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means capturing parts of the memory that may have been dissociated and so are absent from conscious recall. By putting sensory details and feelings into words, presumably memories are brought more under control of the neocortex, where the reactions they kindle can be rendered more understandable and so more manageable. The emotional relearning at this point is largely accomplished through reliving the events and their emotions, but this time in surroundings of safety and security, in the company of a trusted therapist. This begins to impart a telling lesson to the emotional circuitry—that security, rather than unremitting terror, can be experienced in tandem with the trauma memories. The five-year-old who drew the picture of the giant eyes after he witnessed the grisly murder of his mother did not make any more drawings after that first one; instead he and his therapist, Spencer Eth, played games, creating a bond of rapport. Only slowly did he begin to retell the story of the murder, at first in a stereotyped way, reciting each detail exactly the same in each telling. Gradually, though, his narrative became more open and free-flowing, his body less tense as
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he told it. At the same time his nightmares of the scene came less often, an indication, says Eth, of some “trauma mastery.” Gradually their talk moved away from the fears left by the trauma to more of
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what was happening in the boy’s day-to-day life as he adjusted to a new home with his father. And finally the boy was able to talk just about his daily life as the hold of the trauma faded. Finally, Herman finds that patients need to mourn the loss the trauma brought—whether an injury, the death of a loved one or a rupture in a relationship, regret over some step not taken to save someone, or just the shattering of confidence that people can be trusted. The mourning that ensues while retelling such painful events serves a crucial purpose: it marks the ability to let go of the trauma itself to some degree. It means that instead of being perpetually captured by this moment in the past, patients can start to look ahead, even to hope, and to rebuild a new life free of the trauma’s grip. It is as if the constant recycling and reliving of the trauma’s terror by the emotional circuitry were a spell that could finally be lifted. Every siren need not bring a flood of fear; every sound in the night need not compel a flashback to terror. Aftereffects or occasional recurrences of symptoms often persist, says Herman, but there are specific signs that the trauma has largely
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been overcome. These include reducing the physiological symptoms to a manageable level, and being able to bear the feelings associated with memories of the trauma. Especially significant is no longer having trauma memories erupt at uncontrollable moments, but rather being able to revisit them voluntarily, like any other memory—and, perhaps more important, to put them aside like any other memory. Finally, it means rebuilding a new life, with strong, trusting relationships and a belief system that finds meaning even in a world where such injustice can happen. 20 All of these together are markers of success in reeducating the emotional brain. PSYCHOTHERAPY AS AN EMOTIONAL TUTORIAL Fortunately, the catastrophic moments in which traumatic memories are emblazoned are rare during the course of life for most of us. But the same circuitry that can be seen so boldly imprinting traumatic memories is presumably at work in life’s quieter moments, too. The more ordinary travails of childhood, such as being chronically ignored and deprived of attention or tenderness by one’s parents, abandonment or loss, or social rejection may never reach the fever pitch of trauma, but they surely leave their imprint on the emotional
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brain, creating distortions—and tears and rages—in intimate relationships later in life. If PTSD can be healed, so can the more muted emotional scars that so many of us bear; that is the task of psychotherapy. And, in general, it is in learning to deal skillfully with these loaded reactions that emotional intelligence comes into play. The dynamic between the amygdala and the more fully informed reactions of the prefrontal cortex may offer a neuroanatomical model for how psychotherapy reshapes deep, maladaptive emotional patterns. As Joseph LeDoux, the neuroscientist who discovered the amygdala’s hair-trigger role in emotional outbursts, conjectures, “Once your emotional system learns something, it seems you never let it go. What therapy does is teach you to control it—it teaches your neocortex how to inhibit your amygdala. The propensity to act is suppressed, while your basic emotion about it remains in a subdued form.” Given the brain architecture that underlies emotional relearning, what seems to remain, even after successful psychotherapy, is a vestigial reaction, a remnant of the original sensitivity or fear at the root of a troubling emotional pattern. 21 The prefrontal cortex can
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21 The prefrontal cortex can refine or put the brakes on the amygdala’s impulse to rampage, but cannot keep it from reacting in the first place. Thus while we cannot decide when we have our emotional outbursts, we have more control over how long they last. A quicker recovery time from such outbursts may well be one mark of emotional maturity. Over the course of therapy, what seems to change in the main are the responses that people make once an emotional reaction is triggered —but the tendency for the reaction to be triggered in the first place does not disappear entirely. Evidence for this comes from a series of studies of psychotherapy conducted by Lester Luborsky and his colleagues at the University of Pennsylvania. 22 They analyzed the main relationship conflicts that brought dozens of patients into psychotherapy—issues such as a deep craving to be accepted or find intimacy, or a fear of being a failure or being overly dependent. They then carefully analyzed the typical (always self-defeating) responses the patients made when these wishes and fears were activated in their relationships—responses such as being too demanding, which created a backlash of anger or coldness in the other person, or withdrawing in
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self-defense from an anticipated slight, leaving the other person miffed by the seeming rebuff. During such ill-fated encounters, the patients, understandably, felt flooded by upsetting feelings—
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hopelessness and sadness, resentment and anger, tension and fear, guilt and self-blame, and so on. Whatever the specific pattern of the patient, it seemed to show up in most every important relationship, whether with a spouse or lover, a child or parent, or peers and bosses at work. Over the course of long-term therapy, however, these patients made two kinds of changes: their emotional reaction to the triggering events became less distressing, even calm or bemused, and their overt responses became more effective in getting what they truly wanted from the relationship. What did not change, however, was their underlying wish or fear, and the initial twinge of feeling. By the time the patients had but a few sessions left in therapy, the encounters they told about showed they had only half as many negative emotional reactions compared to when they first started therapy, and were twice as likely to get the positive response they deeply desired from the other person. But what did not change at all was the particular sensitivity at the root of these needs. In brain terms, we can speculate, the limbic circuitry would send alarm signals in response to cues of a feared event, but the prefrontal
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cortex and related zones would have learned a new, more healthy response. In short, emotional lessons—even the most deeply implanted habits of the heart learned in childhood—can be reshaped. Emotional learning is lifelong.
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14 Temperament Is Not Destiny So much for altering emotional patterns that have been learned. But what about those responses that are givens of our genetic endowment —what of changing the habitual reactions of people who by nature are, say, highly volatile, or painfully shy? This range of the emotional compass falls under the sweep of temperament, the background murmur of feelings that mark our basic disposition. Temperament can be defined in terms of the moods that typify our emotional life. To some degree we each have such a favored emotional range; temperament is a given at birth, part of the genetic lottery that has compelling force in the unfolding of life. Every parent has seen this: from birth a child will be calm and placid or testy and difficult. The question is whether such a biologically determined emotional set can be changed by experience. Does our biology fix our emotional destiny, or can even an innately shy child grow into a more confident adult? The clearest answer to this question comes from the work of Jerome Kagan, the eminent developmental psychologist at Harvard University. 1 Kagan posits that there are at least four temperamental
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Kagan posits that there are at least four temperamental types—timid, bold, upbeat, and melancholy—and that each is due to a different pattern of brain activity. There are likely innumerable differences in temperamental endowment, each based in innate differences in emotional circuitry; for any given emotion people can differ in how easily it triggers, how long it lasts, how intense it becomes. Kagan’s work concentrates on one of these patterns: the dimension of temperament that runs from boldness to timidity. For decades mothers have been bringing their infants and toddlers to Kagan’s Laboratory for Child Development on the fourteenth floor of Harvard’s William James Hall to take part in his studies of child development. It was there that Kagan and his coresearchers noticed early signs of shyness in a group of twenty-one-month-old toddlers brought for experimental observations. In free play with other toddlers, some were bubbly and spontaneous, playing with other babies without the least hesitation. Others, though, were uncertain
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and hesitant, hanging back, clinging to their mothers, quietly watching the others at play. Almost four years later, when these same children were in kindergarten, Kagan’s group observed them again. Over the intervening years none of the outgoing children had become timid, while two thirds of the timid ones were still reticent. Kagan finds that children who are overly sensitive and fearful grow into shy and timorous adults; from birth about 15 to 20 percent of children are “behaviorally inhibited,” as he calls them. As infants, these children are timid about anything unfamiliar. This makes them finicky about eating new foods, reluctant to approach new animals or places, and shy around strangers. It also renders them sensitive in other ways—for example, prone to guilt and self-reproach. These are the children who become paralyzingly anxious in social situations: in class and on the playground, when meeting new people, whenever the social spotlight shines on them. As adults, they are prone to be wallflowers, and morbidly afraid of having to give a speech or perform in public. Tom, one of the boys in Kagan’s study, is typical of the shy type. At
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every measurement through childhood—two, five, and seven years of age—Tom was among the most timid children. When interviewed at thirteen, Tom was tense and stiff, biting his lip and wringing his hands, his face impassive, breaking into a tight smile only when talking about his girlfriend; his answers were short, his manner subdued. 2 Throughout the middle years of childhood, until about age eleven, Tom remembers being painfully shy, breaking into a sweat whenever he had to approach playmates. He was also troubled by intense fears: of his house burning down, of diving into a swimming pool, of being alone in the dark. In frequent nightmares, he was attacked by monsters. Though he has felt less shy in the last two years or so, he still feels some anxiety around other children, and his worries now center on doing well at school, even though he is in the top 5 percent of his class. The son of a scientist, Tom finds a career in that field appealing, since its relative solitude fits his introverted inclinations. By contrast, Ralph was one of the boldest and most outgoing
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children at every age. Always relaxed and talkative, at thirteen he sat back at ease in his chair, had no nervous mannerisms, and spoke in a confident, friendly tone, as though the interviewer were a peer— though the difference in their ages was twenty-five years. During childhood he had only two short-lived fears—one of dogs, after a big
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dog jumped on him at age three, and another of flying, when he heard about plane crashes at age seven. Sociable and popular, Ralph has never thought of himself as shy. The timid children seem to come into life with a neural circuitry that makes them more reactive to even mild stress—from birth, their hearts beat faster than other infants’ in response to strange or novel situations. At twenty-one months, when the reticent toddlers were holding back from playing, heart rate monitors showed that their hearts were racing with anxiety. That easily aroused anxiety seems to underlie their lifelong timidity: they treat any new person or situation as though it were a potential threat. Perhaps as a result, middle-aged women who remember having been especially shy in childhood, when compared with their more outgoing peers, tend to go through life with more fears, worries, and guilt, and to suffer more from stress-related problems such as migraine headaches, irritable bowel, and other stomach problems. 3 THE NEUROCHEMISTRY OF TIMIDITY The difference between cautious Tom and bold Ralph, Kagan believes, lies in the excitability of a neural circuit centered on the amygdala.
