June 23, 2016
(++++) CHILDREN: AN OWNER’S MANUAL (OR TWO)
Self-Reg: How to Help Your Child (and You) Break the Stress Cycle and Successfully Engage with Life. By Stuart Shanker, Ph.D., with Teresa Barker. Penguin Press. $28.
The Silenced Child: From Labels, Medications, and Quick-Fix Solutions to Listening, Growth, and Lifelong Resilience. By Claudia M. Gold, M.D. Da Capo. $24.99.
Given the uniformly wrong way in which many authors say the medical community and society as a whole deal with children, it is a wonder that any kids grow up to be reasonably responsible and even marginally healthy. The authorial prescription for what is really needed is for today’s parents, no matter how overwhelmed they may be by the vicissitudes of everyday life and their own needs (emotional, psychological, financial, etc.), to spend time they do not have reading scores of books by scores of experts on scores of different (and generally mutually exclusive) ways of helping their children cope with existence and (if you choose the right expert with the right guidance) be more successful in life than kids whose parents spend their time in different ways – such as, say, interacting with their kids and reading decidedly non-adult books to and with them.
That extremely bleak and cynical overview of the fertile “better ways to raise children” field is admittedly an over-simplification – but so are a great many of the books in the field, no matter how well-constructed and sincere they may be. There are some very good ones out there, and Self-Reg and The Silenced Child are among them, but responsible adults must not simply accept the notion that any author has all the answers for any situation involving any child. And they must not waste their minimal free time focusing on books about everything they are doing that is wrong and everything they should be doing instead – devoting extra time to children is far, far more important than reading how you should do this and you need to do that.
With those caveats firmly in mind, parents will find considerable value here. Stuart Shanker’s Self-Reg starts from the wholly unsurprising premises that there are no “bad kids” and that the ubiquitous stresses of everyday life are responsible for children’s dysfunctional behavior. That is, the issue is not the child but the child’s environment. Refining this formulation further, Shanker focuses on what he calls “hidden stressors,” meaning ones in addition to those that parents can readily identify as affecting their children and themselves (such as time pressure, school requirements, social issues, financial matters, relationship difficulties, etc., etc., etc.). Shanker suggests that kids’ behavior is an acting-out provoked by stressors of which the child and parent may be totally unaware. For example, certain specific sounds at certain specific levels may be a stressor, or particular smells at certain intensities, or needing to wait in a line or sit in a waiting room. Self-Reg correctly points out that stressors are as varied as people, and that just as people change over time (the book covers early childhood through to adolescence), stressors change as well. Thus, what creates a kind of subliminal stress one day may not create it a day later – and, as a corollary, what helps a person cope with stress one day may not be helpful the next. Therefore, constant parental awareness of a child’s feelings and moods is crucial, and a child’s ability to recognize and talk about his or her emotions is key to finding ways to manage them better.
Shanker uses the metaphor of a light’s dimmer switch to indicate the importance of “dialing down” stress after correctly identifying it. Awareness is central – not awareness of stress itself and its overt symptoms, but awareness of the causes of stress, both the ones readily identifiable and the ones typically ignored. Only upon recognition and understanding of those stressors, Shanker argues, is it possible to develop techniques for managing them. The logic is impeccable, and Shanker’s repeated reminder that there is no perfect stress-management solution for everybody is welcome in a world (and publishing industry) where one-size-fits-all solutions are regularly trotted out as the Holy Grail. Shanker backs up his analyses with information on human physiology, explained clearly and without talking down to readers. His recommendation is that parents harness their and their children’s own bodily self-regulatory processes to dial down the levels of hidden stressors sufficiently to end the counterproductive behavior that results from high stress levels. This is unexceptionable – it is akin to recommending that patients facing medical stress from disease find ways to engage their placebo response, which is tied to the body’s ability to self-heal and which results in approximately 30% of patients in clinical trials getting better even when given a placebo rather than an active medication. But how to dial down stress reaction is a slippery issue, just as slippery as how to engage the placebo response. Shanker’s recommendation of self-aware meditative mindfulness, modified as needed for each individual, is a good one, and one that does not require pharmaceutical intervention. But this is scarcely a perfect solution: Shanker correctly notes that the requirements of learned and (at least initially) supervised mindfulness can themselves be stressors for some people – the requirement of focused breathing is not for everyone. And of course not everyone can come to Shanker’s Mehrit Centre in Canada to experience his approach directly. However, readers of Self-Reg can at least learn to redefine certain behavior of their children as being maladaptive and stress-related rather than caused by lack of self-control or any sort of “bad” impulse. This alone can be a big step when a child is restless, aggressive, impulsive, frequently frustrated, withdrawn, hostile – the list goes on and on. Parents who can manage their own stressors well enough to step back from their children’s behavior and reevaluate it, and can then use mindfulness techniques themselves and also help their children utilize them, will have gotten the full benefit of Shanker’s book. However, and it is an important “however,” there are very, very few hyper-stressed parents who will have the time to read this book carefully and absorb its lessons thoroughly – and indeed, the requirement to do so and the importance of following Shanker’s analytical and perceptual model will themselves be significant stressors for exactly the people who stand to benefit the most from his analysis. That is a Gordian knot that even a Herculean effort may be insufficient to cut.
