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Interview with Sherryl Goodman
An Interview with Robyn Fivush
Institutes of Mental Health
on Children's Mental Health
Mental illness afflicts one out of ten American
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.
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.
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
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.'"