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Kagan proposes that people like Tom, who are prone to fearfulness, are born with a neurochemistry that makes this circuit easily aroused, and so they avoid the unfamiliar, shy away from uncertainty, and suffer anxiety. Those who, like Ralph, have a nervous system calibrated with a much higher threshold for amygdala arousal, are less easily frightened, more naturally outgoing, and eager to explore new places and meet new people. An early clue to which pattern a child has inherited is how difficult and irritable she is as an infant, and how distressed she becomes when confronted with something or someone unfamiliar. While about one in five infants falls into the timid category, about two in five have the bold temperament—at least at birth. Part of Kagan’s evidence comes from observations of cats that are unusually timid. About one in seven housecats has a pattern of fearfulness akin to the timid children’s: they draw away from novelty (instead of exhibiting a cat’s legendary curiosity), they are reluctant to explore new territory, and they attack only the smallest rodents, being too timid to take on larger ones that their more courageous feline
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peers would pursue with gusto. Direct brain probes have found that portions of the amygdala are unusually excitable in these timid cats, especially when, for instance, they hear a threatening howl from another cat. The cats’ timidity blossoms at about one month of age, which is the point when their amygdala matures enough to take control of the brain circuitry to approach or avoid. One month in kitten brain maturation is akin to eight months in a human infant; it is at eight or nine months, Kagan notes, that “stranger” fear appears in babies—if the baby’s mother leaves a room and there is a stranger present, the result is tears. Timid children, Kagan postulates, may have inherited chronically high levels of norepinephrine or other brain chemicals that activate the amygdala and so create a low threshold of excitability, making the amygdala more easily triggered. One sign of this heightened sensitivity is that, for example, when young men and women who were quite shy in childhood are measured in a laboratory while exposed to stresses such as harsh smells, their heart rate stays elevated much longer than for their more outgoing peers—a sign that surging norepinephrine is keeping their
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amygdala excited and, through connected neural circuits, their sympathetic nervous system aroused. 4 Kagan finds that timid children have higher levels of reactivity across the range of sympathetic nervous system indices, from higher resting blood pressure and greater dilation of the pupils, to higher levels of norepinephrine markers in their urine. Silence is another barometer of timidity. Whenever Kagan’s team observed shy and bold children in a natural setting—in their kindergarten classes, with other children they did not know, or talking with an interviewer—the timid children talked less. One timid kindergartener would say nothing when other children spoke to her, and spent most of her day just watching the others play. Kagan speculates that a timid silence in the face of novelty or a perceived threat is a sign of the activity of a neural circuit running between the forebrain, the amygdala, and nearby limbic structures that control the ability to vocalize (these same circuits make us “choke up” under stress). These sensitive children are at high risk for developing an anxiety disorder such as panic attacks, starting as early as sixth or seventh grade. In one study of 754 boys and girls in those grades, 44 were
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found to have already suffered at least one episode of panic, or to
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have had several preliminary symptoms. These anxiety episodes were usually triggered by the ordinary alarms of early adolescence, such as a first date or a big exam—alarms that most children handle without developing more serious problems. But teenagers who were timid by temperament and who had been unusually frightened by new situations got panic symptoms such as heart palpitations, shortness of breath, or a choking feeling, along with the feeling that something horrible was going to happen to them, like going crazy or dying. The researchers believe that while the episodes were not significant enough to rate the psychiatric diagnosis “panic disorder,” they signal that these teenagers would be at greater risk for developing the disorder as the years went on; many adults who suffer panic attacks say the attacks began during their teen years. 5 The onset of the anxiety attacks was closely tied to puberty. Girls with few signs of puberty reponed no such attacks, but of those who had gone through puberty about 8 percent said they had experienced panic. Once they have had such an attack, they are prone to developing the dread of a recurrence that leads people with panic disorder to shrink from life.
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disorder to shrink from life. NOTHING BOTHERS ME: THE CHEERFUL TEMPERAMENT In the 1920s, as a young woman, my aunt June left her home in Kansas City and ventured on her own to Shanghai—a dangerous journey for a solitary woman in those years. There June met and married a British detective in the colonial police force of that international center of commerce and intrigue. When the Japanese captured Shanghai at the outset of World War II, my aunt and her husband were interned in the prison camp depicted in the book and movie Empire of the Sun . After surviving five horrific years in the prison camp, she and her husband had, literally, lost everything. Penniless, they were repatriated to British Columbia. I remember as a child first meeting June, an ebullient elderly woman whose life had followed a remarkable course. In her later years she suffered a stroke that left her partly paralyzed; after a slow and arduous recovery she was able to walk again, but with a limp. In those years I remember going for an outing with June, then in her seventies. Somehow she wandered off, and after several minutes I
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heard a feeble yell—June crying for help. She had fallen and could
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not get up on her own. I rushed to help her up, and as I did so, instead of complaining or lamenting she laughed at her predicament. Her only comment was a lighthearted “Well, at least I can walk again.” By nature, some people’s emotions seem, like my aunt’s, to gravitate toward the positive pole; these people are naturally upbeat and easygoing, while others are dour and melancholy. This dimension of temperament—ebullience at one end, melancholy at the other—seems linked to the relative activity of the right and left prefrontal areas, the upper poles of the emotional brain. That insight has emerged largely from the work of Richard Davidson, a University of Wisconsin psychologist. He discovered that people who have greater activity in the left frontal lobe, compared to the right, are by temperament cheerful; they typically take delight in people and in what life presents them with, bouncing back from setbacks as my aunt June did. But those with relatively greater activity on the right side are given to negativity and sour moods, and are easily fazed by life’s difficulties; in a sense, they seem to suffer because they cannot turn off their worries and depressions.
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off their worries and depressions. In one of Davidson’s experiments volunteers with the most pronounced activity in the left frontal areas were compared with the fifteen who showed most activity on the right. Those with marked right frontal activity showed a distinctive pattern of negativity on a personality test: they fit the caricature portrayed by Woody Allen’s comedy roles, the alarmist who sees catastrophe in the smallest thing —prone to funks and moodiness, and suspicious of a world they saw as fraught with overwhelming difficulties and lurking dangers. By contrast to their melancholy counterparts, those with stronger left frontal activity saw the world very differently. Sociable and cheerful, they typically felt a sense of enjoyment, were frequently in good moods, had a strong sense of self-confidence, and felt rewardingly engaged in life. Their scores on psychological tests suggested a lower lifetime risk for depression and other emotional disorders. 6 People who have a history of clinical depression, Davidson found, had lower levels of brain activity in the left frontal lobe, and more on the right, than did people who had never been depressed. He found the same pattern in patients newly diagnosed with depression.
