Where love and science meet

By Janice Cormie

Children’s charity Kids Company hosted an intriguing conference, ‘No Bullshit: What Still Matters to Every Child’, on 28 June 2011.

The charistmatic and always colourful Camila Batmanghelidjh issued a call to arms to the assembled care workers, teachers and child therapists. Poverty and maltreatment of children, she said, are due to a lack of imagination. Politicians are not malicious; they simply don’t think about vulnerable children. And it is important for everyone to work together – a recurring theme in the psychotherapy field, we at New Associations are finding, and one reflected her declaration that ‘the work of love and the work of science are about to meet.’

The first of the impressive roster of speakers to take up this challenge was Ian Goodyer (Cambridge), who predicted that the structure and function of the mind will be revealed within the next twenty years, altering the paradigm of how we think about the psychology of mind. Goodyear, part of the mental health and neuroscience network (Cambridge and UCL), compressed several years’ worth of findings on the neurobiology of mood and antisocial behaviour in adolescents into form suitable for an audience doing its best to wrap its collective and partly non-scientific head around this wealth of information.

After a brief look at the psychopathology of violence, he described the neural maturation gap, the period during adolescence during which the frontal brain development has yet to catch up with the limbic system – the period when most mental illnesses are seen to emerge. Other recent work on functional brain networks uses computation models to map changes in brain networks, for instance in adolescents diagnosed with schizophrenia.

Eamon McCrory, of UCL and the Anna Freud Centre, followed up with a quick look at neurobiology and the genetics of childhood maltreatment. He brought the case of ‘Tom’, one of two brothers sharing a background of parental substance abuse, domestic violence, and foster placements. Tom had developed conduct disorder in adolescence, whilst his brother had managed a more normal life trajectory. How do environmental factors influence genetics and neurocognitive factors?

Studies suggest that maltreatment leads to a series of neurocognitive changes that are adaptive in the short term, but are ultimately maladaptive, increasing the risk of later mental health problems. Also, biological differences mean that different children will respond in different ways. There are no particular genes for mental health disorders, but there are genetic variants. Consider the serotonin transporter gene, associated with depression. In combination with a risk environment of maltreatment, a ‘risk genotype’ leads to a greater likelihood of developing depression symptoms. (On a more optimistic note, it has also been found that regular contact with a trusted adult moderates this effect.) So Tom may have carried the genetic variants (polymorphisms) that put him at greater risk of a poor outcome

McCrory also sketched out findings that abused children more readily recognise angry faces, and become hypervigilant – a constant scanning for threats that diverts brain resources from other areas, such as being able to concentrate on tasks. Other studies point to structural differences in specific areas of the brain in women who have experienced sexual abuse, depending on the age at which abuse occurred.

He added that more work needs to be done on resilience and recovery. Future research, he hopes, will help identify neural markers of resilience.

Pasco Fearon, also from UCL, reported on the collaboration with Kids Company, which now has its own neuroscience lab on the premises. He confessed to a sense of being on the cusp of ‘an exciting period informed by neuroscience’. Researchers are beginning now to map out attachment in these terms. He outlined the different patterns of attachment (secure, avoidant, resistant, disorganised, disinhibited) and highlighted disorganised attachment, which risks the worst developmental outcomes. He suggested two possible intervention strategies: the psychotherapeutic model, which would involve working with parents’ attachment histories and with the relationship (e.g. parent-infant psychotherapy); and using supportive networks, home visiting, and sensitivity-based interventions such as video feedback. In any case, Fearon said, early intervention is vital to improve the quality of attachments.

The Tavistock’s Alessandra Lemma ended the scientific part of the morning, dealing with mentalizing trauma. She recommended bringing a psychoanalytic perspective to any work which entails being in a relationship with someone needing help. A trauma, she said, is an attack on our attachments; it is experienced as a breach in the quality and felt security of them. Trauma also undermines the psychically integrating function of narrative, with a breakdown in the capacity to reflect on and represent lived experience.

She offered some suggestions for working with sufferers of trauma, including placing less emphasis on techniques and more on the way of thinking about the therapeutic process and the therapist’s stance; adopting a mentalizing stance, focusing on the patient’s mind rather than on the event; developing a narrative about the trauma, giving it conscious and unconscious meanings; and working with the past in the present, helping the patient develop a perspective on the past by resolving current experience.

The audience members were then handed a West African drum each, and led through a revivifying lesson in bass and tone drum techniques which put a new spin on the concept of ‘working through’. The effect on 300 or so social workers and therapists of sustained drumming more or less in sync gave physical expression to the sense, pervading the conference, of the energy and potential of young people; a theme vigorously and movingly explored in a performance by Chickenshed Theatre. ‘Crime of the Century’, inspired by the real-life murder of a child in 2008, portrayed the circumstances around adolescents’ descent into youth gangs and knife crime.

It was a hard act for the Tavistock’s Frank Lowe to follow, but he brought the audience’s attention back to the legacy of maltreatment in adult life. Children do not simply grow out of maltreatment, he reminded us. The degree of its impact on adult life is influenced by protective factors, such as good-enough care, secure attachment, even class. But the legacy of maltreatment is more common than is assumed. Defence mechanisms may emerge only later in life; it can produce self-sabotage or relationship problems; and the legacy may persist across generations. Maltreatment by primary carers during the early years leads to an impaired sense of autonomy, a stultified development of self, and of cognitive, emotional and relationship capacities. Lowe’s case examples illustrated the frustrations and difficulties for clinicians in working through trauma with their patient, and he emphasised the importance of giving them personal and professional support.

The rest of the day was packed with personal stories and breakout sessions covering aggression, resistance to learning, and problems of trust. After several heartfelt numbers by singer-songwriter Judith Owen, someone who has successfully turned her depression into creativity, Camila resumed the podium. She closed the day with the acknowledgement that the basic act of respect and care for the patient is the gift that practitioners have: their compassionate witnessing presence. They communicate to the child that their ‘credit rating’ (‘respect’) is not in the balance. The vision, Camila said, is of a community of carers to restore respect and dignity, not only through caring, but through demanding political change

Janice Cormie, the BPC’s head of services, is not normally known for drumming.

Janice Cormie