As child growing up in New York City, I saw my mother's young clients come and go in her home-based psychology practice. When, as a high school student, I had the good fortune to work with the late psychiatrist and psychoanalyst Paulina Kernberg, I decided to go to medical school. While at first I wanted to be a psychiatrist, I saw how as a pediatrician I would be involved in the lives of children and families from the start, and changed paths.
But while I was well educated, including a fellowship in developmental and behavioral pediatrics, it was not until after practicing pediatrics for many years in a range of settings, when I “discovered” D.W. Winnicott and Peter Fonagy in my studies as a scholar with the Berkshire Psychoanalytic Institute (BPI) that I finally felt I had the tools and knowledge needed to actually help my patients.
At around this time, when swim practice, theater and dance performances of my two then school age children led me to want to be home and available to them, I stopped doing general pediatrics and began to do exclusively behavioral pediatrics, which offered a more flexible schedule. I was also able to devote more time to study and writing.
My studies with BPI led me to the growing field of infant mental health. My personal discoveries occurred in parallel with the explosion in the diagnosis of bipolar disorder in children, along with exponential rise in treatment of young children with psychiatric medication, including atypical antipsychotics.
I became aware of and distraught by the enormous gulf between the wealth of ideas generated in contemporary developmental science and the realities of mental health care for young children. The research I was learning about offered a completely different model for understanding and treating the problems of these children and families from the model offered by the pharmaceutical industry and many in the field of child psychiatry.
It was not uncommon for parents to bring an 18-month-old child to see me with the question “Does he have bipolar disorder?” I was seeing hundreds of kids, often sent by the school, for “ADHD evaluation.” In fact their stories were so much more complex, yet there was a high expectation on the part of parents, teachers and other physicians that these children would simply be treated with medication. This experience led me to write my first book, Keeping Your Child in Mind.
Next, an opportunity to develop a new program at Newton-Wellesley Hospital within the division of child psychiatry, a program I named the “Early Childhood Social Emotional Health Program,” gave me a range of important experiences. The program was successful from the start. I was referred many very young children and their families by the community pediatricians who may have had interest but did not have time or knowledge to address the problems in depth. But changes in leadership and the realities of a division facing huge waiting lists for older children got in the way. I was given an inside view of the obstacles to providing this preventive model of care.
While that story was unfolding, the ideas for my new book The Silenced Child were growing after first being inspired by a personal experience. In the spring of 2012 my then 88-year-old father spoke to my son’s eighth grade class following its visit to the Holocaust museum. In that one hour, when he did not even pause for a drink of water, I heard more about his experience growing up under the rise of Hitler and subsequent escape to the US, leaving his parents behind, than I had in my whole life. I suggested we write a book together. But the cracking in his voice when he tried to say more, followed by his assertions that he didn’t have time, led me to see that he could say little more than he had on that visit to the school. So I set out to tell his story through mine.
In my practice I was increasingly recognizing how parents and children had meaningful moments of connection when they moved through periods of grieving unmourned loss, and how in the wake of these moments “problem behaviors” often evaporated. When my editor asked me what led to these transformative moments and I replied “space and time for listening.” A new book was born.
My current work focuses on writing, teaching, and practice of early childhood mental health. I write regularly for my blog Child in Mind and Psychology Today. I am on the faculty of the University of Massachusetts Boston Infant-Parent Mental Health Program, William James College, and the Austen Riggs Center. I am in the process of developing a new community-based infant-parent mental health program under the sponsorship of the Austen Riggs Center as part of its new Human Development Program.