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the same pattern in patients newly diagnosed with depression. Davidson speculates that people who overcome depression have learned to increase the level of activity in their left prefrontal lobe—a speculation awaiting experimental testing. Though his research is on the 30 percent or so of people at the
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extremes, just about anyone can be classified by their brain wave patterns as tending toward one or the other type, says Davidson. The contrast in temperament between the morose and the cheerful shows up in many ways, large and small. For example, in one experiment volunteers watched short film clips. Some were amusing—a gorilla taking a bath, a puppy at play. Others, like an instructional film for nurses featuring grisly details of surgery, were quite distressing. The right-hemisphere, somber folks found the happy movies only mildly amusing, but they felt extreme fear and disgust in reaction to the surgical blood and gore. The cheerful group had minimal reactions to the surgery; their strongest reactions were of delight when they saw the upbeat films. Thus we seem by temperament primed to respond to life in either a negative or a positive emotional register. The tendency toward a melancholy or upbeat temperament—like that toward timidity or boldness—emerges within the first year of life, a fact that strongly suggests it too is genetically determined. Like most of the brain, the frontal lobes are still maturing in the first few months of life, and so
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their activity cannot be reliably measured until the age of ten months or so. But in infants that young, Davidson found that the activity level of the frontal lobes predicted whether they would cry when their mothers left the room. The correlation was virtually 100 percent: of dozens of infants tested this way, every infant who cried had more brain activity on the right side, while those who did not had more activity on the left. Still, even if this basic dimension of temperament is laid down from birth, or very nearly from birth, those of us who have the morose pattern are not necessarily doomed to go through life brooding and crotchety. The emotional lessons of childhood can have a profound impact on temperament, either amplifying or muting an innate predisposition. The great plasticity of the brain in childhood means that experiences during those years can have a lasting impact on the sculpting of neural pathways for the rest of life. Perhaps the best illustration of the kinds of experiences that can alter temperament for the better is in an observation that emerged from Kagan’s research with timid children. TAMING THE OVEREXCITABLE AMYGDALA
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The encouraging news from Kagan’s studies is that not all fearful infants grow up hanging back from life—temperament is not destiny. The overexcitable amygdala can be tamed, with the right experiences. What makes the difference are the emotional lessons and responses children learn as they grow. For the timid child, what matters at the outset is how they are treated by their parents, and so how they learn to handle their natural timidness. Those parents who engineer gradual emboldening experiences for their children offer them what may be a lifelong corrective to their fearfulness. About one in three infants who come into the world with all the signs of an overexcitable amygdala have lost their timidness by the time they reach kindergarten. 7 From observations of these once- fearful children at home, it is clear that parents, and especially mothers, play a major role in whether an innately timid child grows bolder with time or continues to shy away from novelty and become upset by challenge. Kagan’s research team found that some of the mothers held to the philosophy that they should protect their timid toddlers from whatever was upsetting; others felt that it was more
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important to help their timid child learn how to cope with these upsetting moments, and so adapt to life’s small struggles. The protective belief seems to have abetted the fearfulness, probably by depriving the youngsters of opportunities for learning how to overcome their fears. The “learn to adapt” philosophy of childrearing seems to have helped fearful children become braver. Observations in the homes when the babies were about six months old found that the protective mothers, trying to soothe their infants, picked them up and held them when they fretted or cried, and did so longer than those mothers who tried to help their infants learn to master these moments of upset. The ratio of times the infants were held when calm and when upset showed that the protective mothers held their infants much longer during the upsets than the calm periods. Another difference emerged when the infants were around one year old: the protective mothers were more lenient and indirect in setting limits for their toddlers when they were doing something that might be harmful, such as mouthing an object they might swallow. The other mothers, by contrast, were emphatic, setting firm limits, giving
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direct commands, blocking the child’s actions, insisting on obedience. Why should firmness lead to a reduction in fearfulness? Kagan speculates that there is something learned when a baby has his steady
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crawl toward what seems to him an intriguing object (but to his mother a dangerous one) interrupted by her warning, “Get away from that!” The infant is suddenly forced to deal with a mild uncertainty. The repetition of this challenge hundreds and hundreds of times during the first year of life gives the infant continual rehearsals, in small doses, of meeting the unexpected in life. For fearful children that is precisely the encounter that has to be mastered, and manageable doses are just right for learning the lesson. When the encounter takes place with parents who, though loving, do not rush to pick up and soothe the toddler over every little upset, he gradually learns to manage such moments on his own. By age two, when these formerly fearful toddlers are brought back to Kagan’s laboratory, they are far less likely to break out into tears when a stranger frowns at them, or an experimenter puts a blood-pressure cuff around their arm. Kagan’s conclusion: “It appears that mothers who protect their high[ly] reactive infants from frustration and anxiety in the hope of effecting a benevolent outcome seem to exacerbate the infant’s uncertainty and produce the opposite effect.” 8
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uncertainty and produce the opposite effect.” 8 In other words, the protective strategy backfires by depriving timid toddlers of the very opportunity to learn to calm themselves in the face of the unfamiliar, and so gain some small mastery of their fears. At the neurological level, presumably, this means their prefrontal circuits missed the chance to learn alternate responses to knee-jerk fear; instead, their tendency for unbridled fearfulness may have been strengthened simply through repetition. In contrast, as Kagan told me, “Those children who had become less timid by kindergarten seem to have had parents who put gentle pressure on them to be more outgoing. Although this temperamental trait seems slightly harder than others to change—probably because of its physiological basis—no human quality is beyond change.” Throughout childhood some timid children grow bolder as experience continues to mold the key neural circuitry. One of the signs that a timid child will be more likely to overcome this natural inhibition is having a higher level of social competence: being cooperative and getting along with other children; being empathic, prone to giving and sharing, and considerate; and being able to
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develop close friendships. These traits marked a group of children first identified as having a timid temperament at age four, who shook it off by the time they were ten years old. 9 By contrast, those timid four-year-olds whose temperament changed
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little over the same six years tended to be less able emotionally: crying and falling apart under stress more easily; being emotionally inappropriate; being fearful, sulky, or whiny; overreacting to minor frustration with anger; having trouble delaying gratification; being overly sensitive to criticism, or mistrustful. These emotional lapses are, of course, likely to mean their relationships with other children will be troubled, should they be able to overcome their initial reluctance to engage. By contrast, it is easy to see why the more emotionally competent— though shy by temperament—children spontaneously outgrew their timidity. Being more socially skilled, they were far more likely to have a succession of positive experiences with other children. Even if they were tentative about, say, speaking to a new playmate, once the ice was broken they were able to shine socially. The regular repetition of such social success over many years would naturally tend to make the timid more sure of themselves. These advances toward boldness are encouraging; they suggest that even innate emotional patterns can change to some degree. A child who comes into the world easily frightened can learn to be calmer, or
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even outgoing, in the face of the unfamiliar. Fearfulness—or any other temperament—may be part of the biological givens of our emotional lives, but we are not necessarily limited to a specific emotional menu by our inherited traits. There is a range of possibility even within genetic constraints. As behavioral geneticists observe, genes alone do not determine behavior; our environment, especially what we experience and learn as we grow, shapes how a temperamental predisposition expresses itself as life unfolds. Our emotional capacities are not a given; with the right learning, they can be improved. The reasons for this lie in how the human brain matures. CHILDHOOD: A WINDOW OF OPPORTUNITY The human brain is by no means fully formed at birth. It continues to shape itself through life, with the most intense growth occurring during childhood. Children are born with many more neurons than their mature brain will retain; through a process known as “pruning” the brain actually loses the neuronal connections that are less used, and forms strong connections in those synaptic circuits that have been utilized the most. Pruning, by doing away with extraneous synapses,
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improves the signal-to-noise ratio in the brain by removing the cause of the “noise.” This process is constant and quick; synaptic connections can form in a matter of hours or days. Experience, particularly in childhood, sculpts the brain. The classic demonstration of the impact of experience on brain growth was by Nobel Prize-winners Thorsten Wiesel and David Hubel, both neuroscientists. 10 They showed that in cats and monkeys, there was a critical period during the first few months of life for the development of the synapses that carry signals from the eye to the visual cortex, where those signals are interpreted. If one eye was kept closed during that period, the number of synapses from that eye to the visual cortex dwindled away, while those from the open eye multiplied. If after the critical period ended the closed eye was reopened, the animal was functionally blind in that eye. Although nothing was wrong with the eye itself, there were too few circuits to the visual cortex for signals from that eye to be interpreted. In humans the corresponding critical period for vision lasts for the first six years of life. During this time normal seeing stimulates the formation of increasingly complex neural circuitry for vision that begins in the eye and
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begins in the eye and ends in the visual cortex. If a child’s eye is taped closed for even a few weeks, it can produce a measurable deficit in the visual capacity of that eye. If a child has had one eye closed for several months during this period, and later has it restored, that eye’s vision for detail will be impaired. A vivid demonstration of the impact of experience on the developing brain is in studies of “rich” and “poor” rats. 11 The “rich” rats lived in small groups in cages with plenty of rat diversions such as ladders and treadmills. The “poor” rats lived in cages that were similar but barren and lacking diversions. Over a period of months the neocortices of the rich rats developed far more complex networks of synaptic circuits interconnecting the neurons; the poor rats’ neuronal circuitry was sparse by comparison. The difference was so great that the rich rats’ brains were heavier, and, perhaps not surprisingly, they were far smarter at solving mazes than the poor rats. Similar experiments with monkeys show these differences between those “rich” and “poor” in experience, and the same effect is sure to occur in humans.
