Transcriber: Ilze Garda Reviewer: Tanya Cushman
When I was little, I was not exactly the outdoors type.
I was quite introverted and often shy, and I actually hated public speaking.
Like really hated it.
Which seems kind of ironic
when I think about standing here on this red dot.
But I loved stories, and I read a lot of books.
My favorite ones were about adventurous people:
explorers,
archaeologists who went into exotic lands,
found traces of ancient civilizations, discovered hidden treasures,
and got themselves in and out of trouble.
I wanted to be like them: be fearless, venture into the unknown.
Now, I'm an adult, and I'm still not very outdoorsy.
I spend most of my working day sitting very still
in a quiet and comfortable office.
But sometimes I think
that I have actually managed to fulfill my childhood fantasies.
You see, I became a child psychiatrist.
And what I do every day
is I venture into the unknown of another person's psyche,
their emotions, their suffering.
Just like an archaeologist,
I excavate layers and layers of family history;
sometimes I find treasures,
sometimes I stumble upon a skeleton of some ancient beast.
And I still think a lot in stories,
stories of how things came to be the way they are for a particular kid
and stories that their development can take.
And I try my best to make these stories better.
So let me tell you a story about a boy whose name is Martin.
Martin was brought to me by his mother
because he had some difficulties at school.
He had difficulties concentrating, was a little bit restless
and not particularly good at maths.
But otherwise, a very happy, sunny, socially competent little kid
with a lot of friends and hobbies, and good grades in languages and sports.
But when I started to dig into Martin's history,
what I found
was that Martin's biological mother abused alcohol heavily during pregnancy,
so he was born prematurely with a very low birth weight.
He had a condition that's called partial fetal alcohol syndrome.
He was taken out of his birth family by the authorities quite soon after birth
because his parents just didn't really care for him,
and he was put into an orphanage, together with other unfortunate children.
And then, when he was around one,
he got lucky.
He was adopted by a family
whose biological children were already grown up.
And the staff of the orphanage actually advised his new parents
against taking the kid
because he also had some physical health problems
and he was quite slow in psychomotor development.
At the age of one, he just barely started sitting up.
And the staff of the orphanage thought that for sure he'll grow up disabled,
and who needs that, right?
But his new parents didn't really care;
they loved the kid as soon as they saw him.
They thought that they had resources to help,
and they felt that they had love to give,
enough love to be able to deal with the challenges they might face.
They decided not to be scared of the grim prospect
and adopted him.
And then they did what all good enough parents do.
They parented.
They cared for the kid.
They stimulated and challenged him.
They supported him when he couldn't cope.
They regulated his emotions
when he was feeling scared and overwhelmed.
And gradually, his development started to catch up.
He started walking, speaking and learning.
And when I saw him for the first time, at the age of seven,
he didn't have any significant emotional or behavioral difficulties.
He just had some minor symptoms of ADHD
and specific difficulties in mathematical thinking,
which only started to be problematic in the school environment.
And the only real reason for a psychiatric consult
was Martin's mother's wish to know if there is something else that she can do
to help the little guy do better at school.
So when you work with children,
the first thing that you have to remember
is that you're working with stories in progress,
that you're working with little people
who are in a very intense process of development.
And when we speak about the development of our mental capacities,
we have to speak about the development of the brain
because the brain is the biological base of our mental functioning.
And what we know about the development of the brain
is that our brain basically develops through death,
through programmed cell death.
In medicine, this process of programmed cell death
is called apoptosis,
which from ancient Greek literally means 'the falling of leaves'.
So while you're sitting here, listening to me,
the cells in your central nervous system
are quietly dying,
like leaves falling from a tree in autumn.
A very disturbing picture, isn't it?
But it's actually a very normal process.
When a child is born,
there are a lot of cells in his central nervous system.
It's 10 to the 11th degree of cells;
it's like one hundred billion.
But many of these cells, they are not mature yet:
they are not specialized, they are not differentiated,
and the process of the growth and development basically goes like that.
The cells that are not used, they die out in apoptosis,
but the ones that are left,
they mature, they specialize, they form connections.
And the older you are,
the less immature cells you have left that can still change
and the more rigid connections between the remaining mature cells.
In English, there is a witty saying
that it's difficult to teach an old dog new tricks.
Everybody knows that, right? It's kind of obvious.
This is called the normal plasticity of the brain.
An old dog has very few cells left that can specialize
and a lot of rigid connections between the cells.
And if you imagine this process of plasticity graphically,
what you get is actually
a downward exponential slope -
a curve of exponential decay.
So the younger we are, the more plastic is the brain,
the more adaptable, the more malleable.
Like clay that's plastic and malleable when wet
but it becomes more and more solid and fragile as it dries off.
If you think about it, it makes perfect evolutionary sense.
