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An Interview with Sherryl Goodman

An Interview with Robyn Fivush

National Institutes of Mental Health
Report on Children's Mental Health

Mental illness afflicts one out of ten American children.

Surgeon General David Satcher's announcement of this mental health statistic in January stunned parents and sparked national media attention. Researchers at Emory, however, were not surprised. Work here to illuminate the neurobiological and psychological events behind the Surgeon General's statistic focuses on subjects ranging from hormones to storytelling.

Stress appears to connect much of this diverse research. But what does "stress"--a term that figures prominently in articles from JAMA to the National Enquirer--really mean?

"We don't know," says Robyn Fivush, professor of psychology. "There's a sort of folk-psychology understanding, but we need more empirical data and theoretical work to really unpack its significance." Candler Professor and chair of biology John Lucchesi offers a working definition of stress as "a set of psychological and physical effects experienced as the result of anxiety or frustration stemming from the sense that one's own expectations or the expectations of others are not being fulfilled." Biological insults or any "experience that jeopardizes homeostasis" can also cause stress, adds Dobbs Professor of Psychology Elaine Walker.

Defining stress so that it resonates across clinical and experimental fields is a particularly thorny issue, Fivush acknowledges. Yet research suggests that in every stage of childhood, stress plays a role in the development of a gamut of mental problems, from social adjustment disorders to depression and schizophrenia. Leading causes of death in American adults, like lung disease and cancer, may be linked to stress experienced by children living in dysfunctional households, according to Vincent Felitti, a scientist with Kaiser Permanente who discussed his findings with Emory's Science and Society Faculty Seminar this spring.

Mechanisms of misery
Growing evidence suggests that environmental stress reaches even into the womb. Walker notes that research on non-human primates confirms early studies of effects of maternal stress in rodents. Both psychological stress, like isolation, and physiological stress, like electric shock, increase the mother's stress hormones. For their entire lives, the offspring of these rat mothers can exhibit high levels of stress hormones and abnormalities in the hypocampus, an area of the brain associated with mood. Strikingly, most of the maternal exposure in those experiments was relatively brief. "It's almost surprising that such circumscribed events could be having the impact on fetal brain development that they seem to be having," says Walker.

Findings in animals, of course, do not necessarily apply to humans. But, Walker explains, the few studies following the development of children whose mothers experienced major stress while pregnant--a natural disaster, for instance--have found a greater incidence of various psychiatric disorders. And just last fall, Reunette W. Harris Professor and chair of psychiatry Charles Nemeroff published findings in JAMA from the first human study to suggest that stressful childhood experiences heighten an individual's response to stress throughout life.

"What's been missing," says Walker, is an understanding of "the biological mechanisms. Why are some people affected and not others?" Investigations into the interaction of genes and hormones, however, promise to add another piece to this puzzle. Walker's own research indicates that increased levels of stress hormones could play a role in triggering genes that harbor vulnerabilities to specific disorders, such as schizophrenia. Nemeroff's study shows that stress in early life makes a part of the central nervous system active in cognitive and emotional processing particularly sensitive to stress. Thus, even relatively mild stress in adulthood may trigger mood and anxiety disorders in these individuals.

The mechanisms causing personal misery associated with less severe problems are similarly complex. Psychology professors Marshall Duke and Steven Nowicki hypothesize that stress can interrupt a young child's learning of nonverbal language, resulting in a condition they call dyssemia. "An anxious or depressed child just doesn't pick up on nonverbal cues," Duke explains. That causes him to react inappropriately to peers who often reject him, causing more stress. Duke emphasizes, however, that this cycle can be broken through learning better social skills and that parents and teachers can often intervene more effectively than psychologists in conditions like dyssemia.

Stress and storytelling
The developing brain's sensitivity to stress may also provide some protection from mental illness. Paul Plotsky, psychology professor and director of the Stress Neurobiology Laboratory at Emory's School of Medicine, established several years ago that newborn rats who receive caring stimulation develop a stress response that equips them to handle stress better throughout their lives.

The distinctly human ability to make meaning through narratives helps explain why some kids suffer more from stressful events than others. The national controversy in the 1980s about the reliability of children's memories in sexual abuse cases piqued Fivush's interest in children's memories of stressful events. Her study of children who survived Hurricane Andrew found that even three-year-olds could recall detailed information. Children's memories of such events may be more detailed, in fact, than memories of more mundane experiences. According to Fivush, a substantial body of research shows that "creating coherent accounts of stressful or traumatic experiences has long term effects on both emotional and physical well-being." Conversations with parents and other adults about those memories can put them in context, offer ways to cope, and provide a sense of closure on negative experiences.

Unfortunately, the twenty-five percent of American girls and fifteen percent of American boys who are sexually abused may experience a silence that compounds the negative effects of abuse, Fivush says. Not only do abusive parents not provide "a coherent verbal framework" for the child, she explains, but they often label the abuse as "punishment for misbehavior" or a "special game." While those kinds of narratives may exacerbate the effects of stressful experiences, another common kind of story told in our culture may equip children to cope with stress.

Fivush and Duke currently are analyzing the effects of family storytelling on children's well-being through a project associated with the Center on Myth and Ritual in American Life. "We're looking at how families tell stories about themselves: positive ones, negatives ones, heroic adventures, and plain old tales," Duke explains. "The hypothesis is that these stories make kids more resilient and able to cope with stress, perhaps through showing that bad things happen, but you can go on. You can find a way to survive."

Investigating the everyday coping mechanisms of functioning families may be as important as understanding deviance and extreme dysfunction. Duke worries about the increasing prevalence of medical models for understanding childhood problems. While medical models "work well for some things, we need to get away from the idea that everything we consider wrong with children is a psychological disorder," Duke says. "Some of what we call 'disorders,' our grandparents called 'life.'"