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in humans. Psychotherapy—that is, systematic emotional relearning—stands as a case in point for the way experience can both change emotional patterns and shape the brain. The most dramatic demonstration comes
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from a study of people being treated for obsessive-compulsive disorder. 12 One of the more common compulsions is hand washing, which can be done so often, even hundreds of times in a day, that the person’s skin cracks. PET scan studies show that obsessive- compulsives have greater than normal activity in the prefrontal lobes. 13 Half of the patients in the study received the standard drug treatment, fluoxetine (better known by the brand name Prozac), and half got behavior therapy. During the therapy they were systematically exposed to the object of their obsession or compulsion without performing it; patients with hand-washing compulsions were put at a sink, but not allowed to wash. At the same time they learned to question the fears and dreads that spurred them on—for example, that failure to wash would mean they would get a disease and die. Gradually, through months of such sessions, the compulsions faded, just as they did with the medication. The remarkable finding, though, was a PET scan test showing that the behavior therapy patients had as significant a decrease in the activity of a key part of the emotional brain, the caudate nucleus, as did the patients successfully treated with the drug fluoxetine. Their
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did the patients successfully treated with the drug fluoxetine. Their experience had changed brain function—and relieved symptoms—as effectively as the medication! CRUCIAL WINDOWS Of all species we humans take the longest for our brains to fully mature. While each area of the brain develops at a different rate during childhood, the onset of puberty marks one of the most sweeping periods of pruning throughout the brain. Several brain areas critical for emotional life are among the slowest to mature. While the sensory areas mature during early childhood, and the limbic system by puberty, the frontal lobes—seat of emotional self-control, understanding, and artful response—continue to develop into late adolescence, until somewhere between sixteen and eighteen years of age. 14 The habits of emotional management that are repeated over and over again during childhood and the teenage years will themselves help mold this circuitry. This makes childhood a crucial window of opportunity for shaping lifelong emotional propensities; habits
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acquired in childhood become set in the basic synaptic wiring of neural architecture, and are harder to change later in life. Given the importance of the prefrontal lobes for managing emotion, the very long window for synaptic sculpting in this brain region may well mean that, in the grand design of the brain, a child’s experiences over the years can mold lasting connections in the regulatory circuitry of the emotional brain. As we have seen, critical experiences include how dependable and responsive to the child’s needs parents are, the opportunities and guidance a child has in learning to handle her own distress and control impulse, and practice in empathy. By the same token, neglect or abuse, the misattunement of a self-absorbed or indifferent parent, or brutal discipline can leave their imprint on the emotional circuitry. 15 One of the most essential emotional lessons, first learned in infancy and refined throughout childhood, is how to soothe oneself when upset. For very young infants, soothing comes from caretakers: a mother hears her infant crying, picks him up, holds and rocks him until he calms down. This biological attunement, some theorists propose, helps the child begin to learn how to do the same for
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propose, helps the child begin to learn how to do the same for himself. 16 During a critical period between ten and eighteen months, the orbitofrontal area of the prefrontal cortex is rapidly forming the connections with the limbic brain that will make it a key on/off switch for distress. The infant who through countless episodes of being soothed is helped along in learning how to calm down, the speculation goes, will have stronger connections in this circuit for controlling distress, and so throughout life will be better at soothing himself when upset. To be sure, the art of soothing oneself is mastered over many years, and with new means, as brain maturation offers a child progressively more sophisticated emotional tools. Remember, the frontal lobes, so important for regulating limbic impulse, mature into adolescence. 17 Another key circuit that continues to shape itself through childhood centers on the vagus nerve, which at one end regulates the heart and other parts of the body, and at the other sends signals to the amygdala via other circuits, prompting it to secrete the catecholamines, which prime the fight-or-flight response. A University of Washington team that assessed the impact of childrearing discovered that emotionally
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that assessed the impact of childrearing discovered that emotionally adept parenting led to a change for the better in vagus-nerve function. As John Gottman, the psychologist who led the research, explained, “Parents modify their children’s vagal tone”—a measure of how easily
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triggered the vagus nerve is—“by coaching them emotionally: talking to children about their feelings and how to understand them, not being critical and judgmental, problem-solving about emotional predicaments, coaching them on what to do, like alternatives to hitting, or to withdrawing when you’re sad.” When parents did this well, children were better able to suppress the vagal activity that keeps the amygdala priming the body with fight-or-flight hormones— and so were better behaved. It stands to reason that the key skills of emotional intelligence each have critical periods extending over several years in childhood. Each period represents a window for helping that child instill beneficial emotional habits or, if missed, to make it that much harder to offer corrective lessons later in life. The massive sculpting and pruning of neural circuits in childhood may be an underlying reason why early emotional hardships and trauma have such enduring and pervasive effects in adulthood. It may explain, too, why psychotherapy can often take so long to affect some of these patterns—and why, as we’ve seen, even after therapy those patterns tend to remain as underlying propensities, though with an overlay of new insights and relearned responses.
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responses. To be sure, the brain remains plastic throughout life, though not to the spectacular extent seen in childhood. All learning implies a change in the brain, a strengthening of synaptic connection. The brain changes in the patients with obsessive-compulsive disorder show that emotional habits are malleable throughout life, with some sustained effort, even at the neural level. What happens with the brain in PTSD (or in therapy, for that matter) is an analog of the effects all repeated or intense emotional experiences bring, for better or for worse. Some of the most telling of such lessons come from parent to child. There are very different emotional habits instilled by parents whose attunement means an infant’s emotional needs are acknowledged and met or whose discipline includes empathy, on the one hand, or self- absorbed parents who ignore a child’s distress or who discipline capriciously by yelling and hitting. Much psychotherapy is, in a sense, a remedial tutorial for what was skewed or missed completely earlier in life. But why not do what we can to prevent that need, by giving children the nurturing and guidance that cultivates the essential emotional skills in the first place?
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PART FIVE EMOTIONAL LITERACY
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15 The Cost of Emotional Illiteracy It began as a small dispute, but had escalated. Ian Moore, a senior at Thomas Jefferson High School in Brooklyn, and Tyrone Sinkler, a junior, had had a falling-out with a buddy, fifteen-year-old Khalil Sumpter. Then they had started picking on him and making threats. Now it exploded. Khalil, scared that Ian and Tyrone were going to beat him up, brought a .38 caliber pistol to school one morning, and, fifteen feet from a school guard, shot both boys to death at point-blank range in the school’s hallway. The incident, chilling as it is, can be read as yet another sign of a desperate need for lessons in handling emotions, settling disagreements peaceably, and just plain getting along. Educators, long disturbed by schoolchildren’s lagging scores in math and reading, are realizing there is a different and more alarming deficiency: emotional illiteracy. 1 And while laudable efforts are being made to raise academic standards, this new and troubling deficiency is not being addressed in the standard school curriculum. As one Brooklyn teacher put it, the present emphasis in schools suggests that “we care more
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about how well schoolchildren can read and write than whether they’ll be alive next week.” Signs of the deficiency can be seen in violent incidents such as the shooting of Ian and Tyrone, growing ever more common in American schools. But these are more than isolated events; the heightening of the turmoil of adolescence and troubles of childhood can be read for the United States—a bellwether of world trends—in statistics such as these: 2 In 1990, compared to the previous two decades, the United States saw the highest juvenile arrest rate for violent crimes ever; teen arrests for forcible rape had doubled; teen murder rates quadrupled, mostly due to an increase in shootings. 3 During those same two decades, the suicide rate for teenagers tripled, as did the number of children under fourteen who are murder victims. 4
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More, and younger, teenage girls are getting pregnant. As of 1993 the birthrate among girls ten to fourteen has risen steadily for five years in a row—some call it “babies having babies”—as has the proportion of unwanted teen pregnancies and peer pressure to have sex. Rates of venereal disease among teenagers have tripled over the last three decades. 5 While these figures are discouraging, if the focus is on African- American youth, especially in the inner city, they are utterly bleak— all the rates are higher by far, sometimes doubled, sometimes tripled or higher. For example, heroin and cocaine use among white youth climbed about 300 percent over the two decades before the 1990s; for African-American youth it jumped to a staggering 13 times the rate of twenty years before. 6 The most common cause of disability among teenagers is mental illness. Symptoms of depression, whether major or minor, affect up to one third of teenagers; for girls, the incidence of depression doubles at puberty. The frequency of eating disorders in teenage girls has skyrocketed. 7 Finally, unless things change, the long-term prospects for today’s
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Finally, unless things change, the long-term prospects for today’s children marrying and having a fruitful, stable life together are growing more dismal with each generation. As we saw in Chapter 9 , while during the 1970s and 1980s the divorce rate was around 50 percent, as we entered the 1990s the rate among newlyweds predicted that two out of three marriages of young people would end in divorce. AN EMOTIONAL MALAISE These alarming statistics are like the canary in the coal miner’s tunnel whose death warns of too little oxygen. Beyond such sobering numbers, the plight of today’s children can be seen at more subtle levels, in day-to-day problems that have not yet blossomed into outright crises. Perhaps the most telling data of all—a direct barometer of dropping levels of emotional competence—are from a national sample of American children, ages seven to sixteen, comparing their emotional condition in the mid-1970s and at the end of the 1980s. 8 Based on parents’ and teachers’ assessments, there was a steady worsening. No one problem stood out; all indicators simply crept steadily in the wrong direction. Children, on average, were
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doing more poorly in these specific ways:
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• Withdrawal or social problems: preferring to be alone; being secretive; sulking a lot; lacking energy; feeling unhappy; being overly dependent • Anxious and depressed: being lonely; having many fears and worries; needing to be perfect; feeling unloved; feeling nervous or sad and depressed • Attention or thinking problems: unable to pay attention or sit still; daydreaming; acting without thinking; being too nervous to concentrate; doing poorly on schoolwork; unable to get mind off thoughts • Delinquent or aggressive: hanging around kids who get in trouble; lying and cheating; arguing a lot; being mean to other people; demanding attention; destroying other people’s things; disobeying at home and at school; being stubborn and moody; talking too much; teasing a lot; having a hot temper While any of these problems in isolation raises no eyebrows, taken as a group they are barometers of a sea change, a new kind of toxicity seeping into and poisoning the very experience of childhood, signifying sweeping deficits in emotional competences. This emotional malaise seems to be a universal price of modern life for children.
