SEBCD Conference Malta September 2007

1. SEBCD ConferenceMalta September 2007 Early Relationships and Adult Mental Health Marion Bennathan Life President Nurture Group Network

2. My theme • Rapid developments in neuroscience and pharmacology are reshaping the understanding of mental health problems and their treatment. Is this relevant to the work we do? • The Double Helix JD Watson & Francis Crick 1953 revealed the bio-chemical basis of life of brain function and led to a leap forward in the understanding of the brain.

3. Most of us who work with troubled young people believe that without early effective help they will end up with wasted lives, perhaps with mental health problems. This adds urgency to our work, puts it in a different time frame, and makes us see our work in a different light. But what do we really know? How can we be sure?What can we learn from neuroscience? Where is the research?

4. Research • Problems in fundamental research on children but since we share our genetic make up as to 98.9% with other mammals , Michael Meaney’s mice experiments are relevant. • Meaney is Professor of Medicine at McGill University. His interests are in early environmental regulation of gene expression; how does early experience exert a influence brain development? • 2 groups of mice and their young: ‘good’ mothers who fed, groomed, nuzzled most had babies with good brain development: these were put with ‘bad’ mothers whose babies showed poor brain development, and vice versa. Rates of development in 2 groups evened out. Such research not possible on humans but a situation where research was possible occurred.

5. Research on child development • The English and Romanian Adoptees Project (See Google) (Rutter) • 2 groups, children adopted by English families from a) conditions of extreme deprivation in Romanian orphanages: b) at early age from non depriving English circumstances. • Romanian: younger age at adoption less the difference. Cognitive catch-up occurred even in older children BUT social development: even the early adopted (0-6 month) showed deficits.

6. Research on schizophrenia • At Royal College of Psychiatry conference in 2005, young scientist presented a highly scientific description of the part of the genome which mediates schizophrenia. Just one sentence, his last, indicated that environment might matter: ‘untoward life circumstances may have an influence’. • Robin Murray, Head of the London Institute of Psychiatry, then reported incidence in young men of Jamaican descent in London and in Jamaica. First was much higher.

7. The Message? • Meaney: “the nurture of nature” • How do we provide the nurture which will help children to flourish whatever their genes? • All educators must understand that schools need a high level of emotional literacy- a relatively new concept; that children damaged by poor early nurture can find learning threatening; that early damage untreated worsens; that a good, caring school is therapeutic.

8. Attachment: an accessible theory • John Bowlby, psychoanalyst, recognised the limitations of the psychoanalytic approach; stressed the biological need of all young mammals to bond, to attach in order to survive. • The interaction between child and carer is intense from birth on: child builds up “Internalised Working Model” which will be reflected in their brain development. This can be picked up by empathetic observation and when damaging to development changed.

9. Nurture Groups • Staff, teachers and assistants with a 4 day training, find it easy to understand and use Bowlby concepts. • They give warm acceptance, set standards of desirable conduct, and teach in ways accessible to the child at the developmental stage reached. • Their success in improving attainments, attachment to school, self esteem, family relationships is confirmed by every evaluation. (See Cooper and Whitbread, Emotional and Behavioural Difficulties Vol 12 No 3 Sept 2007)

10. Adult Mental Health. Diagnostic and Statistical Manual of Mental Disorders. APPI • An example: Borderline Personality DisorderThis is a much used diagnosis; origins of condition not well understood; it is difficult to treat. • “A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: •  frantic efforts to avoid real or imagined abandonment.. • a pattern of unstable and intense interpersonal relationships characterised by alternating between extremes of idealisation and devaluation • identity disturbance: markedly and persistently unstable self-image or sense of self

11. Borderline Personality Disorder (2) • impulsivity in at least two areas that are potentially self-damaging (e.g. spending, substance abuse, reckless driving, binge eating). • recurrent suicidal behaviour, gestures, or threats, or self-mutilating behaviour •  affective instability due to a marked reactivity of mood (e.g intense episodic dysphoria, irritability, or anxiety usually lasting a few hours only rarely more than a few days) • chronic feelings of emptiness: inappropriate, intense anger or difficulty controlling anger (e.g frequent displays of temper, constant anger, recurrent physical fights)”This reminds us of many of our pupils with SEBD and emphasises the importance of helping the child to change.

