ZZ’s Corner

Wishing you all peace, and a very healthy, safe, joyous and fulfilling 2005.

There are transitional points in everyone’s life. Zero To Three (ZTT) Mid Career Harris Fellowship is one of those in my life. It came as close as it could to “coming home” for me. It brought me closer to a family of minds and mentors I admire, and colleagues and friends I trust. This Fellowship is a lifetime commitment on both sides, the fellow and the ZTT family, in efforts to improve the lives of young children and their caregivers around the world. ZTT 2003-2004 fellows graduated on December 4, 2004 joining the other pioneer ZTT Graduate Fellows.

Young children of the world lost Irving Harris, a leading champion on September 25, 2004. ZTT Mid-Career Fellowship is renamed in honor of Irving Harris, who pioneered support and funding services for children across the United States. He helped to create Zero To Three, coined the term Zero To Three, and served as a supporter and board member for the past 20+ years. His marks of generosity, compassion and caring for the youngest and the most vulnerable populations continued to the last days of his life. He also helped to create Yale Child Study Center at Yale University, the University of Chicago’s Graduate School of Public Policy Studies, and the Erikson Institute for Advanced Studies in Child Development. In 1996, in one of his books, “Children in Jeopardy: Can We Break the Cycle of Poverty?” Irving Harris emphasized the importance of early intervention and its impact on learning readiness.

As my gratitude, and on behalf of those children and families for whom I care, I submit the following poem to his memory and in his honor.

Ervin Harris Dies

You need a window to your heart
for the world to see
what eyes
cannot.

Pulsing fibers tense with feelings
melancholic moods
raw emotions
anticipation, doubt, hope, but never fear.

You “chose the road less traveled”
and you “made all the difference”. (1)
This is all the choice there is.

Eyes on the horizon
chin firmly set,
a hand upon the wheel
in every storm,
you steer your vessel on
toward the land rising ahead.

Moving gently and quietly
Through myriad of life form;

Butterfly’s wings,
Moving air,
Rocks warming
Under the first rays of sun at dawn

Shadowy feature of an angel
holding an eagle feather

The gazelle gracefully
disappearing into the forest.

Growing around the narrow streams,
Below the edges of the fallen rocks,
Beyond sorrow of our loss,
And where the sun shines,
The first rays of light and warmth,
Where I can hang
Portrait of hope for dawn.

(1) Referring to the poem “Road Less Traveled” by Robert Frost.

Brief Article

Postpartum Disorders
Written by: Zari Hedayat, Ph.D., MFT

Postpartum disorders comprise a cluster of conditions that could happen at any time during the first year after maternity, and which have sometimes erroneously become synonymous with the “baby blues” or “postpartum depression.” Postpartum disorders include the latter two conditions, but also include postpartum anxiety disorders, namely obsessive-compulsive disorders and panic disorders, and finally postpartum psychosis, which is a rare condition.

Not long ago, the tragic incident of a Texan woman drowning her 5 children, ages 6 months to 7 years, attracted media attention, and a Newsweek Magazine had postpartum depression in large prints on its cover page. This is regrettable, as this woman’s condition would be more accurately described as “postpartum psychosis” and not depression. The former can cause auditory hallucinations, especially what is commonly known as hallucinations of command: hearing voices telling you to kill or hurt someone. To hear voices is vastly different from having frightening thoughts about harming the baby, a common condition known as OCD or obsessive compulsive disorder, which does not place the baby in danger. Mislabeling such a tragedy as depression could cause countless women who suffer from postpartum depression and anxiety to be terrified of their condition and further isolate them into silence.

