When Love Isnt Enough

[Applause]

at maturity

coastal redwood trees grow to about 350

to 370 feet tall

for context that’s roughly goal post to

goal post

on a regulation size football field it’s

as tall

as the statue of liberty if you’ve ever

wanted to be a tree hugger

a redwood’s a great place to start as

long as you’re cool with linking arms

with

12 to 15 of your best friends and kind

of doing like this

redwoods are enormous so it would stand

to reason then

that the roots must run very deep

actually the roots of a redwood tree

reach down only about three to six

feet in the sandy loamy soil in which

they grow best

three to six feet that’s about it

instead those roots grow outward in long

networks intertwining with the roots of

the trees

around it sometimes even becoming fused

it’s literally the strength of the many

that holds up the one

now when i think of what the roots of a

redwood tree look like it’s sort of what

i

imagine the brain might look like as

synapses are wiring and things are

firing and

information is passing from one side of

the brain to the next much like

food and water passes across roots of a

redwood tree

it’s a network and an infrastructure in

our brain that’s wiring for growth

all right so i’m not a doctor clearly

i’m just a mom i’m a mom

who has read books and gleaned as much

information and tried to learn as much

as i possibly can

about a child’s early brain development

so from my uh layperson’s perspective

here’s what i’ve come to learn

before a baby is born the brain stem is

the first part of the brain to develop

in utero

it’s the thing that controls involuntary

actions things like the fact that

you just do breath into your lungs

or the fact that your heart is beating

in your chest even now

without you even thinking about it the

brain stem is also responsible for our

most

primal fight or flight reaction and when

we’re faced with a threat

the brain stem literally takes over and

tells the rest of the brain

don’t even worry about it i’ve got this

the brain stem is responsible for the

core of what keeps us

alive now when a baby is born

their brain is most open to learning and

they’re gathering

information at an incredible rate about

the world around them

they’re learning cause and effect things

like i’m hungry

and i cry and someone brings me food

awesome or i’m lonely

and i cry and someone picks me up and

holds me

gives me nurturance and love

but what about when a baby uh when their

environment is not met with those same

cause and effect

situations instead what about when a

baby is met with uh

i’m hungry and i cry but there is no

food

or i’m lonely i’m scared and i cry

but no one’s coming

well a baby’s brain is gathering

information about that

as well and it’s learning really there’s

no point in crying because no one’s

coming

adults don’t take care of you you can’t

trust them

and if you’re going to survive in this

world it’s up to you

to take care of yourself that

early brain wiring is what’s responsible

for something called reactive

attachment disorder

i’d love to tell you about l elle

is vibrant and active

she is impossibly perceptive that girl

sees

everything she loves pancakes with

sprinkles in them she loves

jeep rides with the top off and if you

were downtown a few saturday nights ago

she was the one

with her bubble wand out of the top of

the jeep letting the wind

blow bubbles into the summer air behind

her

that girl is hilarious she can crack

jokes

and farts that’ll make you laugh

and groan at the exact same time much

like any eight-year-old

she’s amazing

elle came into my family’s life like

unexpectedly like a

leaf blown in on a breeze in october

of 2013.

