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Stress can also lead to ulceration of the gastrointestinal tract,
triggering symptoms in ulcerative colitis and in inflammatory bowel
disease. The brain itself is susceptible to the long-term effects of
sustained stress, including damage to the hippocampus, and so to
memory. In general, says McEwen, “evidence is mounting that the
nervous system is subject to ‘wear and tear’ as a result of stressful
experiences.”
21
Particularly compelling evidence for the medical impact from
distress has come from studies with infectious diseases such as colds,
the flu, and herpes. We are continually exposed to such viruses, but
ordinarily our immune system fights them off—except that under
emotional stress those defenses more often fail. In experiments in
which the robustness of the immune system has been assayed directly,
stress and anxiety have been found to weaken it, but in most such
results it is unclear whether the range of immune weakening is of
clinical significance—that is, great enough to open the way to
disease.
22
For that reason stronger scientific links of stress and anxiety
to medical vulnerability come from prospective studies: those that
start with healthy people and monitor first a heightening of distress | emotional_intelligence.pdf |
f4ab7c833c0e-2 | start with healthy people and monitor first a heightening of distress
followed by a weakening of the immune system and the onset of
illness. | emotional_intelligence.pdf |
423b02687a6b-0 | In one of the most scientifically compelling studies, Sheldon Cohen,
a psychologist at Carnegie-Mellon University, working with scientists
at a specialized colds research unit in Sheffield, England, carefully
assessed how much stress people were feeling in their lives, and then
systematically exposed them to a cold virus. Not everyone so exposed
actually comes down with a cold; a robust immune system can—and
constantly does—resist the cold virus. Cohen found that the more
stress in their lives, the more likely people were to catch cold. Among
those with little stress, 27 percent came down with a cold after being
exposed to the virus; among those with the most stressful lives, 47
percent got the cold—direct evidence that stress itself weakens the
immune system.
23
(While this may be one of those scientific results
that confirms what everyone has observed or suspected all along, it is
considered a landmark finding because of its scientific rigor.)
Likewise, married couples who for three months kept daily
checklists of hassles and upsetting events such as marital fights
showed a strong pattern: three or four days after an especially intense
batch of upsets, they came down with a cold or upper-respiratory | emotional_intelligence.pdf |
423b02687a6b-1 | infection. That lag period is precisely the incubation time for many
common cold viruses, suggesting that being exposed while they were
most worried and upset made them especially vulnerable.
24
The same stress-infection pattern holds for the herpes virus—both
the type that causes cold sores on the lip and the type that causes
genital lesions. Once people have been exposed to the herpes virus, it
stays latent in the body, flaring up from time to time. The activity of
the herpes virus can be tracked by levels of antibodies to it in the
blood. Using this measure, reactivation of the herpes virus has been
found in medical students undergoing year-end exams, in recently
separated women, and among people under constant pressure from
caring for a family member with Alzheimer’s disease.
25
The toll of anxiety is not just that it lowers the immune response;
other research is showing adverse effects on the cardiovascular
system. While chronic hostility and repeated episodes of anger seem
to put men at greatest risk for heart disease, the more deadly emotion
in women may be anxiety and fear. In research at Stanford University
School of Medicine with more than a thousand men and women who | emotional_intelligence.pdf |
423b02687a6b-2 | School of Medicine with more than a thousand men and women who
had suffered a first heart attack, those women who went on to suffer a
second heart attack were marked by high levels of fearfulness and
anxiety. In many cases the fearfulness took the form of crippling
phobias: after their first heart attack the patients stopped driving, quit | emotional_intelligence.pdf |
8492cb55f9fc-0 | their jobs, or avoided going out.
26
The insidious physical effects of mental stress and anxiety—the kind
produced by high-pressure jobs, or high-pressure lives such as that of
a single mother juggling day care and a job—are being pinpointed at
an anatomically fine-grained level. For example, Stephen Manuck, a
University of Pittsburgh psychologist, put thirty volunteers through a
rigorous, anxiety-riddled ordeal in a laboratory while he monitored
the men’s blood, assaying a substance secreted by blood platelets
called adenosine triphosphate, or ATP, which can trigger blood-vessel
changes that may lead to heart attacks and strokes. While the
volunteers were under the intense stress, their ATP levels rose sharply,
as did their heart rate and blood pressure.
Understandably, health risks seem greatest for those whose jobs are
high in “strain”: having high-pressure performance demands while
having little or no control over how to get the job done (a
predicament that gives bus drivers, for instance, a high rate of
hypertension). For example, in a study of 569 patients with colorectal
cancer and a matched comparison group, those who said that in the
previous ten years they had experienced severe on-the-job aggravation | emotional_intelligence.pdf |
8492cb55f9fc-1 | were five and a half times more likely to have developed the cancer
compared to those with no such stress in their lives.
27
Because the medical toll of distress is so broad, relaxation
techniques—which directly counter the physiological arousal of stress
—are being used
clinically to ease the symptoms of a wide variety of
chronic illnesses. These include cardiovascular disease, some types of
diabetes, arthritis, asthma, gastrointestinal disorders, and chronic
pain, to name a few. To the degree any symptoms are worsened by
stress and emotional distress, helping patients become more relaxed
and able to handle their turbulent feelings can often offer some
reprieve.
28
The Medical Costs of Depression
She had been diagnosed with metastatic breast cancer, a return and spread of the
malignancy several years after what she had thought was successful surgery for the
disease. Her doctor could no longer talk of a cure, and the chemotherapy, at best,
might offer just a few more months of life. Understandably, she was depressed—so
much so that whenever she went to her oncologist, she found herself at some point | emotional_intelligence.pdf |
8492cb55f9fc-2 | bursting out into tears. Her oncologist’s response each time: asking her to leave the | emotional_intelligence.pdf |
870b72772619-0 | office immediately.
Apart from the hurtfulness of the oncologist’s coldness, did it matter
medically that he would not deal with his patient’s constant sadness?
By the time a disease has become so virulent, it would be unlikely
that any emotion would have an appreciable effect on its progress.
While the woman’s depression most certainly dimmed the quality of
her final months, the medical evidence that melancholy might affect
the course of cancer is as yet mixed.
29
But cancer aside, a smattering
of studies suggest a role for depression in many other medical
conditions, especially in worsening a sickness once it has begun. The
evidence is mounting that for patients with serious disease who are
depressed, it would pay medically to treat their depression too.
