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Learning to Listen: A Life Caring for Children

by T. Berry Brazelton, M.D. Boston, Da Capo Press, 2013, 256 pp., $24.99.

Reviewed by Michael Jellinek, M.D.
Am J Psychiatry 2014;171:121-122. doi:10.1176/appi.ajp.2013.13050600
View Author and Article Information

The author reports no financial relationships with commercial interests.

Boston, Mass.
Dr. Jellinek is a Professor of Psychiatry and of Pediatrics at Harvard Medical School, Boston.

Accepted May , 2013.

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Learning to Listen relates, with insight and humility, the many outstanding contributions Dr. T. Berry Brazelton has made to infants, children, and families. The book starts as a charming, self-revealing, and honest history of Dr. Brazelton’s own childhood and family. For example, he notes the racism and poverty that were culturally expected growing up in the 1920s in Waco, Tex. He writes, “Looking back I wonder whether part of my life’s work may have been compensation for the deep hurts and prejudice I saw inflicted on many children in this small, ultraconservative town” (p. 2).

Both his parents were progressive: his father liberal to the point of provoking a cross burning on his lawn by the Ku Klux Klan and his mother “gallant” and “strong minded” enough to play the new, radical compositions of Gershwin. Dr. Brazelton’s father came home from World War I and felt rejected by his then 9-month-old son, whose expected stranger anxiety made him burst into tears when he left his mother’s arms for the first time to be hugged by his father. This moment became iconic: “I’m sure he loved me, but I never really knew him. My mother fostered that distance with what I now see as unconscious ‘gatekeeping’” (p. 5). When he was 2 ½ years old, his brother, Churchill Jones Brazelton, was born, and he instantly experienced the competition with his “cute” brother. Dr. Brazelton simply admits, “I hated him.” His mother doted on the new baby, never fostered appropriate autonomy, and increased the resentment between the two brothers, as well as between mother and older son. He was never close to his brother, who sadly lived a dependent life and died of alcoholism at age 60. His distant relationship with his father and brother are but two of many stories linking childhood experiences to his later passionate career goals of caring for children. I cannot help recounting one more. At Princeton, he was a gifted student and a talented actor. He was offered a role with Ethel Merman and encouraged by Jimmy Stewart to go to Hollywood. His family firmly said no to these options, demanding he stay premed. Yet anyone who has seen Dr. Brazelton’s mesmerizing films of his work with infants knows he would have been a star of stage and screen.

After Princeton, he was forced by his family to attend a medical school in Texas, but after his father’s unexpected death at age 49, he accepted a scholarship from Columbia. He did not enjoy the curriculum, as he was desperate to relate to patients and acknowledges that all he remembers is the bedside teaching of Dr. Robert Loeb, a gifted clinician. After a harrowing tour as the sole physician on a Navy destroyer escort during World War II, Dr. Brazelton was accepted to a pediatric internship at Massachusetts General Hospital and then a residency at Boston Children’s Hospital. He went on to a residency in child psychiatry. He bridges these two related disciplines, and in this chapter highlights the earliest roots of child psychiatry and developmental pediatrics in the United States.

Dr. Brazelton’s training and early practice experience set the stage for critical insight. For many of the problems, parents were “not to blame” but needed support, empathy, and a guide. The work of Chess and Thomas on temperament and “goodness of fit” fully supported Dr. Brazelton’s focus on attachment, parents’ needs to understand their baby’s behavior, and the value families derive from being supported by an enlightened pediatrician.

Dr. Brazelton discusses his experiences and character and how the integration of his own life events, his family, his personal insights, his training, his personal psychotherapy, and his work as a pediatrician all come together to a matter-of-fact conclusion: a highly meaningful, driven, and productive desire to provide optimal care to children. Early in this phase of his career, he developed “the Brazelton,” a neonatal behavioral assessment that evaluates the baby’s strengths, adaptive responses, and vulnerabilities and leads to enhancing the parents’ caregiving strategies.

Through a number of studies, the Brazelton was used in many populations within the United States and cross-culturally in Mexico, Guatemala, Kenya, Japan, China, and Greece. Dr. Brazelton notes that so much is missed if we do not embrace other cultures and the differences they bring that can enrich our institutions and society.

Much of the second half of this book describes Dr. Brazelton’s tireless advocacy. He worked with the leadership of Boston Children’s Hospital to change from limited visiting hours to inviting parental participation in the care of children. He recommended adding house staff to support the time needed for maternity leaves. He describes the formation of a development section in the Society for Pediatric Research, founding the Society for Developmental and Behavioral Pediatrics, starting a fellowship program, obtaining the funds for the Brazelton Chair at Harvard Medical School, and procuring the eventual requirement of a child development rotation in pediatric residency training. He notes the history of the American Academy of Pediatrics Bright Futures program and his own national effort to support families through Touchpoints, a program with branches coast to coast.

Dr. Brazelton tells how his work with media—authoring 20 books (some of which sold over a million copies), magazine articles, and an Emmy-winning television series titled What Every Baby Knows—led to the public gaining an increasing appreciation of infant capacities. His national reputation and relationships resulted in congressional opportunities to advocate for legislation helping children with special needs, consulting on health policy with the Clinton Administration, and international advocacy with the World Health Organization. This book ends just before Dr. Brazelton was awarded the Presidential Citizen’s Medal, the second highest federal recognition, by President Obama.

I enthusiastically recommend anyone who cares about children and families to read Learning to Listen. I do not believe that this title was chosen lightly. The tone of the book is not self-congratulatory but rather a remembrance of what Dr. Brazelton has learned from a lifetime of listening to infants and parents. At a deeper level, this book describes the integration of life events into a life well lived—with humility, passion, purpose and dedication—to the well-being of children and families.




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