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.
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