One complication in treating depression in medical patients is that
its symptoms, including loss of appetite and lethargy, are easily
mistaken for signs of other diseases, particularly by physicians with
little training in psychiatric diagnosis. That inability to diagnose
depression may itself add to the problem, since it means that a
patient’s depression—like that of the weepy breast-cancer patient—
goes unnoticed and untreated. And that failure to diagnose and treat | emotional_intelligence.pdf |
870b72772619-1 | may add to the risk of death in severe disease.
For instance, of 100 patients who received bone marrow
transplants, 12 of the 13 who had been depressed died within the first
year of the transplant, while 34 of the remaining 87 were still alive
two years later.
30
And in patients with chronic kidney failure who
were receiving dialysis, those who were
diagnosed with major
depression were most likely to die within the following two years;
depression was a stronger predictor of death than any medical sign.
31
Here the route connecting emotion to medical status was not
biological but attitudinal: The depressed patients were much worse
about complying with their medical regimens—cheating on their
diets, for example, which put them at higher risk.
Heart disease too seems to be exacerbated by depression. In a study
of 2,832 middle-aged men and women tracked for twelve years, those
who felt a sense of nagging despair and hopelessness had a heightened
rate of death from heart disease.
32
And for the 3 percent or so who
were most severely depressed, the death rate from heart disease,
compared to the rate for those with no feelings of depression, was
four times greater. | emotional_intelligence.pdf |
870b72772619-2 | four times greater.
Depression seems to pose a particularly grave medical risk for heart | emotional_intelligence.pdf |
3b30e0c59d6a-0 | attack survivors.
33
In a study of patients in a Montreal hospital who
were discharged after being treated for a first heart attack, depressed
patients had a sharply higher risk of dying within the following six
months. Among the one in eight patients who were seriously
depressed, the death rate was five times higher than for others with
comparable disease—an effect as great as that of major medical risks
for cardiac death, such as left ventricular dysfunction or a history of
previous heart attacks. Among the possible mechanisms that might
explain why depression so greatly increases the odds of a later heart
attack are its effects on heart rate variability, increasing the risk of
fatal arrhythmias.
Depression has also been found to complicate recovery from hip
fracture. In a study of elderly women with hip fracture, several
thousand were given psychiatric evaluations on their admission to the
hospital. Those who were depressed on admission stayed an average
of eight days longer than those with comparable injury but no
depression, and were only a third as likely ever to walk again. But
depressed women who had psychiatric help for their depression along
with other medical care needed less physical therapy to walk again | emotional_intelligence.pdf |
3b30e0c59d6a-1 | and had fewer rehospitalizations over the three months after their
return home from the hospital.
Likewise, in a study of patients whose condition was so dire that
they were among the top 10 percent of those using medical services—
often because of having multiple illnesses, such as both heart disease
and diabetes—about one in six had serious depression. When these
patients were treated for the problem, the number of days per year
that they were disabled dropped from 79 to 51 for those who had
major depression, and from 62 days per year to just 18 in those who
had been treated for mild depression.
34
THE MEDICAL BENEFITS OF
POSITIVE FEELINGS
The cumulative evidence for adverse medical effects from anger,
anxiety, and depression, then, is compelling. Both anger and anxiety,
when chronic, can make people more susceptible to a range of
disease. And while depression may not make people more vulnerable
to becoming ill, it does seem to impede medical recovery and
heighten the risk of death, especially with more frail patients with
severe conditions. | emotional_intelligence.pdf |
07482dc046a7-0 | But if chronic emotional distress in its many forms is toxic, the
opposite range of emotion can be tonic—to a degree. This by no
means says that positive emotion is curative, or that laughter or
happiness alone will turn the course of a serious disease. The edge
positive emotions offer seems subtle, but, by using studies with large
numbers of people, can be teased out of the mass of complex variables
that affect the course of disease.
The Price of Pessimism—and Advantages of Optimism
As with depression, there are medical costs to pessimism—and
corresponding benefits from optimism. For example, 122 men who
had their first heart attack were evaluated on their degree of optimism
or pessimism. Eight years later, of the 25 most pessimistic men, 21
had died; of the 25 most optimistic, just 6 had died. Their mental
outlook proved a better predictor of survival than any medical risk
factor, including the amount of damage to the heart in the first attack,
artery blockage, cholesterol level, or blood pressure. And in other
research, patients going into artery bypass surgery who were more
optimistic had a much faster recovery and fewer medical
complications during and after surgery than did more pessimistic | emotional_intelligence.pdf |
07482dc046a7-1 | complications during and after surgery than did more pessimistic
patients.
35
Like its near cousin optimism, hope has healing power. People who
have a great deal of hopefulness are, understandably, better able to
bear up under trying circumstances, including medical difficulties. In
a study of people paralyzed from spinal injuries, those who had more
hope were able to gain greater levels of physical mobility compared to
other patients with similar degrees of injury, but who felt less hopeful.
Hope is especially telling in paralysis from spinal injury, since this
medical tragedy typically involves a man who is paralyzed in his
twenties by an accident and will remain so for the rest of his life. How
he reacts emotionally will have broad consequences for the degree to
which he will make the efforts that might bring him greater physical
and social functioning.
36
Just why an optimistic or pessimistic outlook should have health
consequences is open to any of several explanations. One theory
proposes that pessimism leads to depression, which in turn interferes
with the resistance of the immune system to tumors and infection—an
unproven speculation at present. Or it may be that pessimists neglect | emotional_intelligence.pdf |
07482dc046a7-2 | themselves—some studies have found that pessimists smoke and drink | emotional_intelligence.pdf |
0250c7293da3-0 | more, and exercise less, than optimists, and are generally much more
careless about their health habits. Or it may one day turn out that the
physiology of hopefulness is itself somehow helpful biologically to the
body’s fight against disease.
With a Little Help From My Friends:
The Medical Value of Relationships
Add the sounds of silence to the list of emotional risks to health—and
close emotional ties to the list of protective factors. Studies done over
two decades involving more than thirty-seven thousand people show
that social isolation—the sense that you have nobody with whom you
can share your private feelings or have close contact—doubles the
chances of sickness or death.
37
Isolation itself, a 1987 report in
Science
concluded, “is as significant to mortality rates as smoking, high blood
pressure, high cholesterol, obesity, and lack of physical exercise.”
Indeed, smoking increases mortality risk by a factor of just 1.6, while
social isolation does so by a factor of 2.0, making it a greater health
risk.
