New insights

For years and years, I had been captivated by literature on secure attachment, by the workings of the HPA-axis (the stress regulation system consisting of a cascade through the hypothalamus, pituitary and adrenal glands) and by the role of the ‘cuddle hormone’ oxytocin, that also happened to be a neurotransmitter. I had ended up there through my work as a breastfeeding volunteer and later lactation consultant IBCLC, that fully revolves around oxytocin and its effects on contractions during and homeostasis straight after birth, on the milk ejection reflex in breastfeeding, and on bonding between mother and baby. Secure attachment, I was taught, was the basis of one’s sense of security and sense of wellbeing. Time and again, I listened to these big names in our field, those world-renowned ‘hot shots’, and over the years, their message sank in more and more deeply, more or less until I became unaware of how much it shaped my view on many things. I was also not really aware that to some extent, although these processes are universal and as old as humanity, I was still working in a niche, in a profession that was fairly new in the healthcare landscape and that seemed to use this knowledge more intensively than some other fields did.

I remember listening to the famous Swedish specialist in perinatal neuroscience Nils Bergman some ten years ago. He is one of the founders of the Kangaroo Mother Care movement and a promoter of skin-to-skin contact between a mother and her newborn baby. He introduced me to the concept of toxic stress, coined by Harvard paediatrician Jack Shonkoff and defined as ‘strong and prolonged activation of the body’s stress management systems in the absence of the buffering protection of adult support’. Toxic stress, Nils Bergman explained, disrupts brain architecture and leads to stress management systems that respond at relatively lower thresholds, thereby increasing the risk of stress-related physical and mental illness.

All in their own way, these passionate professionals added elements to what for me became a stronger and clearer and ever more logical framework of where illness and disease originate. It had always felt intuitively obvious that childhood has a huge impact on how we develop from a fully dependent child into an adult with their own characteristics, strengths and weaknesses, vulnerabilities and shining capacities… but how? Which internal processes combine all those influences, all those experiences, all those curses and blessings into the person we become? There is actually a word that describes them as one big fascinating, internally communicating signalling system: psychoneuroimmunoendocrinology! As Nils Bergman would say, quoting neuropsychologist Donald Hebb: ‘Cells that fire together, wire together!’ The more the mind, nervous system, immune apparatus, and hormone-secreting glands talk with one another, the more pathways are built, the closer and tighter all these organ systems become connected, and the more efficiently they can inform one another of what is needed to maintain the organism’s balance.

As beautiful as this is… it also works vice versa. If certain pathways are trodden over and over again, others become neglected and get pruned. Part of the nuance disappears from the (neural) communication and as most of us know all too well: if conversations overlook important details, their quality can rapidly decline, become defensive, and turn into fight or flight (both neurologically and between people). The conversation loses colour differentials and becomes black and white, good or bad, for or against, complicating the stress response.

This, sadly enough, is exactly what happens to many infants and young children when they have to endure a lot of toxic stress without the buffering protection of a supportive adult. They have a hard time maintaining their sense of security as their whole system is in survival mode. It is this what researchers Vincent Felitti and Robert Anda called ‘Adverse Childhood Experiences’ (or ACEs) in their 1998 study on this topic. You can find their study here to get an impression of what ACEs are about. They are not only about psychoneuroimmunoendocrinological processes inside the individual body, as a ‘life-style’ issue; importantly, they are also very much about the sociocultural, political and economic circumstances that impact them.

Jack Shonkoff says in the film ‘Resilience’ that the child may not remember all that happened early on, but the body remembers. He says that what we thought of as ‘intractable and unsolvable problems’ should, seen through the lens of ACEs science, be approached with a non-defeatist attitude. ‘We should be going after it like a bear!’, Shonkoff smilingly says. Let’s join him in the hunt!

Posted in Miscellaneous.