The saying “A picture is worth a thousand words” was driven home to ne this week. Even though I believed in this concept for many years, and indeed my profession as an art therapist depends on it as a working assumption, it took actually seeing it to realize the profound truth that lies in the saying. Ever since John Bowlby’s pioneering work on Attachment Theory and child development in the early 1950’s, his thinking became the gold standard in child-development theory. Donald Winnicott, who was a pediatrician and child psychoanalyst, had an immense influence on Bowlby’s work and career. Bowlby and Winnicott had several similarities within their professional work as they were the first to explain the importance of social interactions at an early age. Both Bowlby and Winnicott argued that humans come into the world with a predisposition to be sensitive to social interactions and to need these interactions in order to develop in a healthy way. Bowlby sought new understanding from such fields as evolutionary biology, ethology, developmental psychology, cognitive science and control systems theory, and drew upon them to formulate the innovative proposition that the mechanisms underlying an infant’s social connection emerged as a result of evolutionary pressure.
This week I saw an amazing picture that showed clearly the wisdom in Bowlby’s thinking process. The picture is that of a 21-week-old unborn baby named Samuel Alexander Armas, who is being operated on by surgeon named Joseph Bruner. The baby was diagnosed with spina bifida and would not survive if removed from his mother’s womb. Little Samuel’s mother, Julie Armas, is an obstetrics nurse in Atlanta. She knew of Dr. Bruner’s remarkable surgical procedure. Practicing at Vanderbilt University Medical Center in Nashville, he performs these special operations while the baby is still in the womb. During the procedure, the doctor removes the uterus via C-section and makes a small incision to operate on the baby. As Dr. Bruner completed the surgery on Samuel, the little guy reached his tiny, but fully developed hand through the incision and firmly grasped the surgeon’s finger.
Dr.Bruner was reported as saying that when his finger was grasped, it was the most emotional moment of his life, and that for an instant during the procedure he was just frozen, totally immobile. The photograph captures this amazing event with perfect clarity. The editors titled the picture, “Hand of Hope.” The text explaining the picture begins, “The tiny hand of 21-week-old fetus Samuel Alexander Armas emerges from the mother’s uterus to grasp the finger of Dr. Joseph Bruner as if thanking the doctor for the gift of life.” Little Samuel’s mother said they ‘wept for days’ when they saw the picture. She said, “The photo reminds us pregnancy isn’t about disability or an illness, it’s about a little person.” Samuel was born in perfect health, the operation 100 percent successful.
This is not the first time I’ve heard of intrauterine surgery to save the life of a fetus. A friend was pregnant with identical twins, and during an ultrasound at the first trimester it was discovered that both were connected to the same artery stemming from the placenta. Since the mother was a physician, she knew of a surgeon in Belgium who had performed experimental intrauterine separations of the blood supply of fetuses. The risks were high, and there was a possibility of losing one or both of the twins. She procrastinated until the last possible minute, then flew to Belgium, and experienced some horrendous difficulties, but both babies survived. Even though they were born prematurely, and spent a lengthy time in incubators at the hospital prenatal unit, they are now happy and well developed 14-year-olds.
A large part of healthy development is due to constant early connection with caregivers at the preemie unit. Following Bowlby’s theory which was expanded into the trend prevalent today of Secure Attachment, parents, caregivers, and family members are taught how to hold, talk and sing to the babies several times a day. The practice of social interaction with the babies aids in their healthy development. This secure attachment practice counteracts the trauma of premature birth, and having to conclude their physiological development outside the uterus. It has been shown that young children who do not receive this attention and care will develop unhealthy attachment styles as they grow up, and have what is termed today ACEs (Adverse Childhood Events) syndrome. Though a variety of trauma in early childhood, including sexual abuse, violence and dysfunctional family conditions are known to contribute to this syndrome, birth trauma is also a fairly common factor. If left untreated, the syndrome may result in delinquent behavior, and illness.
The ACE study originated in 1985 in Dr. Vincent Felitti’s obesity clinic in California. Felitti was frustrated that a number of the people in his program dropped out, even though they were successfully losing weight. Upon reviewing the history of the people who dropped out, he found that many people in his clinic had a background of adverse childhood experiences, such as physical or sexual abuse. He began to wonder if obesity might be, for some people, an unconscious defense that lingered as a result of adverse childhood experiences. He developed a 10-item self-report questionnaire which was used in the study. When I read the report of the study for the first time, I remembered one particular client of mine, who had a very abusive childhood and adolescence, including sexual and physical abuse, as well as jail time. She was 35 years old and extremely obese. She developed diabetes, and tried to lose weight. At one of the sessions, she had a revelation, and said: “When I put on weight and become really big, no one can hurt me.” Researchers found that weight gain was indeed the way some of those who had experienced childhood abuse had attempted to protect themselves, whether consciously or unconsciously, from further incidents of abuse. This behavior was corroborated by the clients who left Felitti’s program due to feelings of anxiety that followed their weight loss. My client worked on her newly discovered insight, but decided to love herself the way she was, and take care of her diabetes by changing her eating habits and taking her medications. She enrolled at the University as a mature student, earned a BA degree and was proud of herself. Her understanding helped her raise her daughter to become an educated, emotionally balanced young professional.
The results of the study showed that childhood trauma and stress early in life, apart from potentially impairing social, emotional, and cognitive development, indicates a higher risk of developing health problems in adulthood. The Centers for Disease Control and Prevention, which was exploring the psychosocial origins of various public health concerns such as alcohol abuse, obesity, and nicotine use, paired up with Kaiser Permanente to develop one of the largest epidemiological studies in the United States. The ACE Study aimed to identify the childhood trauma experiences of more than 17,000 adult participants, who underwent a physical examination and completed the ACE Questionnaire, in order to determine whether there truly was a link between adverse experiences in childhood and health concerns, both physical and mental, later in life. The study showed that adverse childhood experiences were more common than had previously been recognized or acknowledged by research and medical findings. The study also identified a direct link between the ACE score and adult chronic illness, as well as emotional and social issues such as depression, domestic violence, and suicide. Another significant finding was that childhood trauma affects mortality: the life expectancy of an individual with an ACE score of six or more may be reduced by up to 20 years. Additionally, the study highlights how these childhood experiences influence the possible development of mental-health issues in adulthood and may serve to assist mental-health professionals in better understanding certain mental-health concerns.
There is, however, a silver lining. Once you are aware that you have a high score on the ACE questionnaire, you can start taking action and turn adversity into opportunity. Opportunity to take action and turn your life around. To find the areas of your resilience. To realize your strengths and help yourself and others. To accept reality and learn to ask for help. Remember, we are wired for relationships. Grab the finger that is pointed towards you with full strength, and use it to pull yourself up. After all, if a little baby in the womb can do it, so can you and I.