Neurosciences Conference in Brisbane

 

I am writing this from Alice Springs, where I work once every 2 months.  Expect a column on Indigenous mental Health soon.

But I promised to tell you about December’s  amazing Neurosciences Conference at the UQ Brain Institute.  There were 250 participants. The demographics were as wonderful as the findings.  Most of the researchers were Gen Y’s, 30 or under !!!! with a few  40 year olds, and about 6 older codgers of my vintage. No medical doctors or psychiatrists, apart from myself and another man, and  he  was from the US. And the major theme was how the brain does empathy, mindfulness, and nurturance, and judging by how caringly and warmly participants interacted with each other,  they were “walking the walk”, as well as “talking the talk” of nurturance….very reassuring to learn this about our youngest generation of neuroscientists.

My psychiatrist colleague Dr Kevin Pelphrey, from YaleUniversityChildStudyCenter, specialises in research in Autism and Aspergers in children.  As we know, they struggle to read what goes on in others (facial expression, eye movements, body language). Although “Autism Spectrum Disorders” have a genetic component, the environment, and its impact at various stages in a child’s development,  have a powerful effect. Kevin and his team are interested in finding out what goes on in the developing brain, and have been using Functional Magnetic Resonance, a technique which show which parts of the brain light up (or don’t) when the subject has certain kinds of experiences (like engaging in a range of social perception process, in the case of our autistic kids). And because some of their Mirror neurone sites do not light up  properly, it is important to find out how they activate a range of brain processes, so that we can find ways to help them develop the circuitry that underlies social perception skills.
They showed us some delightful modifications to the FMRI machines to make them much more “infant-friendly”.  They have also started to give the kids sniffs of oxytocin (the “bonding” hormone) during therapy, with strong facilitation  effects (showing up in FMRI findings as well as clinical improvement).

Currently. diagnosis of Autistic Spectrum Disorder is made on the basis of clinical findings, but specific brain patterns are emerging in FMRI studies making it possible to use this to provide more objectivity.

FMRI machines are cumbersome and expensive, but Qualitative  Electro Encephalography (QEEG) is office-based and inexpensive.

The Solstices Clinic at Tweed offers QEEG tests and treatment for autism. I will be featuring  their work soon.

 

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What is MORE important than nurturance?

This must be the most unread blog on Planet Earth.

Is it technical stuff, like choosing a name like watikanyilpai that no-one is ever going to put into a search engine?  Failing to link it with my own name Leon Petchkovsky, or the Pinniger Clinic,  or obvious search words like “attachment” or “nurture” ?

Maybe the writing is tedious ?

Maybe “nurturance” generates an avoidance response ?

 

 

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What is MORE important than nurturance?

I’ve often argued that the political process not only takes very little notice of the importance of nurturance in society (except when pollies hug babies), but seems as if driven by avoidance dynamics.

I’m inviting your reflective responses to the following prompt.
1. Nurturance : a definition ………..what we do in a caring and engaged way with our babies, infants, children, to develop mindfulness (accurate self-awareness) and empathy (kindly awareness of how other beings experience their own subjectivities)…………..by extension, anything we do to encourage mindfulness and empathy, in our relationships with other people, animals, the environment, could also be in the nurturance domain.

2. Is there anything even more important than nurturance for society?

3. If so, name it, and advance an argument for it.

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It’s the grandchildren, Stupid !!

Our population is aging, our Baby Boomers approach the end, as all of us must do eventually.. And as we approach the end, some of our thoughts naturally go to the next generation, no matter how intractably narcissistic we may be.
This blog argues some of the reasons why nurturance is THE most important thing we can do in life. But even from a cynical vote chasing perspective, it baffles me why the political spin merchants have not seized on the aging population’s concerns for the grandchildren. There must be a HUGE vote waiting to be tapped.
If Julia Gillard simply said “You’d prefer to have our grandchildren suffer the consequences?” every time Tony Abbott goes on about the Carbon Tax, he’d have packed it in ages ago.
Ditto with education inequities, the proceeds of the mining boom, the child care debate, health, the environment.
It’s the long term perspective that should be driving the political process, not the latest poll and the next election.
I wish EVERY party (Greens, Labor, Coalition) had a well-thought through, caring, and publicly articulated core policy supporting nurturance/the grandchildren. They could all use the slogan “It’s the granchildren,Stupid”. I would then have enormous problems knowing WHICH one to vote for.