Historically, postpartum disorders have been under-diagnosed and unrecognized, because women are too embarrassed by their feelings of melancholia and anxiety, at a time when the culture wants them to be happy, to report their symptoms to their physician. The women who do report their symptoms to their physician, are for the most part reassured that they are having the normal baby blues, considered to be hormonal and that it will pass shortly. But the fact is that to consider postpartum disorders, as being only hormonal is to minimize and simplify a very complex phenomenon. There are important psychological and socio-cultural factors involved. In fact, new research finding on fathers are pointing to the fact that fathers too, suffer from postpartum depression, but in their case, hormones can’t be considered the contributing factor. Another interesting fact is that the prevalence of the “baby blues”, which is 50-80% of all women, is found to be true across cultures. The same is true for postpartum psychosis, the prevalence of which is 1/1000 women. Both these conditions are believed to be largely hormonal due to the sudden drop of hormonal levels shortly after delivery, and usually both occur within 2 weeks after delivery. However, some research points to the fact that the prevalence of postpartum depression and anxiety disorders, which is 10-15% is not universal (Stern & Kruckman, 1983)¹ , thus putting in question its hormonal etiology.

How can we account for the fact that postpartum depression is relatively unknown in kin based societies in non-western countries and so common in the US and most industrialized Western countries?

In most societies around the world, pregnancy and the postpartum period is viewed as a major life crisis, for which the group of kin and friends prepare through rituals that recognize and ease the transition of the woman into motherhood. For example, in most Latin cultures, new mothers observe the cuarantena, which represents a 40 day rest period, during which time the mother is usually confined to her home, and receives the assistance of close family members for the provision of food and household chores, so that she can attend to her baby free of other responsibilities. In Iran, there is a “one week”marker, at the end of which a group of women (usually close family members) go to the public bath together with the baby.

Then, there is the 40-day marker, at which time visitors can come see the baby. In Iran, as in many cultures, the belief and fear of the evil eye or evil spirit is partially responsible for these protective measures and leads to other rituals such as the burning of certain incense and the prohibition of certain foods to protect the mother and her baby from evil spirits. In these cultures, complementing the new baby is not desirable. For example, in Ethiopia, after the baby is complemented, the parent will spit on the baby, to make it less desirable for the bad spirit to want to take it away. According to Kruckman (2000)², postpartum rituals give a socio-cultural context and meaning to the postpartum events. They are a way for recognizing and honoring the role transition of the mother, and thus are a symbolic form of support and learning that is protective of the mother.

On the other hand, in the US, pregnancy and postpartum is viewed as a happy time, with no social structuring of the transition to motherhood or social recognition of the postpartum period as being a life crisis. The extent of the rituals can be summarized as comprising “baby showers” which are for the baby and not the mother, and ritualized medical assistance.

What is it about the Western culture that wants women to go home from the hospital after a mere 24 hours stay, to live happily ever after with their new infant, whom they are supposed to love at first sight? What is it about our culture that creates the notion that pregnancy makes a woman glow and that this should be a joyous time? How many times, do we hear of new moms saying, “why didn’t anybody tell me what this was really going to be like?” “Why didn’t anybody educate us about postpartum disorders?” In a culture of mass information, how come women aren’t informed about postpartum conditions? Is it that we have become so focused on the value of “positive thinking and feeling” that we can no longer speak of what doesn’t feel good?

I believe that pregnancy and the postpartum period is fraught with a sense of loss: loss of one’s life as one knew it, loss of the self as one knew it, loss of one’s body and body image, loss of freedom, and possible loss of professional opportunities, to name a few. The fact is, pregnancy can easily be regarded as a period of mourning during which a woman must become aware of a sense of loss. Pregnancy, by heralding a new beginning, inevitably becomes an ending of sort. And terminations are difficult. I can think of women who told me “I didn’t love my life before the baby, but it was a loss anyway”, or “I didn’t do much with my freedom before the baby (i.e. travel, go out, etc…), but now I feel trapped”.

When a person suffers the death of someone, the loss is recognized by the society at large, and mourning rituals are present to support the grieved. The sense of loss and ending with pregnancy and the postpartum period is purely symbolic and an internal experience that for some reasons the society at large prefers to deny. Thus new mothers often feel alone and isolated, silently suffering from the lack of a social support structure that could help them embrace the new beginning with both good and bad feelings.