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malaise seems to be a universal price of modern life for children. While Americans often decry their problems as particularly bad compared to other cultures’, studies around the world have found rates on a par with or worse than in the United States. For example, in the 1980s teachers and parents in the Netherlands, China, and Germany rated children at about the same level of problems as were found for American children in 1976. And some countries had children in worse shape than current U.S. levels, including Australia, France, and Thailand. But this may not remain true for long. The larger forces that propel the downward spiral in emotional competence seem to be picking up speed in the United States relative to many other developed nations. 9 No children, rich or poor, are exempt from risk; these problems are universal, occurring in all ethnic, racial, and income groups. Thus while children in poverty have the worst record on indices of emotional skills, their rate of deterioration over the decades was no worse than for middle-class children or for wealthy children: all show the same steady slide. There has also been a corresponding threefold rise in the number of children who have gotten psychological help
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(perhaps a good sign, signaling that help is more available), as well as a near doubling of the number of children who have enough emotional problems that they should get such help but have not (a bad sign)—from about 9 percent in 1976 to 18 percent in 1989. Urie Bronfenbrenner, the eminent Cornell University developmental psychologist who did an international comparison of children’s well- being, says: “In the absence of good support systems, external stresses have become so great that even strong families are falling apart. The hecticness, instability, and inconsistency of daily family life are rampant in all segments of our society, including the well-educated and well-to-do. What is at stake is nothing less than the next generation, particularly males, who in growing up are especially vulnerable to such disruptive forces as the devastating effects of divorce, poverty, and unemployment. The status of American children and families is as desperate as ever.… We are depriving millions of children of their competence and moral character.” 10 This is not just an American phenomenon but a global one, with worldwide competition to drive down labor costs creating economic forces that press on the family. These are times of financially besieged
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families in which both parents work long hours, so that children are left to their own devices or the TV baby-sits; when more children than ever grow up in poverty; when the one-parent family is becoming ever more commonplace; when more infants and toddlers are left in day care so poorly run that it amounts to neglect. All this means, even for well-intentioned parents, the erosion of the countless small, nourishing exchanges between parent and child that build emotional competences. If families no longer function effectively to put all our children on a firm footing for life, what are we to do? A more careful look at the mechanics of specific problems suggests how given deficits in emotional or social competences lay the foundation for grave problems—and how well-aimed correctives or preventives could keep more children on track. TAMING AGGRESSION In my elementary school the tough kid was Jimmy, a fourth grader when I was in first grade. He was the kid who would steal your lunch money, take your bike, slug you as soon as talk to you. Jimmy was the
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classic bully, starting fights with the least provocation, or none at all. We all stood in awe of Jimmy—and we all stood at a distance. Everyone hated and feared Jimmy; no one would play with him. It was as though everywhere he went on the playground an invisible bodyguard cleared kids out of his way. Kids like Jimmy are clearly troubled. But what may be less obvious is that being so flagrantly aggressive in childhood is a mark of emotional and other troubles to come. Jimmy was in jail for assault by the time he reached sixteen. The lifelong legacy of childhood aggressiveness in kids like Jimmy has emerged from many studies. 11 As we have seen, the family life of such aggressive children typically includes parents who alternate neglect with harsh and capricious punishments, a pattern that, perhaps understandably, makes the children a bit paranoid or combative. Not all angry children are bullies; some are withdrawn social outcasts who overreact to being teased or to what they perceive as slights or unfairness. But the one perceptual flaw that unites such children is that they perceive slights where none were intended,
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children is that they perceive slights where none were intended, imagining their peers to be more hostile toward them than they actually are. This leads them to misperceive neutral acts as threatening ones—an innocent bump is seen as a vendetta—and to attack in return. That, of course, leads other children to shun them, isolating them further. Such angry, isolated children are highly sensitive to injustices and being treated unfairly. They typically see themselves as victims and can recite a list of instances when, say, teachers blamed them for doing something when in fact they were innocent. Another trait of such children is that once they are in the heat of anger they can think of only one way to react: by lashing out. These perceptual biases can be seen at work in an experiment in which bullies are paired with a more peaceable child to watch videos. In one video, a boy drops his books when another knocks into him, and children standing nearby laugh; the boy who dropped the books gets angry and tries to hit one of those who laughed. When the boys who watched the video talk about it afterward, the bully always sees
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the boy who struck out as justified. Even more telling, when they have to rate how aggressive the boys were during their discussion of the video, the bullies see the boy who knocked into the other as more combative, and the anger of the boy who struck out as justified. 12 This jump to judgment testifies to a deep perceptual bias in people
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who are unusually aggressive: they act on the basis of the assumption of hostility or threat, paying too little attention to what is actually going on. Once they assume threat, they leapfrog to action. For instance, if an aggressive boy is playing checkers with another who moves a piece out of turn, he’ll interpret the move as “cheating” without pausing to find out if it had been an innocent mistake. His presumption is of malevolence rather than innocence; his reaction is automatic hostility. Along with the knee-jerk perception of a hostile act is entwined an equally automatic aggression; instead of, say, pointing out to the other boy that he made a mistake, he will jump to accusation, yelling, hitting. And the more such children do this, the more automatic aggression becomes for them, and the more the repertoire of alternatives—politeness, joking—shrinks. Such children are emotionally vulnerable in the sense that they have a low threshold for upset, getting peeved more often by more things; once upset, their thinking is muddled, so that they see benign acts as hostile and fall back on their overlearned habit of striking out. 13
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out. 13 These perceptual biases toward hostility are already in place by the early grades. While most children, and especially boys, are rambunctious in kindergarten and first grade, the more aggressive children fail to learn a modicum of self-control by second grade. Where other children have started to learn negotiation and compromise for playground disagreements, the bullies rely more and more on force and bluster. They pay a social price: within two or three hours of a first playground contact with a bully, other children already say they dislike him. 14 But studies that have followed children from the preschool years into the teenage ones find that up to half of first graders who are disruptive, unable to get along with other kids, disobedient with their parents, and resistant with teachers will become delinquents in their teen years. 15 Of course, not all such aggressive children are on the trajectory that leads to violence and criminality in later life. But of all children, these are the ones most at risk for eventually committing violent crimes. The drift toward crime shows up surprisingly early in these children’s lives. When children in a Montreal kindergarten were rated for hostility and troublemaking, those highest at age five already had
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far greater evidence of delinquency just five to eight years later, in their early teens. They were about three times as likely as other
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children to admit they had beaten up someone who had not done anything to them, to have shoplifted, to have used a weapon in a fight, to have broken into or stolen parts from a car, and to have been drunk—and all this before they reached fourteen years of age. 16 The prototypical pathway to violence and criminality starts with children who are aggressive and hard to handle in first and second grade. 17 Typically, from the earliest school years their poor impulse control also contributes to their being poor students, seen as, and seeing themselves as, “dumb”—a judgment confirmed by their being shunted to special-education classes (and though such children may have a higher rate of “hyperactivity” or learning disorders, by no means all do). Children who on entering school already have learned in their homes a “coercive” style—that is, bullying—are also written off by their teachers, who have to spend too much time keeping the children in line. The defiance of classroom rules that comes naturally to these children means that they waste time that would otherwise be used in learning; their destined academic failure is usually obvious by about third grade. While boys on a trajectory toward delinquency
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tend to have lower IQ scores than their peers, their impulsivity is more directly at cause: impulsivity in ten-year-old boys is almost three times as powerful a predictor of their later delinquency as is their IQ. 18 By fourth or fifth grade these kids—by now seen as bullies or just “difficult”—are rejected by their peers and are unable to make friends easily, if at all, and have become academic failures. Feeling themselves friendless, they gravitate to other social outcasts. Between grade four and grade nine they commit themselves to their outcast group and a life of defying the law: they show a fivefold increase in their truancy, drinking, and drug taking, with the biggest boost between seventh and eighth grade. By the middle-school years, they are joined by another type of “late starters,” who are attracted to their defiant style; these late starters are often youngsters who are completely unsupervised at home and have started roaming the streets on their own in grade school. In the high-school years this outcast group typically drops out of school in a drift toward delinquency, engaging in petty crimes such as shoplifting, theft, and drug dealing.