38
Isolation is harder on men than on women. Isolated men were two
to three times more likely to die as were men with close social ties; | emotional_intelligence.pdf |
0250c7293da3-1 | for isolated women, the risk was one and a half times greater than for
more socially connected women. The difference between men and
women in the impact of isolation may be because women’s
relationships tend to be emotionally closer than men’s; a few strands
of such social ties for a woman may be more comforting than the
same small number of friendships for a man.
Of course, solitude is not the same as isolation; many people who
live on their own or see few friends are content and healthy. Rather, it
is the subjective sense of being cut off from people and having no one
to turn to that is the medical risk. This finding is ominous in light of
the increasing isolation bred by solitary TV-watching and the falling
away of social habits such as clubs and visits in modern urban
societies, and suggests an added value to self-help groups such as
Alcoholics Anonymous as surrogate communities.
The power of isolation as a mortality risk factor—and the healing
power of close ties—can be seen in the study of one hundred bone
marrow transplant patients.
39
Among patients who felt they had
strong emotional support from their spouse, family, or friends, 54
percent survived the transplants after two years, versus just 20 | emotional_intelligence.pdf |
16857568a05b-0 | percent among those who reported little such support. Similarly,
elderly people who suffer heart attacks, but have two or more people
in their lives they can rely on for emotional support, are more than
twice as likely to survive longer than a year after an attack than are
those people with no such support.
40
Perhaps the most telling testimony to the healing potency of
emotional ties is a Swedish study published in 1993.
41
All the men
living in the Swedish city of Göteborg who were born in 1933 were
offered a free medical exam; seven years later the 752 men who had
come for the exam were contacted again. Of these, 41 had died in the
intervening years.
Men who had originally reported being under intense emotional
stress had a death rate three times greater than those who said their
lives were calm and placid. The emotional distress was due to events
such as serious financial trouble, feeling insecure at work or being
forced out of a job, being the object of a legal action, or going through
a divorce. Having had three or more of these troubles within the year
before the exam was a stronger predictor of dying within the ensuing | emotional_intelligence.pdf |
16857568a05b-1 | seven years than were medical indicators such as high blood pressure,
high concentrations of blood triglycerides, or high serum cholesterol
levels.
Yet among men who said they had a dependable web of intimacy—
a wife, close friends, and the like—
there was no relationship whatever
between high stress levels and death rate. Having people to turn to
and talk with, people who could offer solace, help, and suggestions,
protected them from the deadly impact of life’s rigors and trauma.
The quality of relationships as well as their sheer number seems key
to buffering stress. Negative relationships take their own toll. Marital
arguments, for example, have a negative impact on the immune
system.
42
One study of college roommates found that the more they
disliked each other, the more susceptible they were to colds and the
flu, and the more frequently they went to doctors. John Cacioppo, the
Ohio State University psychologist who did the roommate study, told
me, “It’s the most important relationships in your life, the people you
see day in and day out, that seem to be crucial for your health. And
the more significant the relationship is in your life, the more it
matters for your health.”
43 | emotional_intelligence.pdf |
16857568a05b-2 | matters for your health.”
43
The Healing Power of Emotional Support | emotional_intelligence.pdf |
6aa48a1e96c5-0 | In
The Merry Adventures of Robin Hood
, Robin advises a young
follower: “Tell us thy troubles and speak freely. A flow of words doth
ever ease the heart of sorrows; it is like opening the waste where the
mill dam is overfull.” This bit of folk wisdom has great merit;
unburdening a troubled heart appears to be good medicine. The
scientific corroboration of Robin’s advice comes from James
Pennebaker, a Southern Methodist University psychologist, who has
shown in a series of experiments that getting people to talk about the
thoughts that trouble them most has a beneficial medical effect.
44
His
method is remarkably simple: he asks people to write, for fifteen to
twenty minutes a day over five or so days, about, for example, “the
most traumatic experience of your entire life,” or some pressing worry
of the moment. What people write can be kept entirely to themselves
if they like.
The net effect of this confessional is striking: enhanced immune
function, significant drops in health-center visits in the following six
months, fewer days missed from work, and even improved liver
enzyme function. Moreover, those whose writing showed most | emotional_intelligence.pdf |
6aa48a1e96c5-1 | enzyme function. Moreover, those whose writing showed most
evidence of turbulent feelings had the greatest improvements in their
immune function. A specific pattern emerged as the “healthiest” way
to ventilate troubling feelings: at first expressing a high level of
sadness, anxiety, anger—whatever troubling feelings the topic
brought up; then, over the course of the next several days weaving a
narrative, finding some meaning in the trauma or travail.
That process, of course, seems akin to what happens when people
explore such troubles in psychotherapy. Indeed, Pennebaker’s findings
suggest one reason why other studies show medical patients given
psychotherapy in addition to surgery or medical treatment often fare
better
medically
than do those who receive medical treatment alone.
45
Perhaps the most powerful demonstration of the clinical power of
emotional support was in groups at Stanford University Medical
School for women with advanced metastatic breast cancer. After an
initial treatment, often including surgery, these women’s cancer had
returned and was spreading through their bodies. It was only a matter
of time, clinically speaking, until the spreading cancer killed them. Dr. | emotional_intelligence.pdf |
6aa48a1e96c5-2 | David Spiegel, who conducted the study, was himself stunned by the
findings, as was the medical community: women with advanced breast
cancer who went to weekly meetings with others survived
twice as
long
as did women with the same disease who faced it on their own.
46
All the women received standard medical care; the only difference | emotional_intelligence.pdf |
87288aa1dde7-0 | was that
some also went to the groups, where they were able to
unburden themselves with others who understood what they faced
and were willing to listen to their fears, their pain, and their anger.
Often this was the only place where the women could be open about
these emotions, because other people in their lives dreaded talking
with them about the cancer and their imminent death. Women who
attended the groups lived for thirty-seven additional months, on
average, while those with the disease who did not go to the groups
died, on average, in nineteen months—a gain in life expectancy for
such patients beyond the reach of any medication or other medical
treatment. As Dr. Jimmie Holland, the chief psychiatric oncologist at
Sloan-Kettering Memorial Hospital, a cancer treatment center in New
York City, put it to me, “Every cancer patient should be in a group
like this.” Indeed, if it had been a new drug that produced the
extended life expectancy, pharmaceutical companies would be
battling to produce it.
