers. They don’t even acknowledged it, let alone deny it. What on earth does it take to bring this to a wider consciousness????

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fMRI responses to Jung’s Word Association Test. Implications for Theory, Treatment, and Research. Leon Petchkovsky, Michael Petchkovsky, Philip Morris, Paul Dickson, Danielle Montgomery, Jonathan Dwyer, Patrick Burnett.

We are presenting a version of this at the RANZCP Psychotherapy Conference in Sydney (Coogee Crown Plaza) 24th of Aug. 

The research looks at “internal conflict”…how the “Internal I” interacts with the “Internal Other”…what emerges is that the mindfulness and empathy circuits light up.  See the pretty picture.

Details are in the Abstract below. Image

ABSTRACT

 Jung’s Word Association Test was performed under fMRI conditions by 12 normal subjects. Pooled complexed responses were contrasted against pooled neutral ones.  The fMRI activation pattern of this generic “complexed response” was very strong (corrected Z scores ranging from 4.90 to 5.69).  The activation pattern in each hemisphere  includes mirror neurone areas  that track “otherness” (perspectival empathy), anterior insula (both self-awareness and emotional empathy), and cingulate gyrus (self-awareness and conflict-monitoring). These are the sites described by Seigel and colleagues as the “resonance circuitry” in the brain which is central to mindfulness (awareness of self) and empathy (sense of the other),   negotiations between self awareness and the “internal other”.  

But there is also an interhemispheric dialogue. Within 3 seconds, the left hemisphere over-rides the right (at least in our normal subjects).

Mindfulness and empathy are central to good  psychotherapy, and complexes can be  windows of opportunity if  left-brain hegemony is resisted. 

This study sets foundations for further research:  (i) QEEG studies (with their finer temporal resolution)  of complexed responses in normal subjects  (ii) QEEG and fMRI studies of complexed responses in  other conditions, like schizophrenia, PTSD, disorders of self organisation. 

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Michael and Leon

Michael and Leon

My eldest son and I in Alice Springs 2011, preparing for a Bush trip. Michael is an artist with serious computer skills who helps me with brain imaging research. See next post

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Violence in Central Australia

 

Back in the early 70’s, I got a job in Alice Springs Hospital, as an Obstetrics and Surgical Registrar, delivering babies and removing appendices. It must have been infectious, because I’ve found myself returning to the Red Centre ever since.
On my January visit, I learned that a young Aboriginal patient had killed his wife, and this had generated much anguished public discussion, some of it fuelled by the new Country National Party NT Government,  abusing their Labour predecessors for not having provided sufficient Police.
While there is no doubt that a highly visible Police presence can reduce violence in an inflamed community, the problem of recurring violence has more fundamental roots. In essence,  violence is a failure of  empathy. The Bible  reminds us to “do unto others” as we would wish them to “do unto ourselves”, but as with so many Biblical  texts, it is the essence of the meaning, rather than the literalisation of  the written words, that carries the message.  For instance, just because  I  might enjoy Chess, or Cheese, whatever,  that does not give me an excuse to inflict Board Games or Camembert upon innocent others. I need to have an accurate sense of what THEY might actually be feeling.  When I  act violently, I am so driven by my process, that there is no room for awareness of the other’s subjectivity. They may as well be made of plastic. Failure of empathy.
But if failure of empathy is a large component of violence, what can we do to   DEVELOP empathy ? Getting the right genes is not a bad start.  Being female usually comes with empathy circuits that are likely to be better developed than the male ones.  Three areas of the brain are involved; the mirror neurone sites (how we perceive others), the insula (how we experience ourselves), and the cingulate gyrus (how we compare the two).  Child psychiatrist Dan Siegel calls these the “resonance circuitry”, and reminds us they also help us do “mindfulness” (awareness of self-process) and empathy.
But genetic card deals notwithstanding, there is an enormous lot in the environment that helps develop empathy (and mindfulness); a peaceful pregnancy, good accurately empathic nurturance.
We know that a range of nurturance failures (neglect, physical and sexual abuse, poor emotional atunement) produce a range of brain changes and failures of development that result in poor empathy. The brain and hormonal system that manage our arousal levels is usually called the HPA Axis . If that’s impaired, we are easily upset, feel miserable a lot of the time, needs alcohol or drugs to dull the pain, have attentions problems and do badly at school even if we are very bright, have poor impulse control and lash out at ourselves or others. There are also physical consequences like weight problems, proneness to cardiovascular disease and  diabetes. But even worse, because bad nurturance actually affects a range of genes responsible for brain health, these modifications can be passed on to our children (this process is called “epigenetics”).
This transgenerational cascade of misery is something that we have been seeing in some
Aboriginal communities for decades, and goes some way towards explaining the high levels of violence and distress (not that this is confined only to Aboriginal communities).
The biggest help  we could give is providing safety and support for young mothers, during pregnancy and those vital early years of nurturance………nurturing the nurturers. This is actually quite a delicate task, and requires well developed empathy skills on  part of the supporters (including cultural sensitivity). But we are not likely to see its impact on the coming generations for 10 to 20 years ( at least in ways that can be picked up by government statistics). It therefore makes it difficult for politicians with their narrow “next election” horizons to offer much support……..much easier to blame the previous mob for not providing enough Police.