12. The Boxall ProfileHandbook for Teachers Part 2. Diagnostic Profile • This consists of items describing behaviours that inhibit or interfere with the child’s satisfactory involvement in school. Made up of 3 clusters: • Cluster 1 – self limiting features (identifies children who lack the normal ‘thrust for growth’) • Cluster 2 – undeveloped behaviour (identifies features, which lack the inner resources to relate to others and engage in an age appropriate level) • Cluster 3 – unsupported development (suggests children who have marked negativism towards others, are anti-social, angry, which may be a result of lack of early nurture or intrusive negative experiences) • Many of behaviours resemble those listed in Borderline Personality Disorder, so if child’s attitudes to self and others change, prospects for good adult life increase.

13. Psychiatry, Psychoanalysis and the New Biology of Mind. E.R.Kandel. APPI 2005 (Kandel began as a psychiatrist interested in psychoanalysis: found it not open to scientific; moved to studying brain function for which he won Nobel prize in 2000 • Genes and their protein products are important determinants of the neural networks that are the source of all mental activities. • While we inherit our genes from our species and our family, at any given time many of the genes which potentially affect brain activity may be dormant. ‘Epigenetics’ is the process by which genes can be turned off or on to produce or ‘express’ protein products. • Among the factors which regulate gene expression are..environment and experience, including psychotherapy which changes gene expression and alters neural connection.

14. For pupils with SEBD, good caring education is therapeutic • A drug addicted mother came to school to collect her 5 year old Stephen. When she saw him she denied he was her child and would not take him home. He pleaded in distress that he really was Stephen. Social worker took them home. • Two days later boy returned to school: after the nurture group was settled he took his teacher firmly by the hand, led her to the mirror, undressed himself completely, inspected his reflection carefully, went to the dressing up box, dressed himself in costume, inspected himself again, took off the costume, put back his clothes, all this was deadly serious, no smiles, not a game, not a word spoken . He then went back to the work table, and got on with his work. • His teacher understood by empathy that she was to say nothing, just be there. This is providing therapy of the highest order. • Later he was placed in a loving foster home and made excellent progress.

15. The voice of the pupilUnsolicited letters from 2 girls, 3 boys aged 13/14 in a nurture group • I came to nurture because I was miserable and not proud of myself . I was also hiding for a very long time that I couldn’t see and it was slowing down my writing and I never got it finished. I have gotten better since then because Sir and Miss always find a way to make me laugh and be happy so I am not miserable and I’m proud of myself. I can now see because I went and got my classes. Haley. • I go to nurture lessons because I needed to learn about myself and my behaviour, I felt unhappy and I felt ugly. Now I have learnt about myself, behaviour improved a lot: I feel really happy and now I have a modelling job!!!! Katie. • I was always in trouble. Sir and Miss have taught me to control my anger. We have done lots of fun things food tasting, breakfast club, lunch club and learned lots of new games. If it was not for Mr W… and Mrs S… I would still be in trouble. They say you taught them how to be good to children so THANK YOU. Barnaby

16. Before I joined nurture I had no real friends and nobody knew me for what I am now. I had a past where I was beaten up every day in my primary and secondary schools. When I moved here I was teased, bullied, pushed about and had low self esteem. I used to walk the corridors alone and acted the class fool to try and get people to like me. Then I joined nurture. Nurture has been the best highlight of my life. I have learned lots of new and interesting stuff and I no longer care for bullies. You couldn’t even imagine what you have done for me. Nurture has rebuilt my life.John

17. A year ago before I came to nurture it wasn’t very pleasant beingme because I felt unwanted and abandoned. My behaviour was provoking my Mum but if did not realise it until now. Nurture is for me one of the most memorable things I have done and since I have been here I have learnt to find myself. I found out what I could do, things I couldn’t do like cook and play an instrument. In my cooking the most exciting thing was well…cooking. In my music it was the sound of me playing it and thinking to myself .. WOW. Wishing you well. Allan.

18. Further references • Bennathan M.& Boxall M. 2nd ed. 2000Effective Intervention in Primary School: Nurture Groups, pub London David Fulton * • Bennathan M.& Boxall M. 1998 The Boxall Profile. Handbook for Teachers Pub Nurture Group Network London* • Bowlby J. Everything he wrote. • Marion Bennathan marionnurture@mistral.co.uk *Available from Nurture Group Network. info@nurturegroups.org www. nurturegroups.org