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(A telling difference emerges in this trajectory between boys and girls. A study of fourth-grade girls who were “bad”—getting in trouble with teachers and breaking rules, but not unpopular with their peers —found that 40 percent had a child by the time they finished the
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high-school years. 19 That was three times the average pregnancy rate for girls in their schools. In other words, antisocial teenage girls don’t get violent—they get pregnant.) There is, of course, no single pathway to violence and criminality, and many other factors can put a child at risk: being born in a high- crime neighborhood where they are exposed to more temptations to crime and violence, coming from a family under high levels of stress, or living in poverty. But none of these factors makes a life of violent crime inevitable. All things being equal, the psychological forces at work in aggressive children greatly intensify the likelihood of their ending up as violent criminals. As Gerald Patterson, a psychologist who has closely followed the careers of hundreds of boys into young adulthood, puts it, “the anti-social acts of a five-year-old may be prototypic of the acts of the delinquent adolescent.” 20 SCHOOL FOR BULLIES The bent of mind that aggressive children take with them through life is one that almost ensures they will end up in trouble. A study of juvenile offenders convicted of violent crimes and of aggressive high- school students found a
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school students found a common mind-set: When they have difficulties with someone, they immediately see the other person in an antagonistic way, jumping to conclusions about the other person’s hostility toward them without seeking any further information or trying to think of a peaceful way to settle their differences. At the same time, the negative consequence of a violent solution—a fight, typically—never crosses their mind. Their aggressive bent is justified in their mind by beliefs like, “It’s okay to hit someone if you just go crazy from anger”; “If you back down from a fight everyone will think you’re a coward”; and “People who get beaten up badly don’t really suffer that much.” 21 But timely help can change these attitudes and stop a child’s trajectory toward delinquency; several experimental programs have had some success in helping such aggressive kids learn to control their antisocial bent before it leads to more serious trouble. One, at Duke University, worked with anger-ridden grade-school troublemakers in training sessions for forty minutes twice a week for six to twelve weeks. The boys were taught, for example, to see how some of the social cues they interpreted as hostile were in fact neutral or friendly.
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They learned to take the perspective of other children, to get a sense of how they were being seen and of what other children might be thinking and feeling in the encounters that had gotten them so angry. They also got direct training in anger control through enacting scenes, such as being teased, that might lead them to lose their temper. One of the key skills for anger control was monitoring their feelings— becoming aware of their body’s sensations, such as flushing or muscle tensing, as they were getting angry, and to take those feelings as a cue to stop and consider what to do next rather than strike out impulsively. John Lochman, a Duke University psychologist who was one of the designers of the program, told me, “They’ll discuss situations they’ve been in recently, like being bumped in the hallway when they think it was on purpose. The kids will talk about how they might have handled it. One kid said, for example, that he just stared at the boy who bumped him and told him not to do it again, and walked away. That put him in the position of exerting some control and keeping his self-esteem, without starting a fight.”
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self-esteem, without starting a fight.” This appeals; many such aggressive boys are unhappy that they lose their temper so easily, and so are receptive to learning to control it. In the heat of the moment, of course, such cool-headed responses as walking away or counting to ten so the impulse to hit will pass before reacting are not automatic; the boys practice such alternatives in role- playing scenes such as getting on a bus where other kids are taunting them. That way they can try out friendly responses that preserve their dignity while giving them an alternative to hitting, crying, or running away in shame. Three years after the boys had been through the training, Lochman compared these boys with others who had been just as aggressive, but did not have the benefit of the anger-control sessions. He found that, in adolescence, the boys who graduated from the program were much less disruptive in class, had more positive feelings about themselves, and were less likely to drink or take drugs. And the longer they had been in the program, the less aggressive they were as teenagers. PREVENTING DEPRESSION
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PREVENTING DEPRESSION Dana, sixteen, had always seemed to get along. But now, suddenly, she just could not relate with other girls, and, more troubling for her, she could not find a way to hold on
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to boyfriends, even though she slept with them. Morose and constantly fatigued, Dana lost interest in eating, in having fun of any kind; she said she felt hopeless and helpless to do anything to escape her mood, and was thinking of suicide. The drop into depression had been triggered by her most recent breakup. She said she didn’t know how to go out with a boy without getting sexually involved right away —even if she was uncomfortable about it—and that she did not know how to end a relationship even if it was unsatisfying. She went to bed with boys, she said, when all she really wanted to do was get to know them better. She had just moved to a new school, and felt shy and anxious about making friends with girls there. For instance, she held back from starting conversations, only talking once someone spoke to her. She felt unable to let them know what she was like, and didn’t even feel she knew what to say after “Hello, how are you?” 22 Dana went for therapy to an experimental program for depressed adolescents at Columbia University. Her treatment focused on helping her learn how to handle her relationships better: how to develop a
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friendship, how to feel more confident with other teens, how to assert limits on sexual closeness, how to be intimate, how to express her feelings. In essence, it was a remedial tutorial in some of the most basic emotional skills. And it worked; her depression lifted. Particularly in young people, problems in relationships are a trigger for depression. The difficulty is as often in children’s relationships with their parents as it is with their peers. Depressed children and teenagers are frequently unable or unwilling to talk about their sadness. They seem unable to label their feelings accurately, showing instead a sullen irritability, impatience, crankiness, and anger— especially toward their parents. This, in turn, makes it harder for their parents to offer the emotional support and guidance the depressed child actually needs, setting in motion a downward spiral that typically ends in constant arguments and alienation. A new look at the causes of depression in the young pinpoints deficits in two areas of emotional competence: relationship skills, on the one hand, and a depression-promoting way of interpreting setbacks, on the other. While some of the tendency to depression almost certainly is due to genetic destiny, some of that tendency
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almost certainly is due to genetic destiny, some of that tendency seems due to reversible, pessimistic habits of thought that predispose children to react to life’s small defeats—a bad grade, arguments with parents, a social rejection—by becoming depressed. And there is evidence to suggest that the predisposition to depression, whatever its basis, is becoming ever more widespread among the young.