BRINGING EMOTIONAL INTELLIGENCE TO MEDICAL CARE
The day a routine checkup spotted some blood in my urine, my doctor
sent me for a diagnostic test in which I was injected with a radioactive | emotional_intelligence.pdf |
87288aa1dde7-1 | dye. I lay on a table while an overhead X-ray machine took successive
images of the dye’s progression through my kidneys and bladder. I
had company for the test: a close friend, a physician himself,
happened to be visiting for a few days and offered to come to the
hospital with me. He sat in the room while the X-ray machine, on an
automated track, rotated for new camera angles, whirred and clicked;
rotated, whirred, clicked.
The test took an hour and a half. At the very end a kidney specialist
hurried into the room, quickly introduced himself, and disappeared to
scan the X-rays. He didn’t return to tell me what they showed.
As we were leaving the exam room my friend and I passed the
nephrologist. Feeling shaken and somewhat dazed by the test, I did
not have the presence of mind to ask the one question that had been
on my mind all morning. But my companion, the physician, did:
“Doctor,” he said, “my friend’s father died of bladder cancer. He’s
anxious to know if you saw any signs of cancer in the X-rays.”
“No abnormalities,” was the curt reply as the nephrologist hurried
on to his next appointment. | emotional_intelligence.pdf |
8700ae7a0b11-0 | My inability to ask the single question I cared about most is
repeated a thousand times each day in hospitals and clinics
everywhere. A study of
patients in physicians’ waiting rooms found
that each had an average of three or more questions in mind to ask
the physician they were about to see. But when the patients left the
physician’s office, an average of only one and a half of those questions
had been answered.
47
This finding speaks to one of the many ways
patients’ emotional needs are unmet by today’s medicine. Unanswered
questions feed uncertainty, fear, catastrophizing. And they lead
patients to balk at going along with treatment regimes they don’t fully
understand.
There are many ways medicine can expand its view of health to
include the emotional realities of illness. For one, patients could
routinely be offered fuller information essential to the decisions they
must make about their own medical care; some services now offer any
caller a state-of-the-art computer search of the medical literature on
what ails them, so that patients can be more equal partners with their
physicians in making informed decisions.
48
Another approach is
programs that, in a few minutes’ time, teach patients to be effective | emotional_intelligence.pdf |
8700ae7a0b11-1 | questioners with their physicians, so that when they have three
questions in mind as they wait for the doctor, they will come out of
the office with three answers.
49
Moments when patients face surgery or invasive and painful tests
are fraught with anxiety—and are a prime opportunity to deal with
the emotional dimension. Some hospitals have developed presurgery
instruction for patients that help them assuage their fears and handle
their discomforts—for example, by teaching patients relaxation
techniques, answering their questions well in advance of surgery, and
telling them several days ahead of surgery precisely what they are
likely to experience during their recovery. The result: patients recover
from surgery an average of two to three days sooner.
50
Being a hospital patient can be a tremendously lonely, helpless
experience. But some hospitals have begun to design rooms so that
family members can stay with patients, cooking and caring for them
as they would at home—a progressive step that, ironically, is routine
throughout the Third World.
51
Relaxation training can help patients deal with some of the distress
their symptoms bring, as well as with the emotions that may be
triggering or exacerbating their symptoms. An exemplary model is Jon | emotional_intelligence.pdf |
8700ae7a0b11-2 | Kabat-Zinn’s Stress Reduction Clinic at the University of | emotional_intelligence.pdf |
908be574807a-0 | Massachusetts Medical Center, which offers a ten-week course in
mindfulness and yoga to patients; the emphasis is on being mindful of
emotional episodes as they are happening, and on cultivating a daily
practice that offers deep relaxation. Hospitals
have made instructional
tapes from the course available over patients’ television sets—a far
better emotional diet for the bedridden than the usual fare, soap
operas.
52
Relaxation and yoga are also at the core of the innovative program
for treating heart disease developed by Dr. Dean Ornish.
53
After a
year of this program, which included a low-fat diet, patients whose
heart disease was severe enough to warrant a coronary bypass
actually reversed the buildup of artery-clogging plaque. Ornish tells
me that relaxation training is one of the most important parts of the
program. Like Kabat-Zinn’s, it takes advantage of what Dr. Herbert
Benson calls the “relaxation response,” the physiological opposite of
the stress arousal that contributes to such a wide spectrum of medical
problems.
Finally, there is the added medical value of an empathic physician
or nurse, attuned to patients, able to listen and be heard. This means | emotional_intelligence.pdf |
908be574807a-1 | fostering “relationship-centered care,” recognizing that the
relationship between physician and patient is itself a factor of
significance. Such relationships would be fostered more readily if
medical education included some basic tools of emotional intelligence,
especially self-awareness and the arts of empathy and listening.
54
TOWARD A MEDICINE THAT CARES
Such steps are a beginning. But for medicine to enlarge its vision to
embrace the impact of emotions, two large implications of the
scientific findings must be taken to heart:
1.
Helping people better manage their upsetting feelings—anger, anxiety,
depression, pessimism, and loneliness—is a form of disease prevention
.
Since the data show that the toxicity of these emotions, when chronic,
is on a par with smoking cigarettes, helping people handle them
better could potentially have a medical payoff as great as getting
heavy smokers to quit. One way to do this that could have broad
public-health effects would be to impart most basic emotional
intelligence skills to children, so that they become lifelong habits. | emotional_intelligence.pdf |
9911112e88bd-0 | Another high-payoff preventive strategy would be to teach emotion
management to people reaching retirement age, since emotional well-
being is one factor that determines whether an older person declines
rapidly or thrives. A third target group might be so-called at-risk
populations—the very poor, single working mothers, residents of
high-crime
neighborhoods, and the like—who live under
extraordinary pressure day in and day out, and so might do better
medically with help in handling the emotional toll of these stresses.
2.
Many patients can benefit measurably when their psychological needs
are attended to along with their purely medical ones
. While it is a step
toward more humane care when a physician or nurse offers a
distressed patient comfort and consolation, more can be done. But
emotional care is an opportunity too often lost in the way medicine is
practiced today; it is a blind spot for medicine. Despite mounting data
on the medical usefulness of attending to emotional needs, as well as
supporting evidence for connections between the brain’s emotional
center and the immune system, many physicians remain skeptical that
their patients’ emotions matter clinically, dismissing the evidence for
this as trivial and anecdotal, as “fringe,” or, worse, as the | emotional_intelligence.pdf |
9911112e88bd-1 | exaggerations of a self-promoting few.