It would be fascinating to be the proverbial fly on the wall during a conversation between Shanker and Claudia M. Gold, whose The Silenced Child devotes just two pages to stress-related “behavioral dysregulation” and two more to an innovative school program that reframes disruptive behavior as maladaptive communication and that requires trauma training for all those who interact with children – teachers, parents, bus drivers, even cafeteria workers. Yet behavioral reframing is an approach as crucial for Gold as it is for Shanker; Gold just sees it in a slightly different context. Her book is about the importance of listening – not just observing difficult behavior and analyzing it, but listening to what a child is trying to say through the behavior (and verbally as well, when there are verbal components of a child’s actions). In other words, Shanker sees maladaptive behavior as primarily reactive, to stress, while Gold sees it as primarily proactive, as a flawed attempt to communicate. The two views are not mutually exclusive but complementary – as are the two books. Gold, a pediatrician, is especially incensed at the current psychiatric standard of care, in which children’s difficulties are quickly labeled with an acceptable diagnosis and then treated with medication. This is in fact the current model for all psychiatric care, driven partly by insurance-reimbursement rates and partly by government insistence 50 years ago that the mentally ill should be “mainstreamed” rather than hospitalized long-term. Gold argues – from a research base supporting her analysis, just as Shanker argues from one supporting his – that every behavioral problem arises from a story of some sort that gives rise to the difficulty, and that evidence about brain growth, from neuroscience and genetics, shows the folly and potential harm of simply giving children behavioral-modification medicines without taking the time to listen to what they are trying to say, both verbally and otherwise.
Gold repeatedly and usefully cites the work of D.W. Winnicott – a pediatrician turned psychoanalyst – in support of her notions of resilience and stress response. Stress management in Gold’s book is an important developmental milestone and, indeed, one that continues well beyond the childhood years. Relationship difficulties are inevitable between parent and child, Gold argues, so what matters is whether those disruptions are or are not repaired. If they are, the child develops resilience – the ability to handle all sorts of disruptors (Shanker would say stressors) throughout life. If they are not, the child’s resilience is compromised and his or her ability to self-repair breaks down or does not develop – and this is the root of much mental illness. Catching the poor development of resilience through careful, extended listening early in a child’s life would go a long way toward stabilizing people in later years, Gold suggests – but this will not happen as long as insurance regulations and coding requirements force clinicians to see more patients in less time and devalue those professionals who do set aside more time for listening. Gold does not deny that medications can reduce or eliminate problematical behavior, but she says that doing this without understanding the meaning of the behavior results in a lack of comprehension of what the behavior is communicating – thus silencing a child who desperately wants to express something important.
Gold’s statement that we need an entirely new paradigm of mental health care – one that is relational and developmental – is utopian and, unfortunately, unrealistic. Among other things, it flies in the face of recent scientific research on the biological basis of psychological symptoms. Gold does not deny the research, but says that it lacks proper context because it involves scanning the patient’s brain but does not include listening to the patient, as better-designed studies would. Be that as it may, the most useful part of The Silenced Child is its fourth and last section, “Ways of Listening,” which contains chapters on listening to the body and finding creative, individually tailored responses to emotional maladaptations that have physical manifestations; listening for loss, which means considering not only a major loss, such as a death, but also the loss felt through relationship disruption; and “Listening with Courage,” by which Gold means accepting uncertainty so as to allow a child to find his or her own method of adaptation and growth without the encumbrance of a diagnosis of a medical condition and without the use of drugs that suppress outward symptoms but do nothing for inward turmoil. Like Shanker’s book, Gold’s contains a great deal of useful information and enough prescriptive specificity so that parents who have the time will benefit from exploring its suggestions. The issue with both these books – and they are just two among hundreds of works, if not thousands, that try to help parents better manage the difficulties of child rearing – is that the people most likely to benefit from them are those least likely to have the time to read them and absorb what they have to say. Neither Shanker nor Gold addresses that problem – which, indeed, has no solution. Hence the attraction for many people of lesser books than these, ones that suggest just a few simple, easy-to-learn things that parents can do to “cure” their children and their own child-related difficulties. The very complexity of raising children, and indeed of human development in general, renders those “easy solution” books valueless; but the time and effort needed to negotiate better and more-thoughtful works such as Gold’s and Shanker’s make them much more difficult to absorb and use. How Gold and Shanker themselves might address that issue would be interesting. Maybe they should have a conversation.