We're born into this world with a brain that's not fully specialized yet,
that's full of potential, that's ready to take on the challenge.
And then the environment and our experiences
gradually shape our brain
into being able to deal with the challenges
of this particular environment.
So over the years,
we have accumulated a lot of information
on how exactly the environment influences the developing brain.
Because of this plasticity,
the brain of a child can compensate for a lot,
even neurological damage,
if the environment is right.
And that's Martin's story.
But we also know what happens to a plastic brain
if the environment is not right.
Research has shown over and over again
how early adverse childhood experiences,
like the experience of violence, abuse and neglect,
shape our brain into being able to deal with these experiences
to ensure survival.
We know that kids who grow up chronically exposed to verbal abuse,
in adulthood have changes in the parts of the brain
that are responsible for analyzing verbal information.
They have disruptions in the architecture of the white matter,
and these are the wires connecting different parts of the brain.
So they have disruptions in the architecture of the white matter -
connecting these auditory centers in the temporal lobes
to the center for analysis and control in the frontal lobe.
And it's logical.
If you're forced to grow up with verbal abuse,
it is better for survival not to hear and not to analyze this information.
If you witness and see a lot of domestic violence in childhood,
in adulthood you will have
changes in the structure and function of the regions of the brain
in the occipital lobes
that are responsible for visual perception.
Because if you see a lot of abuse,
it's better not to see and not to understand.
If you suffer from sexual abuse, it might be better not to feel the pain.
And indeed, in adulthood,
we find thinning of the parts of the somatosensory cortex
that's corresponding to the genital area
in the brains of childhood sex abuse survivors.
The problem is that because of this exponentially diminishing plasticity,
these early adaptations,
they get stuck, they get fixed in the very structure of the brain.
And then we grow up,
and in our turn, we start changing and shaping the environment around us
to bring it closer to the one that our brains have adapted to living in.
And don't get me wrong: all is not lost also in adulthood.
There is always some window of plasticity.
But the older you are, the more narrow it gets,
the more energy, effort, repetition you have to invest
for the brain to change,
to develop new behaviors and new coping strategies.
Working in clinical practice as a child psychiatrist,
I see this process in action day in and day out.
And every time I meet Martin and his mother,
I cannot help but feeling completely overwhelmed
with joy and gratitude to this woman, to this family
for giving a great gift: the prospect of a good, fulfilling life.
Because I know how different the story of this child could have been
if he hadn't been as lucky.
And unfortunately, for every story like Martin's,
I have ten stories of kids who were not as lucky.
I often see a child who was left in the orphanage
and got pulled into the cycle of institutional abuse and neglect
and has learned to survive.
But when he's an adolescent, he's starting to abuse others
just because that's the only type of interaction his brain has adapted to.
I see a kid from a very well-off family
whose parents have neglected him from an early age
because they were too caught up in their own businesses
to spend a little time, to read a bedtime story,
to pay a little attention,
and now the kid is seeking for this attention
by acting out in all the wrong ways.
And I always try to help, and often I can,
but sometimes this damage is not easily undone.
Remember the plasticity curve.
And it makes me so sad and so, so angry
because I know how different the stories of these children could have been
if only they were lucky enough
in these critical periods of their development
to have at least one adult who genuinely cares for them.
And this is the main reason why I'm here today.
This is the reason why I find myself spending less and less time
in my quiet and comfortable office
and more and more time going out speaking to people
who sit in other comfortable offices in governments and ministries,
speaking to students,
speaking from big, extremely frightening stages like this one.
This is the reason I tell these stories about the development of the brain.
Because I know for a fact that we can do better.
We have to do better, as people and as a society.
It is much easier to prevent early adversity
than to deal with the consequences.
As Frederick Douglass once put it,
"it is easier to build stronger children than to repair broken men."
I'm here telling these stories because I believe
that the only way forward for us as a society is actually -
not conceptually, but actually -
investing in children.
It is making sure that nobody has to suffer abuse and neglect
in orphanages and other institutions.
It is making sure that families who struggle
can receive social and psychological support they need
to be able to provide their children with the love and care we all deserve.
It's because I'm sure that the only way how we can sustain as biological species
living on this speck of dust in the wide, cold, unforgiving universe
is creating a better world for our children now
so that they can create a better world for their children later.
So if there's one thing I want you to remember from this talk,
it's that there is always something you can do.
If you're in a position of power,
use that power to stop the cycle of institutional abuse.
If you have resources, take a kid out of an orphanage.
Adopt.
Foster.
If you don't have resources, stop abuse when you see abuse.
Take an interest.
Comfort a child in distress.
Help a family in need.
Together, we can do it.
And then, maybe I'll have less work as a child psychiatrist
and take up archaeology instead.
Thank you.
(Applause)