–––

Dr. Hedayat is a licensed marriage and family therapist in private practice since 1986, currently located in Brentwood, California. She is adjunct faculty at Antioch University, Los Angeles, and community agency liaison for the Infant Mental Health Specialist Training Program at Cedars Sinai Medical Center, Los Angeles. She holds a certificate in psychoanalytic psychotherapy from the Wright Institute of Los Angeles. She has a keen interest in the psychological vicissitudes of pregnancy and the postpartum period. She is a member of PSI (Postpartum Support International) and PHA (Postpartum Health Alliance).

Following, you may find contact information for Dr. Hedayat.

11980 San Vicente Blvd. #909
Los Angeles, Ca. 90049
Tel: (310) 457-8039
Fax: (310) 826-9008
Email: hedayat@aol.com

News Briefs

ADHD

About 900 parents of children diagnosed with ADHD from eight countries of Australia, Canada, Germany, Italy, Mexico, the Netherlands, Spain, the U.K., and the U.S. were surveyed by a market research firm, Osnos in partnership with Eli Lilly and Company, and was supported by ADHD advocacy groups such as: ADD Association in Queensland, Australia; Learning and Attentional Disorders Society in NSW, Australia; AIFA in Italy; AMDAH in Mexico; Balans in the Netherlands; ADANA Foundation in Spain; ANSHDA in Spain; APNADAH in SPAIN; ADDISS in United Kingdom; and CHADD in the United States.

The results of the survey were presented in August 2004 in Berlin at the 16th World Congress of the International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP).

A couple of highlights of the reported results were as follows:

• ADHD is one of the most common disorders of childhood and adolescence, affecting 3-7% of school age children.

• There is an international variability in the length of time to diagnose ADHD by a health professional. The sample in the US showed it to be one year, while the sample in Italy the average time was just over three years.

To see the report and the data from each of the countries check www.wfmh.org, the World Federation for Mental Health web site.

Editor’s Note:

• Generalizability of the results to the variety of subcultures in each country should be considered while reading the findings.

• Education is necessary to reduce the length of time to diagnosis. Three years is too long in a life of a child with ADHD or any other childhood disorder to receive intervention and care.

BABY STAGES: A Parent’s and Caregiver’s Guide to the Social and Emotional Development of Infants and Toddlers is a product of the Michigan Association for Infant Mental Health and the Michigan Department of Community Health. It is an easy to use circular information sheet for the parents. For information and copies call 1-800-EARLY ON.

“Scoop of Indian Children was genocide” writes Sandra Takeaway, on the Repatriation Process of the aboriginal children removed from their families and communities during the 1960’s by Canadian’s Aid Society. This practice was conducted without any consideration to the long-term consequences of separation during early years of life, and lack of consideration for cultural identity of the child, heritage and historical traditions. Resolution 1981 put an end to this practice. For more information please check www.firstperspective.ca. In the United States, the Indian Child Welfare Act of 1978, put stop to the governmental jurisdiction to remote American Indian children from their families and homes for placement in non American Indian families and agencies.

The year 2000 Census data shows that California is home to the largest American Indian population in the United States with 109 recognized tribes and over 40 unrecognized tribes in the state. However, accessible, culturally sensitive health services, especially for families with young children in this state are at best sporadic and rare.

The 2004 Children’s ScoreCard prepared by the Los Angeles County Children’s Planning Council that was released this month reporting on 2002 statistics, shows that American Indian Children in Los Angeles County represent only 0.3% of the “Demographic Data (Page 27). It does not include American Indian children and youth category in its categories of “Uninsured Children by Race/Ethnicity “(Page 7), and “Children with Asthma by Race/Ethnicity” (Page 8). Additional information noted in this report portrays the grim picture of American Indian children in our community. For example, American Indian children suffer from highest percentage of “Very Low Birthweight Births” (38.9%; Page 9), and second lowest rate for “Infants Whose Mothers Received Prenatal Care in the First Trimester of Pregnancy” (85.8%; Page 9). For more information on the status of children in Los Angeles County and access to this report, please check www.childrensplanningcouncil.org.