Though more and more patients seek a more humane medicine, it is
becoming endangered. Of course, there remain dedicated nurses and
physicians who give their patients tender, sensitive care. But the
changing culture of medicine itself, as it becomes more responsive to
the imperatives of business, is making such care increasingly difficult
to find.
On the other hand, there may be a business advantage to humane
medicine: treating emotional distress in patients, early evidence
suggests, can save money—especially to the extent that it prevents or
delays the onset of sickness, or helps patients heal more quickly. In a
study of elderly patients with hip fracture at Mt. Sinai School of
Medicine in New York City and at Northwestern University, patients
who received therapy for depression in addition to normal orthopedic
care left the hospital an average of two days earlier; total savings for
the hundred or so patients was $97,361 in medical costs.
55
Such care also makes patients more satisfied with their physicians
and medical treatment. In the emerging medical marketplace, where
patients often have the option to choose between competing health | emotional_intelligence.pdf |
a9f5a1714e99-0 | plans, satisfaction levels will no doubt enter the equation of these very
personal decisions—souring experiences can lead patients to go
elsewhere for care, while pleasing ones translate into loyalty.
Finally, medical ethics may demand such an approach. An editorial
in the
Journal of the American Medical Association
, commenting on a
report that depression increases fivefold the likelihood of dying after
being treated for a heart attack, notes: “[T]he clear demonstration
that psychological factors like
depression and social isolation
distinguish the coronary heart disease patients at highest risk means it
would be unethical not to start trying to treat these factors.”
56
If the findings on emotions and health mean anything, it is that
medical care that neglects how people
feel as
they battle a chronic or
severe disease is no longer adequate. It is time for medicine to take
more methodical advantage of the link between emotion and health.
What is now the exception could—and should—be part of the
mainstream, so that a more caring medicine is available to us all. At
the least it would make medicine more humane. And, for some, it
could speed the course of recovery. “Compassion,” as one patient put | emotional_intelligence.pdf |
a9f5a1714e99-1 | it in an open letter to his surgeon, “is not mere hand holding. It is
good medicine.”
57 | emotional_intelligence.pdf |
a5ad81520e13-0 | PART FOUR
WINDOWS
OF
OPPORTUNITY | emotional_intelligence.pdf |
620e9c16cb45-0 | 12
The Family Crucible
It’s a low-key family tragedy. Carl and Ann are showing their daughter Leslie, just five,
how to play a brand-new video game. But as Leslie starts to play, her parents’ overly
eager attempts to “help” her just seem to get in the way. Contradictory orders fly in
every direction.
“To the right, to the right—stop. Stop. Stop!” Ann, the mother, urges, her voice
growing more intent and anxious as Leslie, sucking on her lip and staring wide-eyed at
the video screen, struggles to follow these directives.
“See, you’re not lined up … put it to the left! To the left!” Carl, the girl’s father,
brusquely orders.
Meanwhile Ann, her eyes rolling upward in frustration, yells over his advice, “Stop!
Stop!”
Leslie, unable to please either her father or her mother, contorts her jaw in tension
and blinks as her eyes fill with tears.
Her parents start bickering, ignoring Leslie’s tears. “She’s not moving the stick
that
much!” Ann tells Carl, exasperated.
As the tears start rolling down Leslie’s cheeks, neither parent makes any move that | emotional_intelligence.pdf |
620e9c16cb45-1 | indicates they notice or care. As Leslie raises her hand to wipe her eyes, her father
snaps, “Okay, put your hand back on the stick … you wanna get ready to shoot. Okay,
put it over!” And her mother barks, “Okay, move it just a teeny bit!”
But by now Leslie is sobbing softly, alone with her anguish.
At such moments children learn deep lessons. For Leslie one
conclusion from this painful exchange might well be that neither her
parents, nor anyone else, for that matter, cares about her feelings.
1
When similar moments are repeated countless times over the course of
childhood they impart some of the most fundamental emotional
messages of a lifetime—lessons that can determine a life course.
Family life is our first school for emotional learning; in this intimate
cauldron we learn how to feel about ourselves and how
others will
react to our feelings; how to think about these feelings and what | emotional_intelligence.pdf |
194ba73162aa-0 | choices we have in reacting; how to read and express hopes and fears.
This emotional schooling operates not just through the things that
parents say and do directly to children, but also in the models they
offer for handling their own feelings and those that pass between
husband and wife. Some parents are gifted emotional teachers, others
atrocious.
There are hundreds of studies showing that how parents treat their
children—whether with harsh discipline or empathic understanding,
with indifference or warmth, and so on—has deep and lasting
consequences for the child’s emotional life. Only recently, though,
have there been hard data showing that having emotionally intelligent
parents is itself of enormous benefit to a child. The ways a couple
handles the feelings between them—in addition to their direct
dealings with a child—impart powerful lessons to their children, who
are astute learners, attuned to the subtlest emotional exchanges in the
family. When research teams led by Carole Hooven and John Gottman
at the University of Washington did a microanalysis of interactions in
couples on how the partners handled their children, they found that
those couples who were more emotionally competent in the marriage
were also the most effective in helping their children with their | emotional_intelligence.pdf |
194ba73162aa-1 | were also the most effective in helping their children with their
emotional ups and downs.
2
The families were first seen when one of their children was just five
years old, and again when the child had reached nine. In addition to
observing the parents talk with each other, the research team also
watched families (including Leslie’s) as the father or mother tried to
show their young child how to operate a new video game—a
seemingly innocuous interaction, but quite telling about the emotional
currents that run between parent and child.
Some mothers and fathers were like Ann and Carl: overbearing,
losing patience with their child’s ineptness, raising their voices in
disgust or exasperation, some even putting their child down as
“stupid”—in short, falling prey to the same tendencies toward
contempt and disgust that eat away at a marriage. Others, however,
were patient with their child’s errors, helping the child figure the
game out in his or her own way rather than imposing the parents’
will. The video game session was a surprisingly powerful barometer of
the parents’ emotional style.
The three most common emotionally inept parenting styles proved
to be: | emotional_intelligence.pdf |
4a69add2d053-0 | • Ignoring feelings altogether
. Such parents treat a child’s emotional
upset as trivial or a bother, something they should wait to blow over.
They fail to use emotional moments as a chance to get closer to the
child or to help the child learn lessons in emotional competence.
