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Secure Attachment As The Ultimate Preventative Health Strategy

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SECURE ATTACHMENT
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Upon receipt of the Murray Stalker award, an award recognizing upcoming leaders in Family Medicine, I had the opportunity to address my peers, mentors and colleagues.

Context is critical, and today the world feels like it did in the days prior to, and after, receiving this award. I am passionate, and especially passionate about kindness. I got on the plane to attend this conference the morning after the US election. I watched the presidential concession speech from a woman who was passionate about kindness, about women's right, about the environment and so much more that I believe so deeply in. I watched her gracefully accept defeat, but at the same time issue this rallying cry:

And to all of the little girls watching this, never doubt that you are valuable and powerful and deserving of every chance and opportunity in the world to pursue and achieve your own dreams.

I also watched a misogynistic narcissist pat himself on the back, attacking the moral character of every individual who opposed or did not believe in his candidacy. My heart sank. Is this the blueprint for the next generation?It felt like I was reliving every time a man had purposely ignored my boundaries, physically and emotionally, had taken credit for my ideas, or it had been assumed that I was incapable or less intelligent because of my gender.

In the wake of the inauguration, these feelings returned, and I was asked to share those words again.

I've been thinking a lot about what I hope to accomplish over the course of my career. My practice is unconventional, with a special focus on demographic groups lacking consistent primary care (ex; HIV+, new moms and babies, young children and families, sex-workers).. What I knew before, but now understand in a different, more profound way, it is that our experiences in childhood shape the rest of our lives.

When a child's needs are not met, when they are not loved, are neglected or abused, they develop insecure attachment - early life events cause physical and physiological changes in the brain, damage that is difficult to undo. Trauma is much more common than we think, or maybe than we want to believe. Diagnoses of depression, bipolar disorder, substance use disorder, personality disorders, etc.... are prevalent, but what I've noticed, is that, if you care to ask the question, the true cause is trauma, and the symptoms are manifestations of PTSD, and other diseases (fibroyalgia, IBS, etc...) profoundly interconnected with mental health.

A quick story from my own experiences. For those of you that know me, "Type A" is probably an understatement. I like to be in control. But life happens, and no matter how much you try to control it, sometimes things don't work out the way you planned. My husband and I had trouble conceiving, and once we finally did thanks to modern medicine - I thought we'd made it through the hard part. We found out that we were having twins, and figured we could plan for that. Hah. I was hospitalized at 24 weeks. We discussed with NICU about whether to resuscitate before 25 weeks. We decided to delay putting up the cribs, because I didn't think I could take them down.

Suddenly, all of your priorities change.

I've never cried as much as I did during those weeks. Luckily, they stayed put until 30 weeks, were born by emergency C-section, and were doing well... but there was still so much uncertainty. Becoming a mother changed me in ways I can't explain, but I never knew how deeply I could love until then. With so much then out of my control, I was told that breastmilk was one thing I could do for them, and so I was on a mission.

Anyone who has struggled with breastfeeding will understand - it can be really hard. As an underproducer, I read everything and tried every supplement to boost my supply - and we exclusively breastfed. This was the hardest thing I've ever done, but also one of the things I am most proud of.

The more I learned about breastfeeding, the more I learned about attachment. The older my kids got, the more I learned about the importance of secure attachment, and just how difficult it was to be a parent. The guilt, judgment, race to "have it all". I lost myself in that for a while. After coming out the other side, I realized that if I, a smart and resourceful woman, with an incredible support system struggled - how was everyone else without those supports doing it?

Breastfeeding is not right or possible for everyone. Secure attachment is absolutely possible without breastfeeding. Women should feel empowered to feed their children in the way that is best for their family - without judgment or guilt. But there is absolutely nothing that compares to the feeling of nourishing your child. The hormonal, chemical, physical interplay between a breastfeeding mother and baby are so complex, and so valuable. In Canada, our breastfeeding rates to 6 months are low. Early supplementation, delays in connecting with health care practitioners, inadequate/incorrect information, and many other factors can lead mom to feel that she is not able to breastfeed. Once the child is supplemented, the need for mom to be present all the time is somewhat lessened - other people can feed baby. It might be easier for bonding to suffer. No one will care for and love your children the way you do. No one will protect them like you will. They don't need anyone else like they need you.

Our clinic has a strong focus on preventative health. Encouraging healthy lifestyles to prevent and treat chronic diseases is our, and many other clinics' mission. But something is missing. We, as a society, need to do a better job of supporting parents and families. We need to break the cycle. Parents develop mental illness, and/or abuse substances to forget their own traumas, children are left with broken adults perpetuating the cycle of abuse, and they themselves eventually seek out ways to numb their pain.

I think secure attachment is the ultimate preventative health strategy.

I want to practice this kind of prevention - where we build community by acknowledging our own struggles and helping others with theirs. If we can improve the connection between parent and child, my hope is that the next generation will understand and practice kindness, acceptance, gratitude, and inclusivity better than we have done in the past - this will be our blueprint.

The summer of 2016 saw unprecedented anger and hostility in medicine amongst physicians, politics for our Southern neighbours, and across the world. There is an ugly side of society - abuse, neglect, disrespect, hatred, and discrimination. We have been disrespectful to each other, we have been political, we have been ambitious.

The outcome of the US election and events afterwards have shaken me to my core. Acts of violence, overt racism, disrespect, and the number of people who seem to think this is ok makes me feel physically ill. We are kidding ourselves if we don't think this exists in Canada.

In family medicine we have a responsibility, a unique and critical role in helping shape the next generation. We are facing a crisis in primary care, and in medicine, especially in Ontario. Our system is not sustainable, wait times are increasing, patients are sicker but trust their doctors less, physicians are unhappy, burned out, and disenfranchised.

The Murray Stalker Award is about leadership and advocacy, both of which we as a world need more of. I encourage each and every one of you to remember why you became a doctor, to remember those patients whose lives you have touched, and those that have touched you, to feel the responsibility that we all share for not just treating the sick, but doing all we can to help prevent suffering and keep people well. To be a leader, showing the world that in Canada, we care for, but also care about our patients and eachother. To be an advocate for tolerance, inclusivity, respect for our colleagues and our patients, but also to support those ideals in our patients right from the start.

Yoga has become a big part of my life and there is one word used at the end of every class that so perfectly captures my hope for the future:

Namaste.
My soul honours your soul. I honour the place in you where the entire universe resides. I honour the light, love, truth, beauty and peace within you, because it is also within me. In sharing these things we are united, we are the same, we are one
.

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