CHILDHOOD UNDER THREAT:
The State of the World’s Children 2005

In this week, UNICEF released its annual report on status of children called: “CHILDHOOD UNDER THREAT: The State of the World’s Children 2005”. The bleak state of universe for children around the world includes some of the most striking conditions in the 21st century. Half the children are devastated by poverty, caught in conflicts and AIDS. Some other eye opening statistics are as follows:

• From 2.2 billion children, more than one billion are denied a healthy and protected upbringing as stated in the “Convention on the Rights of the Child” of 1989. More than 29,000 children die daily from mostly preventable diseases and living conditions, more than 2 million are used as sex labors, 1.2 millions are trafficked, over 120 million did not attend primary schools, majority of them girls.

• Nearly half of 3.6 million people killed in wars, including the 55 civil wars, during the last decade were children. Additionally, millions of children are recruited or abducted as soldiers, forced labor and sex slaves, are victims of landmines, are forced displaced, and victims and witnesses of violence.

• Between 2001 and 2003, an additional 3.5 million children were orphaned because of AIDS, which raised this number to 15 million.

• Soaring number of death of caregivers in Africa (parents, health and education professionals) is threatening life and impacting health and well being of children.

• Children’s poverty level has worsened and almost 22% of United States’ children live in poverty.

• 90 million children of the world are malnourished and food deprived, and 270 million of them have no access to health care services.

We are failing our next generation and our future.

Just for Your Information

Training & Continuing Education

The Center For Child Mental Health
2004-2005 – London, England
2-18 Britannia row, Islington, London, N1 8PA
Phone: 020-7704-2534
Fax: 020-7704-0171
info@childmentalhealthcenter.org

Born to Learn
Parents as Teachers 14th annual Conference
March 21-24, 2005
Renaissance Grand Hotel in St. Louis
2228 Ball Drive, St. Louis, MO 63146
Phone: 314-432-4330
Fax: 314-432-8963
www.patnc.org

23rd Annual Conference on Protecting Our Children
National American Indian Conference on Child Abuse and Neglect (NICWA)
April 24-27, 2005
Albuquerque, New Mexico
National Indian Child Welfare Association
5100 W. Macadam Ave., Suite 300
Portland, Oregon 97239
Phone: 503-222-4044, ext. 113
www.nicwa.org

Funding Alert – First Five LA Healthy Births Initiative RFP
Healthy Babies – Best Babies Collaboratives Initiative
For further information contact: Aizita Magana, Program Officer:
Phone: 213-482-9427
Email: amagana@first5.org

Peace Project in Azerbaijan: Training for Civil Society
The Institute for International Connections (IIC) and the Azerbaijan Psychological Association (APA) invites sponsors and participants for one or more of the upcoming training programs that will take place in Baku, Azerbaijan:

• March 11-20, 2005
• June 10-20, 2005
• August 26-September 4, 2005

For further information please contact: Alexander Cheryomukhin, President APA, at: alexcherpsy@yahoo.com.

Just for Your Information

Training & Continuing Education

ZERO TO THREE NTI – 19th National Training Institute
December 3 – 5, 2004, Sacramento Convention Center, Sacramento, California
2000 M Street, NW, Washington, DC 20036
Fax: 202-624-1766
www.zerotothree.org

Indigenous Women’s Conference – Australia
November 4 – 8, 2004
Contact: Dr. Graeme Ward
AIATSIS
GPO Box 553, Canberra 2601 AU
Fax: +61 2 6249 7714
Email: conf2004@aiatsis.gov.au

Healing American Indian Nations – 2nd American Indian Annual Conference
November 18 & 19, 2004
LAC DMH Training and Cultural Competency Bureau,
Contact: Virginia A. Borrero
550 S. Vermont, Suite 605, LA, CA 90020
Phone: 213-738-2325
Fax: 213-351-2026 or 213-351-2015
vborrero@dmh.co.la.ca.us

Developmental Interventions in Neonatal Care
November 8 – 10, Seattle, Washington
Sponsored by: Contemporary Forums
11900 Silvergate Drive, Dublin, CA 94568
Phone: 800-377-7707
Fax: 800-329-9923
www.contemporaryforums.com

The Center For Child Mental Health
2004-2005 – London, England
2-18 Britannia row, Islington, London, N1 8PA
Phone: 020-7704-2534
Fax: 020-7704-0171
info@childmentalhealthcenter.org