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A COST OF MODERNITY: RISING RATES OF DEPRESSION These millennial years are ushering in an Age of Melancholy, just as the twentieth century became an Age of Anxiety. International data show what seems to be a modern epidemic of depression, one that is spreading side by side with the adoption throughout the world of modern ways. Each successive generation worldwide since the opening of the century has lived with a higher risk than their parents of suffering a major depression—not just sadness, but a paralyzing listlessness, dejection, and self-pity, and an overwhelming hopelessness—over the course of life. 23 And those episodes are beginning at earlier and earlier ages. Childhood depression, once virtually unknown (or, at least, unrecognized) is emerging as a fixture of the modern scene. Although the likelihood of becoming depressed rises with age, the greatest increases are among young people. For those born after 1955 the likelihood they will suffer a major depression at some point in life is, in many countries, three times or more greater than for their grandparents. Among Americans born before 1905, the rate of those
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having a major depression over a lifetime was just 1 percent; for those born since 1955, by age twenty-four about 6 percent had become depressed. For those born between 1945 and 1954, the chances of having had a major depression before age thirty-four are ten times greater than for those born between 1905 and 1914. 24 And for each generation the onset of a person’s first episode of depression has tended to occur at an ever-earlier age. A worldwide study of more than thirty-nine thousand people found the same trend in Puerto Rico, Canada, Italy, Germany, France, Taiwan, Lebanon, and New Zealand. In Beirut, the rise of depression tracked political events closely, the upward trends rocketing during periods of civil war. In Germany, for those born before 1914 the rate of depression by age thirty-five is 4 percent; for those born in the decade before 1944 it is 14 percent at age thirty-five. Worldwide, generations that came of age during politically troubled times had higher rates of depression, though the overall upward trend holds apart from any political events. The lowering into childhood of the age when people first experience
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The lowering into childhood of the age when people first experience depression also seems to hold worldwide. When I asked experts to hazard a guess as to why, there were several theories. Dr. Frederick Goodwin, then director of the National Institute of
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Mental Health, speculated, “There’s been a tremendous erosion of the nuclear family—a doubling of the divorce rate, a drop in parents’ time available to children, and an increase in mobility. You don’t grow up knowing your extended family much anymore. The losses of these stable sources of self-identification mean a greater susceptibility to depression.” Dr. David Kupfer, chairman of psychiatry at the University of Pittsburgh medical school, pointed to another trend: “With the spread of industrialization after World War II, in a sense nobody was home anymore. In more and more families there has been growing parental indifference to children’s needs as they grow up. This is not a direct cause of depression, but it sets up a vulnerability. Early emotional stressors may affect neuron development, which can lead to a depression when you are under great stress even decades later.” Martin Seligman, the University of Pennsylvania psychologist, proposed: “For the last thirty or forty years we’ve seen the ascendance of individualism and a waning of larger beliefs in religion, and in supports from the community and extended family. That means a loss of resources that can buffer you against setbacks and failures. To the
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of resources that can buffer you against setbacks and failures. To the extent you see a failure as something that is lasting and which you magnify to taint everything in your life, you are prone to let a momentary defeat become a lasting source of hopelessness. But if you have a larger perspective, like a belief in God and an afterlife, and you lose your job, it’s just a temporary defeat.” Whatever the cause, depression in the young is a pressing problem. In the United States, estimates vary widely for how many children and teens are depressed in any given year, as opposed to vulnerability over their lifetime. Some epidemiological studies using strict criteria —the official diagnostic symptoms for depression—have found that for boys and girls between ten and thirteen the rate of major depression over the course of a year is as high as 8 or 9 percent, though other studies place it at about half that rate (and some as low as about 2 percent). At puberty, some data suggest, the rate nearly doubles for girls; up to 16 percent of girls between fourteen and sixteen suffer a bout of depression, while the rate is unchanged for boys. 25 THE COURSE OF DEPRESSION IN THE YOUNG
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That depression should not just be treated, but prevented , in children is clear from an alarming discovery: Even mild episodes of depression in a child can augur more severe episodes later in life. 26 This challenges the old assumption that depression in childhood does not matter in the long run, since children supposedly “grow out of it.” Of course, every child gets sad from time to time; childhood and adolescence are, like adulthood, times of occasional disappointments and losses large and small with the attendant grief. The need for prevention is not for these times, but for those children for whom sadness spirals downward into a gloom that leaves them despairing, irritable, and withdrawn—a far more severe melancholy. Among children whose depression was severe enough that they were referred for treatment, three quarters had a subsequent episode of severe depression, according to data collected by Maria Kovacs, a psychologist at Western Psychiatric Institute and Clinic in Pittsburgh. 27 Kovacs studied children diagnosed with depression when they were as young as eight years old, assessing them every few years until some were as old as twenty-four. The children with major depression had episodes lasting about
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The children with major depression had episodes lasting about eleven months on average, though in one in six of them it persisted for as long as eighteen months. Mild depression, which began as early as age five in some children, was less incapacitating but lasted far longer—an average of about four years. And, Kovacs found, children who have a minor depression are more likely to have it intensify into major depression—a so-called double depression. Those who develop double depression are much more prone to suffer recurring episodes as the years go on. As children who had an episode of depression grew into adolescence and early adulthood, they suffered from depression or manic-depressive disorder, on average, one year in three. The cost to children goes beyond the suffering caused by depression itself. Kovacs told me, “Kids learn social skills in their peer relations— for example, what to do if you want something and aren’t getting it, seeing how other children handle the situation and then trying it yourself. But depressed kids are likely to be among the neglected children in a school, the ones other kids don’t play with much.” 28 The sullenness or sadness such children feel leads them to avoid
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initiating social contacts, or to look away when another child is trying to engage them—a social signal the other child only takes as a rebuff; the end result is that depressed children end up rejected or neglected on the playground. This lacuna in their interpersonal experience
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means they miss out on what they would normally learn in the rough- and-tumble of play, and so can leave them social and emotional laggards, with much catching up to do after the depression lifts. 29 Indeed, when depressed children have been compared to those without depression, they have been found to be more socially inept, to have fewer friends, to be less preferred than others as playmates, to be less liked, and to have more troubled relationships with other children. Another cost to these children is doing poorly in school; depression interferes with their memory and concentration, making it harder to pay attention in class and retain what is taught. A child who feels no joy in anything will find it hard to marshal the energy to master challenging lessons, let alone experience flow in learning. Understandably, the longer children in Kovacs’s study were depressed, the more their grades dropped and the poorer they did on achievement tests, so that they were more likely to be held back in school. In fact, there was a direct correlation between the length of time a child had been depressed and his grade-point average, with a steady plummet over the course of the episode. All of this academic
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rough going, of course, compounds the depression. As Kovacs observes, “Imagine you’re already feeling depressed, and you start flunking out of school, and you sit home by yourself instead of playing with other kids.” DEPRESSIONOGENIC WAYS OF THOUGHT Just as with adults, pessimistic ways of interpreting life’s defeats seem to feed the sense of helplessness and hopelessness at the heart of children’s depression. That people who are already depressed think in these ways has long been known. What has only recently emerged, though, is that children who are most prone to melancholy tend toward this pessimistic outlook before they become depressed. This insight suggests a window of opportunity for inoculating them against depression before it strikes. One line of evidence comes from studies of children’s beliefs about their own ability to control what happens in their lives—for example, being able to change things for the better. This is assessed by children’s ratings of themselves in such terms as “When I have problems at home I’m better than most kids at helping to solve the
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problems” and “When I work hard I get good grades.” Children who say none of these positive descriptions fits them have little sense that they can do anything to change things; this sense of helplessness is highest in those children who are most depressed. 30 A telling study looked at fifth and sixth graders in the few days after they received report cards. As we all remember, report cards are one of the greatest sources of elation and despair in childhood. But researchers find a marked consequence in how children assess their role when they get a worse grade than they expected. Those who see a bad grade as due to some personal flaw (“I’m stupid”) feel more depressed than those who explain it away in terms of something they could change (“If I work harder on my math homework I’ll get a better grade”). 31 Researchers identified a group of third, fourth, and fifth graders whom classmates had rejected, and tracked which ones continued to be social outcasts in their new classes the following year. How the children explained the rejection to themselves seemed crucial to whether they became depressed. Those who saw their rejection as due to some flaw in themselves grew more depressed. But the optimists,
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who felt that they could do something to change things for the better, were not especially depressed despite the continuing rejection. 32 And in a study of children making the notoriously stressful transition to seventh grade, those who had the pessimistic attitude responded to high levels of hassles at school and to any additional stress at home by becoming depressed. 33 The most direct evidence that a pessimistic outlook makes children highly susceptible to depression comes from a five-year study of children beginning when they were in third grade. 34 Among the younger children, the strongest predictor that they would become depressed was a pessimistic outlook coupled with a major blow such as parents divorcing or a death in the family, which left the child upset, unsettled, and, presumably, with parents less able to offer a nurturing buffer. As the children grew through the elementary-school years, there was a telling shift in their thinking about the good and bad events of their lives, with the children increasingly ascribing them to their own traits: “I’m getting good grades because I’m smart”; “I don’t have many friends because I’m no fun.” This shift seems to set in gradually over the third to fifth grades. As this happens those children
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who develop a pessimistic outlook—attributing the setbacks in their lives to some dire flaw in themselves—begin to fall prey to depressed
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moods in reaction to setbacks. What’s more, the experience of depression itself seems to reinforce these pessimistic ways of thinking, so that even after the depression lifts, the child is left with what amounts to an emotional scar, a set of convictions fed by the depression and solidified in the mind: that he can’t do well in school, is unlikable, and can do nothing to escape his own brooding moods. These fixed ideas can make the child all the more vulnerable to another depression down the road. SHORT-CIRCUITING DEPRESSION The good news: there is every sign that teaching children more productive ways of looking at their difficulties lowers their risk of depression. * In a study of one Oregon high school, about one in four students had what psychologists call a “low-level depression,” not severe enough to say it was beyond ordinary unhappiness as yet. 35 Some may have been in the early weeks or months of what was to become a depression. In a special after-school class seventy-five of the mildly depressed students learned to challenge the thinking patterns associated with depression, to become more adept at making friends, to get along better with their parents, and to engage in more social activities they
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found pleasant. By the end of the eight-week program, 55 percent of the students had recovered from their mild depression, while only about a quarter of equally depressed students who were not in the program had begun to pull out of their depression. A year later a quarter of those in the comparison group had gone on to fall into a major depression, as opposed to only 14 percent of students in the depression-prevention program. Though they lasted just eight sessions, the classes seemed to have cut the risk of depression in half. 36 Similarly promising findings came from a special once-a-week class given to ten- to thirteen-year-old youngsters at odds with their parents and showing some signs of depression. In after-school sessions they learned some basic emotional skills, including handling disagreements, thinking before acting, and, perhaps most important, challenging the pessimistic beliefs associated with depression—for example, resolving to study harder after doing poorly on an exam instead of thinking, “I’m just not smart enough.”