•
Being too laissez-faire
. These parents notice how a child feels, but
hold that however a child handles the emotional storm is fine—even,
say, hitting. Like those who ignore a child’s feelings, these parents
rarely step in to try to show their child an alternative emotional
response. They try to soothe all upsets, and will, for instance, use
bargaining and bribes to get their child to stop being sad or angry.
•
Being contemptuous, showing no respect for how the child feels
. Such
parents are typically disapproving, harsh in both their criticisms and
their punishments. They might, for instance, forbid any display of the
child’s anger at all, and become punitive at the least sign of
irritability. These are the parents who angrily yell at a child who is
trying to tell his side of the story, “Don’t you talk back to me!”
Finally, there are parents who seize the opportunity of a child’s | emotional_intelligence.pdf |
4a69add2d053-1 | Finally, there are parents who seize the opportunity of a child’s
upset to act as what amounts to an emotional coach or mentor. They
take their child’s feelings seriously enough to try to understand
exactly what is upsetting them (“Are you angry because Tommy hurt
your feelings?”) and to help the child find positive ways to soothe
their feelings (“Instead of hitting him, why don’t you find a toy to
play with on your own until you feel like playing with him again?”).
In order for parents to be effective coaches in this way, they must
have a fairly good grasp of the rudiments of emotional intelligence
themselves. One of the basic emotional lessons for a child, for
example, is how to distinguish among feelings; a father who is too
tuned out of, say, his own sadness cannot help his son understand the
difference between grieving over a loss, feeling sad in a sad movie,
and the sadness that arises when something bad happens to someone
the child cares about. Beyond this distinction, there are more
sophisticated insights, such as that anger is so often prompted by first
feeling hurt.
As children grow the specific emotional lessons they are ready for— | emotional_intelligence.pdf |
4a69add2d053-2 | As children grow the specific emotional lessons they are ready for—
and in need of—shift. As we saw in
Chapter 7
the lessons in empathy
begin in infancy, with parents who attune to their baby’s feelings.
Though some emotional skills are honed with friends through the
years, emotionally adept parents can do much to help their children | emotional_intelligence.pdf |
eb293266aaae-0 | with each of the basics of emotional intelligence: learning how to
recognize, manage, and harness their feelings; empathizing; and
handling the feelings that arise in their relationships.
The impact on children of such parenting is extraordinarily
sweeping.
3
The University of Washington team found that when
parents are emotionally
adept, compared to those who handle feelings
poorly, their children—understandably—get along better with, show
more affection toward, and have less tension around their parents. But
beyond that, these children also are better at handling their own
emotions, are more effective at soothing themselves when upset, and
get upset less often. The children are also more relaxed
biologically
,
with lower levels of stress hormones and other physiological
indicators of emotional arousal (a pattern that, if sustained through
life, might well augur better physical health, as we saw in
Chapter
11
). Other advantages are social: these children are more popular
with and are better-liked by their peers, and are seen by their teachers
as more socially skilled. Their parents and teachers alike rate these
children as having fewer behavioral problems such as rudeness or | emotional_intelligence.pdf |
eb293266aaae-1 | children as having fewer behavioral problems such as rudeness or
aggressiveness. Finally, the benefits are cognitive; these children can
pay attention better, and so are more effective learners. Holding IQ
constant, the five-year-olds whose parents were good coaches had
higher achievement scores in math and reading when they reached
third grade (a powerful argument for teaching emotional skills to help
prepare children for learning as well as life). Thus the payoff for
children whose parents are emotionally adept is a surprising—almost
astounding—range of advantages across, and beyond, the spectrum of
emotional intelligence.
HEART START
The impact of parenting on emotional competence starts in the cradle.
Dr. T. Berry Brazelton, the eminent Harvard pediatrician, has a simple
diagnostic test of a baby’s basic outlook toward life. He offers two
blocks to an eight-month-old, and then shows the baby how he wants
her to put the two blocks together. A baby who is hopeful about life,
who has confidence in her own abilities, says Brazelton,
will pick up one block, mouth it, rub it in her hair, drop it over the side of the table,
watching to see whether you will retrieve it for her. When you do, she finally | emotional_intelligence.pdf |
5dd30bf7ea42-0 | completes the requested task—place the two blocks together. Then she looks up at you
with a bright-eyed look of expectancy that says, “Tell me how great I am!”
4
Babies like these have gotten a goodly dose of approval and
encouragement from the adults in their lives; they expect to succeed
in life’s little challenges. By contrast, babies who come from homes
too bleak, chaotic, or
neglectful go about the same small task in a way
that signals they already expect to fail. It is not that these babies fail
to bring the blocks together; they understand the instruction and have
the coordination to comply. But even when they do, reports Brazelton,
their demeanor is “hangdog,” a look that says, “I’m no good. See, I’ve
failed.” Such children are likely to go through life with a defeatist
outlook, expecting no encouragement or interest from teachers,
finding school joyless, perhaps eventually dropping out.
The difference between the two outlooks—children who are
confident and optimistic versus those who expect to fail—starts to
take shape in the first few years of life. Parents, says Brazelton, “need
to understand how their actions can help generate the confidence, the | emotional_intelligence.pdf |
5dd30bf7ea42-1 | to understand how their actions can help generate the confidence, the
curiosity, the pleasure in learning and the understanding of limits”
that help children succeed in life. His advice is informed by a growing
body of evidence showing that success in school depends to a
surprising extent on emotional characteristics formed in the years
before a child enters school. As we saw in
Chapter 6
, for example, the
ability of four-year-olds to control the impulse to grab for a
marshmallow predicted a 210-point advantage in their SAT scores
fourteen years later.
The first opportunity for shaping the ingredients of emotional
intelligence is in the earliest years, though these capacities continue to
form throughout the school years. The emotional abilities children
acquire in later life build on those of the earliest years. And these
abilities, as we saw in
Chapter 6
, are the essential foundation for all
learning. A report from the National Center for Clinical Infant
Programs makes the point that school success is not predicted by a
child’s fund of facts or a precocious ability to read so much as by
emotional and social measures: being self-assured and interested;
knowing what kind of behavior is expected and how to rein in the
impulse to misbehave; being able to wait, to follow directions, and to | emotional_intelligence.pdf |
5dd30bf7ea42-2 | turn to teachers for help; and expressing needs while getting along
with other children.