But then, we should all have such problems.

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The Politics of Nurturance

Why isn’t ALP (or the Greens for that matter) making more of Wilkinson and Pickett’s “The Spirit Level” , which argues a powerful empirical case for the way wealth inequality in any society is associated with more violence, obesity, teenage pregnancies, physical and mental health problems, etc etc. Even David Cameron referred to the book in his pre-election speeches.
My own take on this is that it impacts negatively on early nurturance 0 to 4 ,at both ends; the poor and disadvantaged of course, but also the ultra-rich through more farming out of infant care.
Wilkinson and Pickett remind us of course that the “elephant in the room” is the HUGE multinationals, whose incomes and turnovers are often larger than those of entire nations, but whose “governance” is profoundly undemocratic…..to the extent that most shareholders have no real say. W and P recommend MORE worker-owned and managed companies.
Again I am at a loss why the Unions are not pushing for this vigorously, at a time of declining Union membership and influence.

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This meta-analysis says it all

The dreary debate about genes versus environment tends to be especially obfuscated around the nurturance issue, for reasons I’ve outlined earlier in this blog.
Here is a wonderful meta-analytic study by Bentall (and colleagues) himself, a psychiatrist I respect greatly. Check out the stuff below. I’ve cut and pasted it directly from the site.
http://schizophreniabulletin.oxfordjournals.org/content/early/2012/03/28/schbul.sbs050.full
http://schizophreniabulletin.oxfordjournals.org/content/early/2012/03/28/schbul.sbs050.full Schizophr Bull (2012) doi: 10.1093/schbul/sbs050 First published online: March 29, 2012

Childhood Adversities Increase the Risk of Psychosis: A Meta-analysis of Patient-Control, Prospective- and Cross-sectional Cohort Studies
Filippo Varese†,1,2, Feikje Smeets†,3, Marjan Drukker3, Ritsaert Lieverse3, Tineke Lataster3, Wolfgang Viechtbauer3, John Read5, Jim van Os*,3,4 and Richard P. Bentall1
Abstract
Evidence suggests that adverse experiences in childhood are associated with psychosis. To examine the association between childhood adversity and trauma (sexual abuse, physical abuse, emotional/psychological abuse, neglect, parental death, and bullying) and psychosis outcome, MEDLINE, EMBASE, PsychINFO, and Web of Science were searched from January 1980 through November 2011. We included prospective cohort studies, large-scale cross-sectional studies investigating the association between childhood adversity and psychotic symptoms or illness, case-control studies comparing the prevalence of adverse events between psychotic patients and controls using dichotomous or continuous measures, and case-control studies comparing the prevalence of psychotic symptoms between exposed and nonexposed subjects using dichotomous or continuous measures of adversity and psychosis. The analysis included 18 case-control studies (n = 2048 psychotic patients and 1856 nonpsychiatric controls), 10 prospective and quasi-prospective studies (n = 41 803) and 8 population-based cross-sectional studies (n = 35 546). There were significant associations between adversity and psychosis across all research designs, with an overall effect of OR = 2.78 (95% CI = 2.34–3.31). The integration of the case-control studies indicated that patients with psychosis were 2.72 times more likely to have been exposed to childhood adversity than controls (95% CI = 1.90–3.88). The association between childhood adversity and psychosis was also significant in population-based cross-sectional studies (OR = 2.99 [95% CI = 2.12–4.20]) as well as in prospective and quasi-prospective studies (OR = 2.75 [95% CI = 2.17–3.47]). The estimated population attributable risk was 33% (16%–47%). These findings indicate that childhood adversity is strongly associated with increased risk for psychosis.