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“What a child learns in these classes is that moods like anxiety, sadness, and anger don’t just descend on you without your having any control over them, but that you can change the way you feel by what you think,” points out psychologist Martin Seligman, one of the developers of the twelve-week program. Because disputing the depressing thoughts vanquishes the gathering mood of gloom, Seligman added, “it’s an instant reinforcer that becomes a habit.” Again the special sessions lowered depression rates by one half— and did so as long as two years later. A year after the classes ended, just 8 percent of those who participated scored at a moderate-to- severe level on a test of depression, versus 29 percent of children in a comparison group. And after two years, about 20 percent of those in the course were showing some signs of at least mild depression, compared to 44 percent of those in the comparison group. Learning these emotional skills at the cusp of adolescence may be especially helpful, Seligman observes, “These kids seem to be better at handling the routine teenage agonies of rejection. They seem to have learned this at a crucial window for risk of depression, just as they
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enter the teen years. And the lesson seems to persist and grow a bit stronger over the course of the years after they learn it, suggesting the kids are actually using it in their day-to-day lives.” Other experts on childhood depression applaud the new programs. “If you want to make a real difference for psychiatric illness like depression, you have to do something before the kids get sick in the first place,” Kovacs commented. “The real solution is a psychological inoculation.” EATING DISORDERS During my days as a graduate student in clinical psychology in the late 1960s, I knew two women who suffered from eating disorders, though I realized this only after many years had passed. One was a brilliant graduate student in mathematics at Harvard, a friend from my undergraduate days; the other was on the staff at M.I.T. The mathematician, though skeletally thin, simply could not bring herself to eat; food, she said, repulsed her. The librarian had an ample figure and was given to bingeing on ice cream, Sara Lee carrot cake, and other desserts; then—as she once confided with some embarrassment —she would secretly go off to the bathroom and make herself vomit.
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Today the mathematician would be diagnosed with anorexia nervosa, the librarian with bulimia. In those years there were no such labels. Clinicians were just beginning to comment on the problem; Hilda Bruch, the pioneer in this movement, published her seminal article on eating disorders in 1969. 37 Bruch, puzzled by women who were starving themselves to death, proposed that one of the several underlying causes lay in an inability to label and respond appropriately to bodily urges—notably, of course, hunger. Since then the clinical literature on eating disorders has mushroomed, with a multitude of hypotheses about the causes, ranging from ever-younger girls feeling compelled to compete with unattainably high standards of female beauty, to intrusive mothers who enmesh their daughters in a controlling web of guilt and blame. Most of these hypotheses suffered from one great drawback: they were extrapolations from observations made during therapy. Far more desirable, from a scientific viewpoint, are studies of large groups of people over a period of several years, to see who among them eventually comes down with the problem. That kind of study allows a
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clean comparison that can tell, for example, if having controlling parents predisposes a girl to eating disorders. Beyond that, it can identify the cluster of conditions that leads to the problem, and distinguish them from conditions that might seem to be a cause, but which actually are found as often in people without the problem as in those who come for treatment. When just such a study was done with more than nine hundred girls in the seventh through tenth grades, emotional deficits—particularly a failure to tell distressing feelings from one another and to control them—were found to be key among the factors leading to eating disorders. 38 Even by tenth grade, there were sixty-one girls in this affluent, suburban Minneapolis high school who already had serious symptoms of anorexia or bulimia. The greater the problem, the more the girls reacted to setbacks, difficulties, and minor annoyances with intense negative feelings that they could not soothe, and the less their awareness of what, exactly, they were feeling. When these two emotional tendencies were coupled with being highly dissatisfied with their body, then the outcome was anorexia or bulimia. Overly controlling parents were found not to play a prime role in causing
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were found not to play a prime role in causing eating disorders. (As Bruch herself had warned, theories based on hindsight were unlikely to be accurate; for example, parents can easily become intensely controlling in response to their daughter’s eating
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disorder, out of desperation to help her.) Also judged irrelevant were such popular explanations as fear of sexuality, early onset of puberty, and low self-esteem. Instead, the causal chain this prospective study revealed began with the effects on young girls of growing up in a society preoccupied with unnatural thinness as a sign of female beauty. Well in advance of adolescence, girls are already self-conscious about their weight. One six-year-old, for example, broke into tears when her mother asked her to go for a swim, saying she’d look fat in a swimsuit. In fact, says her pediatrician, who tells the story, her weight was normal for her height. 39 In one study of 271 young teenagers, half the girls thought they were too fat, even though the vast majority of them were normal in weight. But the Minneapolis study showed that an obsession with being overweight is not in and of itself sufficient to explain why some girls go on to develop eating disorders. Some obese people are unable to tell the difference between being scared, angry, and hungry, and so lump all those feelings together as signifying hunger, which leads them to overeat whenever they feel
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upset. 40 Something similar seems to be happening in these girls. Gloria Leon, the University of Minnesota psychologist who did the study of young girls and eating disorders, observed that these girls “have poor awareness of their feelings and body signals; that was the strongest single predictor that they would go on to develop an eating disorder within the next two years. Most children learn to distinguish among their sensations, to tell if they’re feeling bored, angry, depressed, or hungry—it’s a basic part of emotional learning. But these girls have trouble distinguishing among their most basic feelings. They may have a problem with their boyfriend, and not be sure whether they’re angry, or anxious, or depressed—they just experience a diffuse emotional storm that they do not know how to deal with effectively. Instead they learn to make themselves feel better by eating; that can become a strongly entrenched emotional habit.” But when this habit for soothing themselves interacts with the pressures girls feel to stay thin, the way is paved for eating disorders to develop. “At first she might start with binge eating,” Leon observes. “But to stay thin she may turn to vomiting or laxatives, or intense
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physical exertion to undo the weight gain from overeating. Another avenue this struggle to handle emotional confusion can take is for the girl not to eat at all—it can be a way to feel you have at least some
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control over these overwhelming feelings.” The combination of poor inner awareness and weak social skills means that these girls, when upset by friends or parents, fail to act effectively to soothe either the relationship or their own distress. Instead their upset triggers the eating disorder, whether it be that of bulimia or anorexia, or simply binge eating. Effective treatments for such girls, Leon believes, need to include some remedial instruction in the emotional skills they lack. “Clinicians find,” she told me, “that if you address the deficits therapy works better. These girls need to learn to identify their feelings and learn ways to soothe themselves or handle their relationships better, without turning to their maladaptive eating habits to do the job.” ONLY THE LONELY: DROPOUTS It’s a grade-school drama: Ben, a fourth grader with few friends, has just heard from his one buddy, Jason, that they aren’t going to play together this lunch period—Jason wants to play with another boy, Chad, instead. Ben, crushed, hangs his head and cries. After his sobs subside, Ben goes over to the lunch table where Jason and Chad are eating.
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eating. “I hate your guts!” Ben yells at Jason. “Why?” Jason asks. “Because you lied,” Ben says, his tone accusatory. “You said this whole week that you were gonna play with me and you lied.” Ben then stalks off to his empty table, crying quietly. Jason and Chad go over to him and try to talk to him, but Ben puts his fingers in his ears, determinedly ignoring them, and runs out of the lunchroom to hide behind the school Dumpster. A group of girls who have witnessed the exchange try to play a peacemaker role, finding Ben and telling him that Jason is willing to play with him too. But Ben will have none of it, and tells them to leave him alone. He nurses his wounds, sulking and sobbing, defiantly alone. 41 A poignant moment, to be sure; the feeling of being rejected and friendless is one most everyone goes through at some point in childhood or adolescence. But what is most telling about Ben’s reaction is his failure to respond to Jason’s efforts to repair their friendship, a stance that extends his plight when it might have ended.
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Such an inability to seize key cues is typical of children who are
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unpopular; as we saw in Chapter 8 , socially rejected children typically are poor at reading emotional and social signals; even when they do read such signals, they may have limited repertoires for response. Dropping out of school is a particular risk for children who are social rejects. The dropout rate for children who are rejected by their peers is between two and eight times greater than for children who have friends. One study found, for example, that about 25 percent of children who were unpopular in elementary school had dropped out before completing high school, compared to a general rate of 8 percent. 42 Small wonder: imagine spending thirty hours a week in a place where no one likes you. Two kinds of emotional proclivities lead children to end up as social outcasts. As we have seen, one is the propensity to angry outbursts and to perceive hostility even where none is intended. The second is being timid, anxious, and socially shy. But over and above these temperamental factors, it is children who are “off”—whose awkwardness repeatedly makes people uncomfortable—who tend to be shunted aside. One way these children are “off” is in the emotional signals they
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send. When grade schoolers with few friends were asked to match an emotion such as disgust or anger with faces that displayed a range of emotions, they made far more mismatches than did children who were popular. When kindergarteners were asked to explain ways they might make friends with someone or keep from having a fight, it was the unpopular children—the ones others shied away from playing with—who came up with self-defeating answers (“Punch him” for what to do when both children wanted the same toy, for example), or vague appeals for help from a grown-up. And when teenagers were asked to role-play being sad, angry, or mischievous, the more unpopular among them gave the least convincing performances. It is perhaps no surprise that such children come to feel that they are helpless to do any better at making friends; their social incompetence becomes a self-fulfilling prophecy. Instead of learning new approaches to making friends, they simply keep doing the same things that have not worked for them in the past, or come up with even more inept responses. 43 In the lottery of liking, these children fall short on key emotional
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