she was the granddaughter of a former

employee and i came to know about this

little girl who needed a place to stay

and so

i just said well she can stay with me i

knew her family had some things that

they needed to get figured out and

squared away

a couple months before she had been

removed from where she was living

in a 2001 chevy impala on a gravel road

on a reservation somewhere in north

dakota

she was with our family for two and a

half months and then again

another breeze blew her along

like a leaf to be with another relative

in another zip code she was there for a

year gone from

us for a year and then tumbled her way

back in when she was removed from

that situation for unsafe living

conditions

and neglect in her formative first

36 months of her life when her brain was

gathering

all this information

she learned not to trust

her brain was wired for survival she

learned early on that cause and effect

of the world around her

and now i can say wired for survival and

on a surface level you can think you

probably know what that means but

the way the brain works in a child with

reactive attachment disorder and ptsd

is so misunderstood

it’s a disconnect that can look like an

inability to

give or receive love i call it her

dishrag hugs when she can come in

to the side for a hug and she sort of

goes through the motion

but there’s really no emotion behind it

it’s really hard as a parent when you

give your child a hug

and they bristle against you makes me

question my parenting worth like if i

can’t

have my child give or receive love

then what does that say about me

reactive attachment disorder can also

look like a compulsion to control every

situation

small situations but for instance i

might say today we’re gonna go to

the grocery store the car wash and the

bank and she’ll say we’re gonna go to

the car wash first

which you guys it doesn’t matter one

iota if we go to the car wash first

right

but what she’s doing is she’s trying to

gain control

and again what’s the big deal it doesn’t

matter

but when she gains control in those

small situations over and over and over

again

she’s proving to herself that she can

take care of herself

make the decisions and she doesn’t need

adults to survive

she’s literally fending off her own

attachment

it can also look like an inability to

handle everyday situations

from an early age say 3 we would notice

these tantrums that were deeper more

intense than

anything i’d ever experienced i’d try to

explain it to people but they’d always

say

oh that’s just how kids are she’s three

she’ll go through it

only i’ve parented three kids before her

and this was like nothing i had ever

seen

we noticed they started to be clustered

together like if she was going to have

one she was going to have two

or three they were clustered together

and it seemed like when she got off

balance it was

really hard for her to find her way back

to center

but now when adoption was finalized in

october of 2016 of course

things were going to get better she

would know that stability was here she

had a forever home

love was freely given and we were so

excited to join her on her healing

journey of course things were about to

get better

but that’s what’s so tough for people to

understand about reactive attachment

disorder

is instead of things getting better the

deeper the relationship goes

the worse it actually gets see

relationships are scary

and the more the brain fights against it

it’s like they’re trying to

sabotage the relationship because it

seems way too good to be true while at

the same time

being terrified of making a mistake

and losing it

she goes into overdrive and

everyday frustrations are really

difficult for her to handle

things that are simple like being told

that uh

you need to brush your teeth take a

shower and

uh and and comb your hair before you can

have screen time

it seems like she just can’t handle

those things

she goes into overdrive and like i said

in an instant she loses

all reason she uh goes into a tailspin

now you or i can say that uh

you know maybe we’ve had a bad day and

we can say man

i cannot handle one more thing

but even those of us who might struggle

with our patients probably have a pretty

reasonably sized window of tolerance

again the number of things that we can

accept in a day

for kiddos with reactive attachment

disorder their window of tolerance

is exponentially smaller and those

everyday little frustrations send them

into a tailspin

again after adoption instead of things

getting better they actually got worse

and in the months and years that went by

uh these tantrums would escalate and

behind closed doors people could have no

idea

what was happening

anxiety and rage would take over her

body so

fully that she would scratch the

undersides of her arms

until they’d bleed

she screamed so long and so loud one

morning that she

burst the capillaries around her eyes

and the visual reminder of that episode

lasted

long after it had finished

with a flip of a switch she was out of

her brainstem

things were getting worse after an

episode

she’s just exhausted and i remember once

as

the rage turned to tears and her little

body was just spent she started to say

owie mommy it hurts it hurts it hurts

and i said what baby tell me what hurts

tell me what hurts

i will never forget the look on her face

as she slid down the wall fully

exhausted and said

everything everything

hurts

i was completely at a loss

we had tried everything we felt helpless

she had been in counseling and play

therapy weekly

since she was three years old and again

things weren’t getting better they were

only getting worse

i talked to a friend of mine who

actually works in child protection was

really familiar with elle’s case

and she said melissa i know you’re

trying

and it’s not your fault but what you’re

doing is not helping

if she had a broken leg you wouldn’t

just

put a band-aid on it and then praise the

days be excited about the days when she

didn’t limp no if she had a broken leg

you would get her to a doctor and you

would get her the help she needed