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Monkey see monkey do; the mirror neurones

 

In the 1990s, a Macaque monkey lived in a laboratory at Parma University, in Italy. Let us call him Mario. Even though Mario was a monkey, his job was to serve as a Guinea pig for a bunch of neurophysiology researchers led by Dr Giacomo Rizolatti and Dr Leonardo Fogassi. They had placed tiny electrodes in his brain, to see what happened when he reached for a banana. One day, one of the humans picked up a banana, and Mario’s neurones fired off in the same pattern, as if Mario himself had picked it up.

Giacomo and Leonardo initially thought something had gone wrong with their equipment. They repeated the experiment many times, getting the same results, finally coming to the conclusion that Mario’s neurones fired off not only when he reached for a banana, but when he saw someone else (including a human) reach for a banana.  This was the birth of the “Mirror neurone” concept. Not only does the brain do a certain firing pattern whenever it performs an action, but it fires the same pattern when it observes another being doing it, acting as a “mirror” of the other’s action. The discovery was initially sent to the prestigious journal, but was rejected for its “lack of general interest”.

We live in exciting times. The last 2 decades have seen an explosion in our understanding of brain function, and hundreds of experiments, in animals and  humans, have confirmed and extended mirror theory. We now know that there are mirror neurone sites not only in the motor areas (having a sense of what others are doing), but in the sensory cortex (what it feels like for other  beings).

We also know that the mirror neurones link up with other (emotional) areas of the brain so that we can not only track ourselves, but also track other beings. One word for the first activity is mindfulness.  One word for the second activity is empathy.

Thus for the first time in human history, we are starting to get an understanding of brain processes underpinning  these two important social functions. Without empathy, we cannot nurture our babies (or anything else much). Without mindfulness, we cannot track ourselves, and act like robots.

Unless we develop our capacity for nurturance and empathy (for everything, not just our narrow social groups), social unrest, ethnic tensions, and  wars of various kinds will worsen. And the environment will continue to deteriorate.

This column’s purpose is to act like a little mirror neurone, reflecting advances in the brain sciences  to do with empathy, mindfulness, and nurturance, and their implication for social well-being and politics,  to engage  the reader’s mirror neurones and stimulate a nurturing dialogue.

Last week, I went to an amazing Neuroscience Conference at the University of Queensland’s Brain Institute. Two of the international keynote speakers were Christian Keysers and his 6 month pregnant wife Valeria, world-leading researchers in the neuroscience of empathy. What warmed my heart even more than the material presented was that both Christian and Valeria were delightfully empathic beings who obviously took their research to  heart in the way they related to others. Next week’s column will report on some of the findings of the Conference, and how they might apply to our daily lives.

And finally, what of poor Mario ?  My mirror neurones pained at the thought of all he had to endure in the laboratory, as  did yours.  And yet, my mirror neurone activities are my patterns, not Mario’s. I see the world through  my “brain-glasses”, and they can distort the view. More of this later.

 

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