Adverse childhood events including trauma is a common experience worldwide, with some estimates suggesting that about a third of the general population may be affected.1 Evidence suggests that its effects in adulthood may include a range of negative social outcomes, including higher criminality,2 a lower educational level3 and lower general health and well-being. Adverse childhood events have also been related to a greater risk of psychiatric disorder1,4,5 and, especially given its high prevalence, it is likely that it is an important determinant of mental ill-health.6
A growing number of methodologically sound studies have examined child maltreatment (eg, sexual abuse, physical abuse, emotional/psychological abuse and neglect), peer victimization (eg, bullying), and experiences of parental loss and separation as risk factors for psychosis and schizophrenia. Nevertheless, the association between adverse childhood events and psychosis has been a topic of enduring controversy. Only narrative reviews have so far attempted to synthesize these findings, with inconsistent conclusions.7–9 Therefore, a systematic quantitative synthesis of the existing data is required.
The present study presents a quantitative review and meta-analysis of the available empirical literature, examining the magnitude and consistency of the effects of different, widely-examined types of adversity and trauma observed in: (i) prospective cohort studies, (ii) large population-based cross-sectional studies, and (iii) case-control studies.

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The eyes have it

There was a good article in the March British Journal of Psychiatry by Dadds and colleagues on empathy, psychopathy and lack of eye contact in children. See Dadds et al doi: 10.1192/bjp.bp.110.085720 .
Dadds also appeared on a recent ABC 21 Catalyst program.
In essence, kids with callous-unemotional traits do poor eye contact, and this is independent of maternal behaviour. Interestingly, their FATHERS also tend to do poor eye contact, and score high on the PPI ( Psychopathic Personality Inventory) fearlessness subscale. fMRI studies also show that the kid’s amygdala are also dysfunctional, don’t light up as much as normals.
Now if your brain is Right Wing wired, you will immediately say “see, I told you so, it is all genetic”.
In fact, it is only partly genetic, because you get something similar in orphanage kids, and an article by Rutter in the same issue March issue of BJP discusses this.
But more to the point, even if you could “correct” it with a gene transplant, that is only step One.

Environmental influences would still have to play their part in pushing genotypy to phenotypy (behavioural expression).
And in fact you can do this WITHOUT genetic tampering.
Dadds has a brillliant program which teaches mums (or other carers) to encourage/develop better eye contact in their “callous-unemotional” kids, from a very young age (4 or less !!!). Of course, those of you who have read their Porges (Polyvagal theory…….how the lateral Nucleus Ambiguus part of the vagus is wired into the face and eyes, and therefore influenced by eye contact), or their Dan Siegel (get the eye contact and facial/gestural/prosodic interactions going, and achieve the same effect of encouraging “theory of mind” , empathy and compassion) .. …will realise immediately that there is a lot that can be done simply cheaply and in the here and now, without having to wait for some US company to patent the psychopathy gene.
But how to get this across to the wider public ? The Politics of nurturance indeed.

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Badinter’s Conflict

Do read Anne Manne’s mindful review of Elizabeth Badinter’s The Conflict in the March Monthly.
Badinter’s book is so obviously a projection of her own internal conflict (Career versus Motherhood…….CAREER v CARER if you like) onto the larger world. What is worth noting is that instead of holding the tensions, she insist on a resolution in favour of Career, as if one could not somehow value BOTH.
As I keep reiterating; the quality of nurturance we get in the first 3 years of life largely determines the quality of our social/relational abilities. This in turn shapes the world we live in. Neuroscience research confirms earlier clinical insights into the importance of nurturance and attachment dynamics. There is a torrent of literature. How could a clever author like Badinter be unaware of it, or so dismissive?
Get early nurturance wrong and the survivors end up in prisons, drug rehab and psychiatric systems. Subtler failures may be even more destructive; like the narcissism, avoidant attachment styles and psychopathy that drive our despots and organisational sharks in suits.
Get it right, and you get autonomous and caring people, good at reading themselves (mindfulness) and reading others (empathy)……..Now figure the broader consequences for society and the planet.
Repair is energy-intensive. Prevention has 2 obstacles.
The first is a withering antipathy to nurturance. Badinter’s prejudice exemplify this, as do many of our political and social systems.
Mindlessness is the second. Developing a capacity for effective nurturance is challenging. The last thing the nurturers of this world need is criticism masquerading as the kind of sentimental concern that Badinter is enmeshed in (and most of us, if the media are any guide) . We need to develop our own mindful empathy to better nurture the nurturers . Six months’ National Service in a pre-school child care centre might help. So would deeper discussion in our media.