and so in may 31st of

2018 my little one entered a

prtf so a prtf that’s a psychiatric

residential

treatment facility

see our family has learned symptoms and

diagnoses

we have learned to navigate the lingo

and learn systems we never

even knew existed

she was in residential treatment for 652

days

nearly two long years

but while she was there she worked

really really hard and

we worked to best understand her and

meet her needs and and

help her grow and thrive and she made

so much progress

she was nearing her discharge date this

spring and we were so excited to visit

the school where she would go

and uh again she was just so excited

about discharge coming up

she’d made so much progress that as we

visited visited the school this day

uh there was this lovely little girl who

came over i mean bless her nurturing

little soul

she came over and rubbed elle on the leg

and said

it seems like you’re a little scared but

you don’t have to be scared we’re all

really nice here

oh my gosh this girl i was so

compassionate

i was just really thankful

but on the way home that afternoon elle

looked out the window and she was quiet

and finally she said thoughtfully you

know what mom

sometimes i really don’t like to be

touched

you guys this was huge she was learning

to

express her needs identify what they

were to begin with

communicate them and stay on the level

it was huge we were excited she was

coming home

i’m a big fan of bose

you put a bow on something you wrap it

up neat

tidy present perfect package

i was so excited to give this ted talk

tonight

and to talk about reactive attachment

disorder

i was excited to tell you about like her

story

cause and effect and then getting help

and and and

everything being great in the end

perfect story arc right

only i’m finding bows don’t exist on

mental health packages

and many times it starts and stops lots

of

progress setbacks and sometimes it feels

like you’re right back at square one

elle was discharged on march 13th this

year into the world

of coven and all of her excitement and

expectations about

going to school and making new friends

and playing with the friends she already

had

were dashed in an instant

the therapist that was we were given a

new therapist and she was going to come

into our home once

twice weekly if needed and suddenly she

was no longer able to come

due to covid so elle went from

full inpatient therapy where every

second of her day was structured

to the world of covid where there was

very little ability to establish

any kind of routine and her

disappointments and

things like the dogs barking and loud

noises triggered

flare-ups of her ptsd she would find

herself

out of her window of tolerance back down

into her brain stem to where

things like even the doorbell ringing

would send her

diving under tables or hiding behind

chairs

she was back into her brain stem once

again

things culminated with some really scary

and harmful violence

descriptive threats of things that she

said she would do to herself

and to others

until one thursday night we found

ourselves

completely scared completely disheveled

doing an emergency admittance into

behavioral health

a few days later she was transferred

back

to her psychiatric residential treatment

facility

i felt like i’d failed her once again

it wasn’t the bow that i thought i was

going to put on this package tonight and

bring to you again cause

effect perfect story arc it’s not what i

thought we’d be talking about but still

i wanted to talk to you about reactive

attachment disorder because i need you

to understand

we need you to understand because elle

and kids like her both in

and out of the system are affected by it

and it’s affecting you and it stems

from birth parents who weren’t given the

tools that they needed to be successful

parents because their parents weren’t

given the tools and their parents

weren’t given the tools

i needed to talk to you about this

tonight and and help you understand

because

knowledge helps break chains

i need you to understand that

parents of kiddos with reactive

attachment disorder are behind closed

doors

giving everything they can

doing what they think is best even when

it’s the hardest thing they’ve ever done

and elle needs you to understand her

because kids with reactive attachment

grow up to be your kids classmates they

grow up to be your co-workers

and they grow up to be adults who will

parent children

themselves dr bruce perry is an

expert in the field of child psychiatry

and reactive attachment disorder

he says by conservative estimates 40

of american children will go through at

least one traumatizing event before age

  1. but what matters most is not the

event itself

no it’s how

the community of adults stands tall

around them

we need you to be redwoods

because even if we look like redwoods

the truth is

every single day we feel like we’re

failing and we feel like we’re falling

down

again what matters most is how we hold

each other up and can rely on one

another

he says fire can warm or consume

water can quench or drown

wind can caress or cut

and so it is with human relationships we

can both create

and destroy nurture and terrorize

traumatize

and heal one another

no this isn’t the bow that i thought i

was going to put on this package and

bring to you tonight

it’s not the story that i had hoped

because there aren’t any bows and

things are messy but still in learning

about those redwood trees

i’m learning how they hold one another

up

you know i’m learning about their roots

elle wasn’t given the roots that one

would hope in her early

early years but still those roots have

been determined they have been resilient

and they have grown outward

again they have touched the lives of so

many others

i have to believe that the roots that

are forming in her life

every single day are the ones that will

hold her up

standing tall and strong as she grows

i have to believe in her healing

and even when it’s really really hard

i have to believe in hope

so tonight i’m asking you to be a strong

redwood

and stand tall and believe in that hope

with us

you

[掌声]

