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The Power of Reflection

The Power of ReflectionIn her new memoir, Tufts School of Medicine graduate and child psychiatrist Nancy Rappaport seeks to understand her mother's suicide, and in the process better understand her most desperate patients.

Medford/Somerville, Mass. [10.14.09] When she's working with suicidal teens, Nancy Rappaport has a lot of experience to draw on. And it's not just from her 18 years as a child psychiatrist in Cambridge public schools or her education at Tufts School of Medicine.

Rappaport was just four years old when her mother killed herself, leaving Rappaport with many questions and few answers. Last month, she published a memoir that explored some of those questions, "In Her Wake: A Child Psychiatrist Explores the Mystery of Her Mother's Suicide," drawing on interviews with family members and her mother's own writings.

On Oct. 3, Rappaport spoke to 200 members of the Tufts School of Medicine class of 2013 at the 13th annual White Coat Ceremony, which symbolically marks their entrance into the medical profession. In sharing lessons learned from her time at Tufts and her career as a psychiatrist, the 1988 medical school graduate emphasized something that the process of writing the memoir proved to her: the value of self-reflection.

Rappaport discusses the messages she relayed to Tufts School of Medicine students in her address at their Oct. 3 White Coat Ceremony.

"Whether it's a tragedy that happens to you, or some other kind of critical developmental experience, being reflective about the meaning of that deepens the work with patients," she says. "Understanding your own vulnerability gives you a certain wisdom."

It was her psychiatry coursework that inspired Rappaport-who arrived at Tufts wanting to become a pediatrician-to pursue that field instead. She was compelled by the idea of a career spent listening to and helping troubled individuals.

"In my experience, Tufts School of Medicine had a tremendous emphasis on giving back to your community, investing time and energy into care for patients and doing outreach to engage patients," says Rappaport. "That part has been seminal to how my personal career has evolved."

Committed to the Community

Rappaport's experience teaching science at a Harlem elementary school before going to medical school inspired her to root her work in an educational context, developing effective support frameworks for troubled children and teens who need access to critical mental health services.

In addition to being an assistant professor of psychiatry at Harvard Medical School, Rappaport directs school-based child psychiatry programs for Cambridge Health Alliance and is the attending psychiatrist to Cambridge public schools and the Teen Health Center at Cambridge Hospital.

Having worked in Cambridge for nearly two decades, she views the community almost like a long-term patient.

"That's a level of rich history to have when I get a referral," she explains. "Having the familiarity and recognition within my community allows me to really be able to support kids in a way that's extremely meaningful to me."

Rappaport's line of work is not without substantial challenges. The toughest is when children don't get the services they need or receive those services too late.

"A lot of times you might end up starting to work with kids after there's been a lot of damage, or where there's been interruption in continuity of services, so kids who are the most vulnerable end up having the most changes," she explains. "Those are the kinds of systemic challenges that we have, that we can't provide enough for the kids when they're in need. I never get immune to that heartbreak."

But Rappaport-in part from her own experience in therapy as a teenager-knows how valuable simply having someone to talk to can be to a young person in trouble. That understanding drives her work.

"I've learned with child psychiatry that it's just about staying in the game," she says. "It's about having a commitment not to leave parents and families alone, and working with them to figure out strategies. You may hit a wall, but then you just back up, and figure out how you're going to take another curve."

A Quest for Understanding

When Rappaport gave birth to her eldest daughter, she began thinking about what drove her mother to commit suicide. She thought that by understanding her mother's motivations, she might be better able to understand how her patients' could be driven to the brink.

rappbook250While her mother's death did not directly influence Rappaport's decision to become a child psychiatrist, her reflection on it has informed her practice, compelling her to pay closer attention to a teenager's level of impulsivity and how others in the family react to events in the teenager's life.

It took Rappaport 18 years to complete "In Her Wake," which is the culmination of years spent talking to relatives, sifting through her mother's writings-including an unfinished novel penned shortly before her death-and probing her own feelings about her mother's suicide.

"I always say, in a way, that the gift that my mother gave from the grave was that I always wanted to write a book, a good book," says Rappaport. "Trying to capture the complexity, to me, of what it meant to lose my mother, I became a writer."

As Rappaport went through that process, she was also consciously trying to communicate to her readers that "if you end up doing something like killing yourself, you will be missed."

As much as she hopes her book educates those who read it, and as much as she got out of writing it, Rappaport is now entering a new phase of the process.

"In a way, when I finished the actual writing of the book, there's a whole other chapter that's unfolding. That's about the way that I'm being changed by how people are responding to it," she says. "When you're a doctor, you're changed by the interaction you have with a patient. And in this experience, I've written this book, and I'm being impacted by how people respond."

Profile by Georgiana Cohen, Office of Web Communications

White Coat Ceremony photos by Alonso Nichols, University Photography. Other images courtesy of Nancy Rappaport.

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