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Neuromythmakers or neuro-deniers? A response to Zoe Williams (with Sue Gerhardt)

This article is a response to Zoe Williams’ piece in the guardian which can be accessed here.  This piece, which critiqued the use of neuroscience in child protection policy,  has generated considerable controversy. Many letters were published about it, many  upset and surprised that she took this line. Letters can be accessed here

 

Zoe Williams, a journalist whose politics we have generally agreed with,  lines up witnesses for the prosecution against what she sees as inappropriate use of brain science in social policy. She scores some direct hits. Yes, there have been clumsy attempts to grab attention with extreme images of severely neglected shrivelled brains. Yes, some attempts to explain the neuroscience have been crude. But a few examples of bad practice do not invalidate an entire body of rigorous science.

Clinicians and practitioners, many of us with decades of experience working with abused and traumatised children and adults, see the effects day  in day out, in serious behavioural problems, in scarred psyches, in mental health issues, in family breakdown, in serious delinquency. We don’t need the neuroscience, it is true, to know the profound effects of awful experiences. Alongside clinical experience, the longitudinal evidence of poor life outcomes, following adverse early experiences is undeniable.

However the neurobiology has been what has convinced many others, not least politicians, of the need to target support.  Rather than neuroscience being used to blame the victims, the research helps argue that these parents are not bad, but are suffering, are struggling, and that unless help is given, yet another generation will be at risk of a lifetime of problems. The Family Nurse Partnership is a good example of a service designed to offer just such support, and the evidence for it in longitudinal studies is powerful . An austerity driven Tory government targeting the most multiply disadvantaged families does not invalidate the programme. Of course worrying parenting practices are no respecter of social class;  another important story is the childhood emotional experiences of many of our leaders in political and other fields.

The neuro-myth critique is in fact a profoundly conservative, neoliberal one, not left-leaning. The contrarians Zoe Williams maybe surprisingly turns to at the Centre for Parenting Culture Studies are against state intervention in parenting in much the same way that UKIP is against Europe. “Leave parents alone” is the basic message. This promotes a backlash against interventions that parents mostly say they want. The ideas play into the hands of those decimating children’s’ mental health and other services just when they are most needed. For most clinicians and professionals it is not a choice between political action or patronising poor parents. We need interventions at multiple levels, including emotional and financial support for parents, the restoration of the Sure Start programme which helped sustain a community of parents, alongside the imperative to combat poverty, community degradation and inequality, all of which of course exacerbate emotional and parenting difficulties.  

Returning to the neurobiology, of course we must ask, do these findings stand up to scrutiny? Can they be used to fuel a backlash against economically deprived parents? The incontestable reality is that a huge body of research in developmental psychology and neurobiology over many decades has shown that early relationship experiences do shape some of the brain’s important structures, particularly those involved in managing stress and emotional responses and particularly during pregnancy and the first 2 years.

For example, stressful early experience can affect the volume or wiring up of the amygdala- a key structure in the ability to read others’ emotions and to react to threat. Early stress can influence the reactivity of the stress response. Babies with sensitive parents who help to manage their emotions gradually learn how to modulate stress for themselves. But when the parent is stressed or has negative attitudes towards her baby, she may not comfort and soothe and pass on these skills.  These babies are then much more at risk of poor self-control later on, which in turn undermines their resilience and chances of being “school ready”. Some of the most powerful evidence comes from the study of neglect, as the neuroscientist Charles Nelson wrote in his letter to the guardian which can be seen here

Thus neurobiology has powerfully confirmed the long-standing, meticulously researched findings of attachment scientists.  Secure children are emotionally well regulated children and insecure children, particularly those with disorganised attachments tend to have difficulty dealing with stressful experience.

Neither attachment researchers nor neurobiologists claim that “the first bond between child and caregiver determines everything that comes after, nothing can really repair that”. Early attachment relationships do though set a child off down a pathway and provide the foundation upon which later development has to build.  If stress responses, for example, are highly reactive because of early experiences, then later developing systems that connect with the amygdala may be affected. In addition optimal development of the pre-frontal cortex may be undermined by high levels of the stress hormone cortisol. The hippocampus, central to memory, and the corpus callosum, that links our cerebral hemispheres, have both also been shown to be affected by early trauma.

We don’t yet know to what extent these emotional systems can recover after the early period of intense development.  There is some hopeful evidence that new and better regulatory systems can be built alongside the original systems, particularly if the child gets help during the post-natal and pre-school period . New attachment styles can also be learnt although there will be a tendency to default to the old ways under pressure. There is also a question of whether it makes sense to develop a secure emotional style in an insecure world.

Disappointingly, Zoe Williams has bought into a scaremongering agenda. Her main fear seems to be that neuroscience is being used to take children away from disadvantaged parents. However, this is alarmist.  Where is the evidence that scans of children’s brains are being used to remove them from their parents, impoverished or otherwise? We do not know of any instances of this and would deplore this approach if it did exist. What always needs assessing is the potential for supportive family relationships, and certainly not some physiological test or snapshot of the brain.

The article risks feeding into the ant-social work lobby just when social workers too need supporting in a time of cuts and criticism. What also is not addressed in the article is the numbers of children who were left too long in appalling circumstances, leaving their capacity for ordinary life, learning, and relationships horribly compromised. Many of our case-loads are made up of such survivors, too many now entering the criminal justice system and other services. Too often the opportunity to intervene was there earlier on and missed.

Overall greater awareness of the neuroscience of early development has been enormously helpful in encouraging governments to consider earlier therapeutic interventions to support early relationships between parents and babies – something that is immensely valuable for families but still woefully underfunded.  It is our job to support, not undermine such developments.

Dr. Sue Gerhardt, psychotherapist and author of Why Love Matters: How affection shapes a baby’s brain, and The Selfish society

Dr. Graham Music, child psychotherapist, Tavistock Clinic  and author of Nurturing Natures: attachment and children’s emotional, sociocultural and brain development, and forthcoming, The Good Life: Wellbeing  and the New Science of Altruism, Selfishness and Immorality

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Sunday, 21 July 2019

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