在成熟时,

沿海红杉树长到大约 350

到 370 英尺高

,这在一个标准大小的足球场上大致相当于一个球门柱到一个

球门柱

,如果你曾经

想成为一个拥抱树的人,它就和自由女神像一样高

红木是一个很好的起点,

只要你很酷,可以与

12 到 15 个最好的朋友联系起来,并且

像这样做,

红木是巨大的,所以有理由

认为,根必须非常深

一棵红杉树的根

在沙质壤土中只能长到大约三到六英尺,在那里

它们长得最好

三到六英尺,

而不是那些根在长长的网络中向外生长,

与它周围的树根交织在一起,

有时甚至变成

当我想到

一棵红杉树的根部看起来像什么时,它实际上是许多人的力量支撑着它,就像

想象的大脑在

突触连接时可能看起来 事情在

燃烧,

信息从大脑的一侧传递到另一侧,

就像

食物和水穿过红杉树的根部一样,

它是我们大脑中的一个网络和一个基础设施,

它为增长而接线,

所以我不是一个 医生显然

我只是一个妈妈

在婴儿出生之前学习脑干

是大脑在子宫内发育的第一个部分

它是控制非自愿

行为的东西,例如

您只是向肺部呼吸

的事实或您的心脏在您的心脏跳动的事实

即使现在

你甚至没有想到胸部,

脑干也负责我们

原始的战斗或逃跑反应,当

我们面临威胁时

,脑干实际上会接管并

告诉大脑的其余部分

甚至不用担心,我知道

了脑干负责

让我们

现在活着的核心。当婴儿出生时,

他们的大脑对学习最开放,

他们正在

以令人难以置信的速度收集

有关 他们周围的世界

他们正在学习因果关系,

比如我饿了

,我哭了,有人给我带来了美味的食物,

或者我很孤独

,我哭了,有人抱起我,

抱着我,

给了我养育和爱,

但是什么时候 一个婴儿,呃,当他们的

环境没有遇到同样的

因果关系

但是没有人会

好起来,婴儿的大脑也在收集

有关这方面的信息

,它正在学习真的

没有必要哭泣,因为没有

人会照顾你,你不能

相信他们

,如果你能活下来 在

这个世界上,由你

来照顾你的 自我认为,

早期的大脑接线

是导致所谓的反应性

依恋障碍的原因

我很想告诉你关于 l elle

充满活力和活跃

她不可思议的洞察力 女孩

看到了

她喜欢的所有东西 她喜欢

洒在上面的煎饼 她喜欢

吉普车的顶部 关闭,如果你

在几个星期六晚上前在市中心,

她就是那个

拿着泡泡棒的人从

吉普车的顶部让风

把泡泡吹到她身后的夏日空气中

那个女孩很搞笑,她会讲

笑话

和放屁 让你

在同一时间发笑和呻吟,

就像任何一个八岁的孩子一样,

她是一个了不起的女孩,

就像 2013 年 10 月微风吹来的树叶一样意外地进入了我家的生活

她是一名前雇员的孙女

, 我开始了解这个

需要一个地方住的小女孩

,所以

我只是说她可以和我住在一起,我

知道她的家人有一些

事情需要弄清楚并解决

几个月前,她在北达科他州某处保留地

的碎石路上开着一辆 2001 年的雪佛兰黑斑羚从她住的地方搬走,

她和我们的家人待了两个

半月,然后

又一阵微风吹过她,

就像 一片叶子与

另一个邮政编码的另一个亲戚在一起她在那里待了

一年离开

我们一年,然后

在她

因不安全的生活

条件

和在她成长的前

36 个月中被忽视而被从那种情况中移除时跌跌撞撞地回来了 她的生活,当她的大脑

收集

所有这些信息时,

她学会了不相信

她的大脑是

为生存而生的

可能知道这意味着什么,

但是大脑在患有

反应性依恋障碍和 ptsd 的孩子身上的工作方式

被误解得

如此之深,它是一种脱节,看起来像是

无法

给予或 接受爱我称之为她的

抹布式拥抱,当她可以

走到一边拥抱她时,她有点

经历了这个动作,

但背后真的没有任何情感

当你给你的孩子一个拥抱时,作为父母真的很难

,他们会发怒 反对你让我

质疑我的养育价值如果我

不能

让我的孩子给予或接受爱

那么这对我有什么看法

反应性依恋障碍也可能

看起来像是一种控制每一种