5
Almost all students who do poorly in school, says the report, lack | emotional_intelligence.pdf |
e58d54c7e5cc-0 | one or more of these elements of emotional intelligence (regardless of
whether they also have cognitive difficulties such as learning
disabilities). The magnitude of the problem is not minor; in some
states close to one in five children have to repeat first grade, and then
as the years go on fall further behind their peers, becoming
increasingly discouraged, resentful, and disruptive.
A child’s readiness for school depends on the most basic of all
knowledge,
how
to learn. The report lists the seven key ingredients of
this crucial capacity—all related to emotional intelligence:
6
1.
Confidence
. A sense of control and mastery of one’s body,
behavior, and world; the child’s sense that he is more likely than not
to succeed at what he undertakes, and that adults will be helpful.
2.
Curiosity
. The sense that finding out about things is positive and
leads to pleasure.
3.
Intentionality
. The wish and capacity to have an impact, and to
act upon that with persistence. This is related to a sense of
competence, of being effective.
4.
Self-control
. The ability to modulate and control one’s own
actions in age-appropriate ways; a sense of inner control.
5.
Relatedness
. The ability to engage with others based on the sense | emotional_intelligence.pdf |
e58d54c7e5cc-1 | Relatedness
. The ability to engage with others based on the sense
of being understood by and understanding others.
6.
Capacity to communicate
. The wish and ability to verbally
exchange ideas, feelings, and concepts with others. This is related to a
sense of trust in others and of pleasure in engaging with others,
including adults.
7.
Cooperativeness
. The ability to balance one’s own needs with
those of others in group activity.
Whether or not a child arrives at school on the first day of
kindergarten with these capabilities depends greatly on how much her
parents—and preschool teachers—have given her the kind of care that
amounts to a “Heart Start,” the emotional equivalent of the Head Start
programs.
GETTING THE EMOTIONAL BASICS
Say a two-month-old baby wakes up at 3
A.M
. and starts crying. Her
mother comes in and, for the next half hour, the baby contentedly | emotional_intelligence.pdf |
b15b9709a752-0 | nurses in her mother’s arms while her mother gazes at her
affectionately, telling her that she’s happy to see her, even in the
middle of the night. The baby, content in her mother’s love, drifts
back to sleep.
Now say another two-month-old baby, who also awoke crying in
the wee hours, is met instead by a mother who is tense and irritable,
having fallen asleep just an hour before after a fight with her
husband. The baby starts to tense up the moment his mother abruptly
picks him up, telling him, “Just be quiet—I can’t stand one more
thing! Come on, let’s get it over with.” As the baby nurses his mother
stares stonily ahead, not looking at him, reviewing her fight with his
father, getting more agitated herself as she mulls it over. The baby,
sensing her tension, squirms, stiffens, and stops nursing. “That’s all
you
want?” his mother says. “Then don’t eat.” With the same
abruptness she puts him back in his crib and stalks out, letting him
cry until he falls back to sleep, exhausted.
The two scenarios are presented by the report from the National | emotional_intelligence.pdf |
b15b9709a752-1 | The two scenarios are presented by the report from the National
Center for Clinical Infant Programs as examples of the kinds of
interaction that, if repeated over and over, instill very different
feelings in a toddler about himself and his closest relationships.
7
The
first baby is learning that people can be trusted to notice her needs
and counted on to help, and that she can be effective in getting help;
the second is finding that no one really cares, that people can’t be
counted on, and that his efforts to get solace will meet with failure. Of
course, most babies get at least a taste of both kinds of interaction.
But to the degree that one or the other is typical of how parents treat
a child over the years, basic emotional lessons will be imparted about
how secure a child is in the world, how effective he feels, and how
dependable others are. Erik Erikson put it in terms of whether a child
comes to feel a “basic trust” or a basic mistrust.
Such emotional learning begins in life’s earliest moments, and
continues throughout childhood. All the small exchanges between
parent and child have an emotional subtext, and in the repetition of
these messages over the years children form the core of their | emotional_intelligence.pdf |
b15b9709a752-2 | these messages over the years children form the core of their
emotional outlook and capabilities. A little girl who finds a puzzle
frustrating and asks her busy mother to help gets one message if the
reply is the mother’s clear pleasure at the request, and quite another if
it’s a curt “Don’t bother me—I’ve got important work to do.” When
such encounters become typical of child and parent, they mold the
child’s emotional expectations about relationships, outlooks that will | emotional_intelligence.pdf |
7ef56290d267-0 | flavor her functioning in all realms of life, for better or worse.
The risks are greatest for those children whose parents are grossly
inept—immature, abusing drugs, depressed or chronically angry, or
simply aimless and living chaotic lives. Such parents are far less likely
to give adequate care, let alone attune to their toddler’s emotional
needs. Simple neglect, studies find, can be more damaging than
outright abuse.
8
A survey of maltreated children found the neglected
youngsters doing the worst of all: they were the most anxious,
inattentive, and apathetic, alternately aggressive and withdrawn. The
rate for having to repeat first grade among them was 65 percent.
The first three or four years of life are a period when the toddler’s
brain grows to about two thirds its full size, and evolves in complexity
at a greater rate than it ever will again. During this period key kinds
of learning take place more readily than later in life—emotional
learning foremost among them.
During this time severe stress can
impair the brain’s learning centers (and so be damaging to the
intellect). Though as we shall see, this can be remedied to some extent | emotional_intelligence.pdf |
7ef56290d267-1 | by experiences later in life, the impact of this early learning is
profound. As one report sums up the key emotional lesson of life’s
first four years, the lasting consequences are great:
A child who cannot focus his attention, who is suspicious rather than trusting, sad or
angry rather than optimistic, destructive rather than respectful and one who is
overcome with anxiety, preoccupied with frightening fantasy and feels generally
unhappy about himself—such a child has little opportunity at all, let alone equal
opportunity, to claim the possibilities of the world as his own.
9
HOW TO RAISE A BULLY
Much can be learned about the lifelong effects of emotionally inept
parenting—particularly its role in making children aggressive—from
longitudinal studies such as one of 870 children from upstate New
York who were followed from the time they were eight until they
were thirty.
10
The most belligerent among the children—those
quickest to start fights and who habitually used force to get their way
—were the most likely to have dropped out of school and, by age
thirty, to have a record for crimes of violence. They also seemed to be
handing down their propensity to violence: their children were, in | emotional_intelligence.pdf |
7ef56290d267-2 | grade school, just like the troublemakers their delinquent parent had | emotional_intelligence.pdf |
e012b6ea3f5a-0 | been.