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Making a start

A little email to Louise Newman, Sarah Mares and Patricia O’Rourke, some of Australia’s leading  workers in the nurturance field
Dear Louise and Sarah

Patricia O’Rourke gave me your email addresses.

As Patricia knows, I have been working on and off with Central Australian Indigenous communities for nearly 3 decades, and have seen how things have deteriorated, despite so many efforts by so many people and organisations. In the 90’s I also acted as principal psychiatric witness for the Stolen Generation’s action against the Commonwealth, and got a first hand taste of the horrors these people went through.
In essence, I think what I’m seeing out Bush is a transgenerational cascade of reactive attachment disorder, activated initially by the fragmenting impact of European contact on the distributive nurturance that worked so well for 50,000 years in Indigenous culture.
How to help?
My worst fear is that any kind of support will simply be experienced as yet more criticism of the poor stressed mothers, and the culture. ( I will be contacting Noel Pearson to get his ideas).

The nurturance issue is, of course, a global one, and the other thing I’m aware of is that in the media, it is either treated mindlessly or generates enormous antipathy/resistance.
I suppose that one of the problems (apart from the Avoidant Attachment dynamics that seem to drive most media commentators on the subject…Anne Manne’s observation to me at Writers’ Conference last year), is that “good enough” nurturance is actually a subtle and paradoxical process, and does not lend itself easily to left brain verbal descriptions [try to teach someone how to ride a bike by writing a textbook on it].

I am aware that you have done a lot of micro-observations of mother-infant interactions, and it occurs to me that you might have some video footage of good moments of nurturance that could make for inspiring YouTube viewing, give beings on this planet a vicarious taste of it, and possibly be adaptable for viewing by some of my Indigenous patients without making them feel too miserable.

Any other suggestions would be very very welcome

All good wishes

Leon

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Hannibal Lector and perspectival empathy

Just as nurturance has its subtleties, so does empathy, this much misunderstood function. Empathy is not just the ability to read others’ minds accurately. US child psychiatrist Bruce Perry (he looked after the children who survived the David Koresh, Waco Texas cult disaster, has written several books that are worth reading) uses the term “perspectival” to refer to the aspect of empathy that has to do with the ability to read someone else’s mind accurately.
Hannibal Lecter is a great mind reader, all the better to eat you. The advertising industry employs some of the most sophisticated motivational psychologists/neuroscientists on the planet, all the better to sell you things. Great sociopaths all. Good with cognitive maps of the other, but devoid of any impulse to feel for the other’s benefit.
On the other hand, empathy cannot exist without cognitive maps. The autism sufferer struggles to get a cognitive map of where the “other” comes from, but is tormented by strong and bewildering feelings, and defaults into ritualisms to manage the turmoil, much as do some of our bureaucracies.
Empathy is also different from sympathy, which always patronises. Empathy is not sentimentality, which stays locked in the subject’s revelling in their own “feelings” without a moment’s consideration for the actual experience of the “other”. Sentimentality does not grant equal psychological status to subject and object. We could say that empathy is not only cognitive and affective, but inter-subjective in a very egalitarian way. The most empathic people I know are beings with a quietly electric sense of presence, the Dalai Lamas of this world. You really know they’re fully there, with you, and with themselves.

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