情况

小情况但例如我

今天可能会说 我们

要去杂货店洗车和

银行,她会说我们要

先去洗车

,伙计们,

如果我们先去洗车

没关系,

但是 她正在做的是她试图

获得控制权

,再一次有什么大不了的,但这并不

重要,

但是当她一次又一次地在那些

小情况下获得控制

权时,她向自己证明,她可以

照顾好自己,

做出决定 并且她不需要

成年人来生存

她实际上是在抵御自己的

依恋

它也可能看起来像是从小就无法

处理日常情况

比如说3我们会注意到

这些发脾气

比我经历过的任何事情都更强烈 我会试着

向人们解释,但他们总是

说,

哦,这就是孩子们的样子,她三岁,

她会经历这一切,

只有我在她之前养过三个孩子

,这就像我从未

见过的一样,

我们注意到他们 开始聚集

在一起,就像如果她要拥有

一个她将拥有两个

或三个他们聚集在一起

,似乎当她失去平衡时,

她真的很难找到

回到中心的路,

但现在当 收养于

2016 年 10 月完成 当然

事情会好转 她

会知道这里的稳定 她

有一个永远的家

爱是免费给予的,我们很

高兴能和她一起踏上她的康复

之旅 事情

即将好转,

但这就是人们很难

理解反应性依恋

障碍

的原因,而不是事情变得更好

,关系越深入

,实际上变得越糟糕,看到

关系是可怕

的,大脑越是与之抗争,

就像他们 ‘试图

破坏这种关系,因为这

似乎太好了,令人难以置信,同时

又害怕犯错

并失去它

告诉

你,你需要刷牙

洗个澡,然后梳理你的头发,然后才能

有屏幕时间

,似乎她无法处理

那些

她超速驾驶的事情,就像我

说的那样,她立刻失去了

一切 为什么她呃现在陷入混乱

你或者我可以说呃

你知道也许我们度过了糟糕的一天

我们可以说男人

我不能再处理一件事

但即使 我们这些可能与我们的患者斗争的人

可能有一个相当

合理的容忍窗口,

对于患有反应性依恋

障碍的孩子,我们一天可以接受的事情的数量他们的容忍窗口

是指数级的更小,那些

每天的小挫折会发送给他们

收养后再次陷入混乱,而不是事情

变得更好,他们实际上变得更糟了

,在过去的几个月和几年里,

这些发脾气会升级,

关起门来人们可能不

知道发生了什么

焦虑和愤怒会占据她的

身体,所以

完全是为了她会抓挠

她的手臂下面

直到流血为止。

一天早上,她尖叫得如此之长,如此响亮,以至于

她眼睛周围的毛细血管破裂了

,那一集的视觉提醒

在它结束后持续

了很长时间。 切换她的

脑干后,

事情变得更糟了,

她刚刚筋疲力尽,我记得有一次

当愤怒变成泪水,她的小

身体刚刚耗尽时,她开始说

owie 妈妈,它很疼,很疼,很疼

,我说什么,宝贝,告诉我什么疼,

告诉我什么疼,

我永远不会忘记

她滑倒时脸上的表情 倒在墙上

筋疲力尽 说

一切都

很疼

我完全不知所措

我们尝试了一切 我们感到无助

她从三岁起就每周接受咨询和游戏

治疗

事情并没有好转 他们

只会越来越好 更糟糕的是,

我和我的一个

真正从事儿童保护工作的朋友谈过

,她对 elle 的案子非常熟悉,她说 melissa 我知道你在

努力

,这不是你的错,但

如果她的腿断了,你所做的无济于事 你不会

只是在上面

贴上创可贴然后赞美那些

日子 为她没有跛行的日子感到兴奋

如果她的腿骨折了

你会带她去看医生 你

会得到她的帮助 需要

等等

2018 年 5 月 31 日,我的孩子进入了

prtf,所以 prtf 是一个精神病

住院

治疗机构,

看到我们的家人已经学会了症状和

诊断,

我们已经学会了使用术语

和学习我们

甚至不知道存在的系统

她在住院治疗 652

将近两年漫长的日子,

但当她在那里时,她工作

非常努力,

我们努力最好地了解她,

满足她的需求,

帮助她成长和茁壮成长,她取得

了很大的进步,

今年春天她即将出院

,我们 很高兴能参观

她要去的学校

