9. ACEs…
• are common
• are harmful
• Lifetime smoking reduces longevity by
10-12 years
• 6+ ACEs reduces longevity by 20 years
10. ACEs…
• are common
• are harmful
4xincreased risk of
Depression
with 4 or more ACEs
32xincreased risk of an
STI
with 4 or more ACEs
2.3xincreased risk of
unemployment
with 4 or more ACEs
5xincreased risk of
Mother <18y
with 4 or more ACEs
10xincreased risk of
hitting someone
in last month
with 4 or more ACEs
3xincreased risk of
attending A&E
in last year
with 4 or more ACEs
12xincreased risk of
suicide
with 4 or more ACEs
11. ACEs…
• are common
• are harmful
• are not the same as
poverty
Poverty &
inequality
ACEs
12. ACEs…
• are common
• are harmful
• are not the same as
poverty
• extend beyond the
household
• Bereavement
• Bullying
• Discrimination
• Witnessing violence
• Neighbourhood safety
• Frequent money problems
• Food insecurity
• Homelessness
• Prolonged parental absence
• Parents always arguing
• No good friends
13. ACEs…
• are common
• are harmful
• are not the same as
poverty
• extend beyond the
household
• can be overcome
14.
15. Beebe et al, Attachment & Human Development 2010 3-141
24. Nussbaum's central capabilities
• a theory of social justice, based
on ideas about human dignity
• "What are people actually able
to do and to be?“
• which genuine opportunities are
open to people?
25. 1. Life
2. Health
3. Bodily integrity
4. Senses, imagination and thought
5. Emotions
6. Practical reason
7. Affiliation
8. Other species
9. Play
10. Control over one’s environment
26. 1. Life
2. Health
3. Bodily integrity
4. Senses, imagination and thought
5. Emotions
6. Practical reason
7. Affiliation
8. Other species
9. Play
10. Control over one’s environment
“… to be secure against violent
assault, including sexual assault
and domestic violence”
27. 1. Life
2. Health
3. Bodily integrity
4. Senses, imagination and thought
5. Emotions
6. Practical reason
7. Affiliation
8. Other species
9. Play
10. Control over one’s environment
“To be able to love, to grieve, to
experience longing, gratitude,
and justified anger”
28. 1. Life
2. Health
3. Bodily integrity
4. Senses, imagination and thought
5. Emotions
6. Practical reason
7. Affiliation
8. Other species
9. Play
10. Control over one’s environment
“… to imagine, think, and
reason in a truly human way,
including literacy, numeracy,
science & creative arts”
29. 1. Life
2. Health
3. Bodily integrity
4. Senses, imagination and thought
5. Emotions
6. Practical reason
7. Affiliation
8. Other species
9. Play
10. Control over one’s environment
“The right to political
expression, participation and
choices”
30. 1. Life
2. Health
3. Bodily integrity
4. Senses, imagination and thought
5. Emotions
6. Practical reason
7. Affiliation
8. Other species
9. Play
10. Control over one’s environment
“… being able to live with and
toward others… to engage in
various forms of social
interaction; to be able to
imagine the situation of
another”
34. the premise...
• Internal states (emotions, thoughts etc) are opaque.
• We make inferences about them...
• but often get it wrong
35. a mentalizing failure
A mother was watching her 5-year old daughter play. The child
had taken a stethoscope out of her mother’s doctor bag and
was playing with it. As she put the stethoscope to her ears, her
mother thought proudly “she seems interested in medicine.
Maybe she will grow up and become a doctor like me”.
36. After a time, the little girl put the listening end of the
stethoscope up to her mouth and exclaimed “Welcome to
MacDonald’s. May I take your order?”
Kornfeld, The Wise Heart
37. interpretations
Secure attachment
“...this young fellow feels he needs a
hug before he goes to sleep – so she
slides up a little closer to him and gives
him a big hug – and ahh strokes his
head...
gets him ready for sleep and she kisses
him good-night – and leaves the
room.”
George & West, Attachment & Human Development 3, 1, 2001
38. Dismissing attachment
“The son is reaching for the mom and
the mom is not really reaching back for
some reason. And I’m not sure if it’s a
cultural or just if it’s personal but she’s
wearing slippers. I’m not a slipper
person but some people are.
Um, so maybe just the floor is cold”
39. Preoccupied attachment
You know like if I was to draw a picture
on her face you know I’d probably have
a smile on it but the child I think would
be – just the first reaction you know
the child’s upset for some reason –
sick. Also reminds me of when my
husband was sick too. Yeah. Um I’d
definitely see that this is being my
husband and you know this being me
because that was really frustrating
with him being unable to communicate
– I didn’t feel there was anything I
could do – I couldn’t understand what
he wanted, there was no way to find
out what he wanted.
40. mentalizing means…
• Holding mind in mind
• Attending to mental states in self and others
• Understanding misunderstandings
• Seeing yourself from the outside and others from the inside
Mentalizing in Clinical Practice
Allen, Fonagy, Bateman
41. • We are already mentalizing
• Mentalizing is highly interactive
• Mentalizing is not warmth & sympathy
• Mentalizing is hard work
42. aspects of mentalizing
• Contemplation, reflection
• Taking other perspectives
• Genuine interest
• Realistic scepticism
• Forgiveness
• Predictability
• Accepting things can be “opaque”
44. not mentalizing
• Excessive detail, excluding thoughts and feelings (fillers)
• Focus on external factors
• Focus on labels
• Focus on physical characteristics or stereotypes
• Preoccupation with rules, “shoulds” and “should nots”
• Denial of involvement in a problem
• Being certain about other peoples’ thoughts and feelings
45. temporary failures of mentalization
• “She does my head in. I can’t think once she starts on me.”
• “You hate me!”
• “Are you trying to drive me crazy?”
46. some techniques
• Not knowing
• Identify differences
• Accept different perspectives
• Active questioning
• Model honesty
• Stay alongside the patient
• Rewind
47. Summary: ACE memes
• Childhood experiences have lifelong effects
• Bodily changes are adaptation, not pathology
• Behaviour is communication
• Distress is contagious
• Services find attachment very difficult
– “Blame shame and punishment” is everywhere
• Secondary responses often worse than the primary causes
• This can be undone – but later is always harder
• We need to start with ourselves
Notas do Editor
Prevention in MH
Reciprocal social exchange
Attachment
Social cognition
Baby initiates responses
Shows a *loss of control* and not a loss of attachment
http://balanceedutainment.com/2012/04/24/play-and-the-toddlers-brain-on-television/
An extensive recent literature suggests that gene-environment interactions may be central to explaining human and animal development. For example, neuroscientist Avshalom Caspi and his colleagues have shown that the adverse impact of the absence of one gene—a particular variant of the Monoamine Oxidase-A gene, which has been associated with antisocial behavior and higher crime rates—is triggered by growing up in a harsh or abusive environment. Geneticist Mario Fraga and his colleagues have shown how life experience substantially differentiates the genetic expression of adult identical twins: their experience gets under their skin—and stays there. Related research shows that isolation affects the expression of genes that moderate adverse health outcomes, and that environment has a powerful role in determining heritability of IQ.