,呃,她

对即将出院感到非常兴奋,

她取得了很大的进步,以至于我们

今天参观了学校,

呃,有个可爱的小女孩

过来了,我的意思是 祝福她养育的

小灵魂

她走过来揉了揉 elle 的

腿说

你好像有点害怕 但

你不必害怕 我们都

很好

哦,天哪,这个女孩,我是如此

富有同情心,

我真的很感激,

但那天下午在回家的路上,艾尔

看着窗外,她很安静

,最后她若有所思地说,你

知道妈妈

有时我真的不喜欢被

触摸 伙计们,这太棒了,她正在学习

表达自己的需求,确定

他们要从什么开始与

他们交流并保持在水平上,

这是巨大的,我们很兴奋她

要回家了,

我是 bose 的忠实粉丝,

你在你的东西上鞠躬 把它包

起来

整洁的礼物 完美的包装

我很高兴今晚能做这个 ted 演讲

并谈论反应性依恋

障碍

我很高兴能告诉你她的

故事

因果关系然后得到帮助

,而且

一切都很好 结束

完美的故事弧是对的,

只有我发现心理健康包上不存在弓,

而且很多时候它开始和停止很多

进展挫折,有时感觉

就像你回到了第一方

elle 于今年 3 月 13 日出院,

进入

了 coven 的世界,她

对上学、结交新朋友

以及与已有的朋友一起玩的所有兴奋和期望

在瞬间破灭

了,我们的治疗师得到了一个

新的 治疗师,如果需要,她将每周两次

到我们家来一次

,突然她

由于covid而无法来了,所以elle从

完全住院治疗开始,

她每天的每一秒

都被安排到covid的世界里

几乎没有能力建立

任何常规,她的

失望和

诸如狗吠和大声喧哗之类的事情

引发

了她的创伤后应激障碍发作,她会发现

自己

超出了她的宽容之窗,回到

了她的脑干,

甚至像 门铃响起

会让她

跳到桌子底下或躲在

椅子

后面 她又回到脑干里

大量暴力

描述性威胁她

说她会对自己

和他人做的事情

直到一个星期四晚上 我们发现

自己

完全害怕 衣冠不整

几天后紧急进入行为健康中心 她被转移

回她的精神病院治疗

机构

i 感觉就像我又一次让她失望了

这不是我认为我

今晚要穿上这个包裹并

再次带给你的弓

因为完美的故事弧这不是我

认为我们会谈论的但仍然

我想和你谈谈反应性

依恋障碍,因为我需要

你理解

我们需要你理解,因为 elle

和像她这样的孩子

在系统内外都受到

它的影响,它正在影响你,它

源于亲生父母 没有提供

他们成为成功父母所需的工具,

因为他们的父母没有

获得这些工具,他们的父母

也没有获得

我需要的工具 我今晚要和你谈谈这件事

,并帮助你理解,

因为

知识有助于打破

枷锁 他们曾经做过的事情

,elle需要你理解她,

因为有反应性依恋的孩子

长大后会成为你的孩子的同学,他们

会成为你的同事

,他们会长大成为成年人,他们会

自己抚养孩子,布鲁斯·佩里博士是 他

是儿童精神病学

和反应性依恋障碍领域的专家,

他说,保守估计,40

名美国儿童

在 18 岁之前至少会经历一次创伤性事件

。但最重要的不是

事件本身,

而是成年人社区的现状

在他们周围高大

我们需要你成为红杉

因为即使我们看起来像红

杉但事实是

每一天我们都觉得我们正在

失败 我们觉得自己

又跌倒了 最重要的是我们如何

互相扶持并相互依赖

他说火可以温暖或消耗

水 可以熄灭或淹没

风可以爱抚或切割

人际关系也是如此 我们

都可以创造

和摧毁 滋养和恐吓

创伤

和治愈彼此

不,这不是我以为

我要放在这个包裹上并

今晚带给你的弓

这不是我所希望的故事,

因为没有 任何弓和

东西都是凌乱的,但仍在

学习那些红木树

那些根仍然

已经确定,它们一直坚韧

,它们再次向外生长

,它们触及了

许多其他人

的生活

随着她的成长,站起来又高又壮,

我必须相信她的康复

,即使真的很难,

我也必须相信希望,

所以今晚我要求你成为坚强的

红木

,站起来,相信

希望 我们