There is a lesson in how aggressiveness is passed from generation to
generation. Any inherited propensities aside, the troublemakers as
grownups acted in a way that made family life a school for aggression.
As children, the troublemakers had parents who disciplined them with
arbitrary, relentless severity; as parents they repeated the pattern.
This was true whether it had been the father or the mother who had
been identified in childhood as highly aggressive. Aggressive little
girls grew up to be just as arbitrary and harshly punitive when they
became mothers as the aggressive boys were as fathers. And while
they punished their children with special severity, they otherwise took
little interest in their children’s lives, in effect ignoring them much of
the time. At the same time the parents offered these children a vivid—
and violent—example of aggressiveness, a model the children took
with them to school and to the playground, and followed throughout
life. The parents were not necessarily mean-spirited, nor did they fail
to wish the best
for their children; rather, they seemed to be simply
repeating the style of parenting that had been modeled for them by
their own parents.
In this model for violence, these children were disciplined | emotional_intelligence.pdf |
e012b6ea3f5a-1 | In this model for violence, these children were disciplined
capriciously: if their parents were in a bad mood, they would be
severely punished; if their parents were in a good mood, they could
get away with mayhem at home. Thus punishment came not so much
because of what the child had done, but by virtue of how the parent
felt. This is a recipe for feelings of worthlessness and helplessness, and
for the sense that threats are everywhere and may strike at any time.
Seen in light of the home life that spawns it, such children’s
combative and defiant posture toward the world at large makes a
certain sense, unfortunate though it remains. What is disheartening is
how early these dispiriting lessons can be learned, and how grim the
costs for a child’s emotional life can be.
ABUSE: THE EXTINCTION OF EMPATHY
In the rough-and-tumble play of the day-care center, Martin, just two and a half,
brushed up against a little girl, who, inexplicably, broke out crying. Martin reached for
her hand, but as the sobbing girl moved away, Martin slapped her on the arm.
As her tears continued Martin looked away and yelled, “Cut it out!
Cut it out!”
over | emotional_intelligence.pdf |
e012b6ea3f5a-2 | Cut it out!”
over
and over, each time faster and louder. | emotional_intelligence.pdf |
09b091b19d84-0 | When Martin then made another attempt to pat her, again she resisted. This time
Martin bared his teeth like a snarling dog, hissing at the sobbing girl.
Once more Martin started patting the crying girl, but the pats on the back quickly
turned into pounding, and Martin went on hitting and hitting the poor little girl
despite her screams.
That disturbing encounter testifies to how abuse—being beaten
repeatedly, at the whim of a parent’s moods—warps a child’s natural
bent toward empathy.
11
Martin’s bizarre, almost brutal response to his
playmate’s distress is typical of children like him, who have
themselves been the victims of beatings and other physical abuse
since their infancy. The response stands in stark contrast to toddlers’
usual sympathetic entreaties and attempts to console a crying
playmate, reviewed in
Chapter 7
. Martin’s violent response to distress
at the day-care center may well mirror the lessons he learned at home
about tears and anguish: crying is met at first with a peremptory
consoling gesture, but if it continues, the progression is from nasty
looks and shouts, to
hitting, to outright beating. Perhaps most | emotional_intelligence.pdf |
09b091b19d84-1 | hitting, to outright beating. Perhaps most
troubling, Martin already seems to lack the most primitive sort of
empathy, the instinct to stop aggression against someone who is hurt.
At two and a half he displays the budding moral impulses of a cruel
and sadistic brute.
Martin’s meanness in place of empathy is typical of other children
like him who are already, at their tender age, scarred by severe
physical and emotional abuse at home. Martin was part of a group of
nine such toddlers, ages one to three, witnessed in a two-hour
observation at his day-care center. The abused toddlers were
compared with nine others at the day-care center from equally
impoverished, high-stress homes, but who were not physically abused.
The differences in how the two groups of toddlers reacted when
another child was hurt or upset were stark. Of twenty-three such
incidents, five of the nine nonabused toddlers responded to the
distress of a child nearby with concern, sadness, or empathy. But in
the twenty-seven instances where the abused children could have
done so, not one showed the least concern; instead they reacted to a | emotional_intelligence.pdf |
09b091b19d84-2 | crying child with expressions of fear, anger, or, like Martin, a physical
attack.
One abused little girl, for instance, made a ferocious, threatening
face at another who had broken out into tears. One-year-old Thomas,
another of the abused children, froze in terror when he heard a child | emotional_intelligence.pdf |
7e05c6d76841-0 | crying across the room; he sat completely still, his face full of fear,
back stiffly straight, his tension increasing as the crying continued—as
though bracing for an attack himself. And twenty-eight-month-old
Kate, also abused, was almost sadistic: picking on Joey, a smaller
infant, she knocked him to the ground with her feet, and as he lay
there looked tenderly at him and began patting him gently on the
back—only to intensify the pats into hitting him harder and harder,
ignoring his misery. She kept swinging away at him, leaning in to slug
him six or seven times more, until he crawled away.
These children, of course, treat others as they themselves have been
treated. And the callousness of these abused children is simply a more
extreme version of that seen in children whose parents are critical,
threatening, and harsh in their punishments. Such children also tend
to lack concern when playmates get hurt or cry; they seem to
represent one end of a continuum of coldness that peaks with the
brutality of the abused children. As they go on through life, they are,
as a group, more likely to have cognitive difficulties in learning, more | emotional_intelligence.pdf |
7e05c6d76841-1 | likely to be aggressive and unpopular with their peers (small wonder,
if their preschool toughness is a harbinger of the future), more prone
to depression, and, as adults, more likely to get into trouble with the
law and commit more crimes of violence.
12
This failure of empathy is sometimes, if not often, repeated over
generations, with brutal parents having themselves been brutalized by
their own parents in childhood.
13
It stands in dramatic contrast to the
empathy ordinarily displayed by children of parents who are
nurturing, encouraging their toddlers to show concern for others and
to understand how meanness makes other children feel. Lacking such
lessons in empathy, these children seem not to learn it at all.
What is perhaps most troubling about the abused toddlers is how
early they seem to have learned to respond like miniature versions of
their own abusive parents. But given the physical beatings they
received as a sometimes daily diet, the emotional lessons are all too
clear. Remember that it is in moments when passions run high or a
crisis is upon us that the primitive proclivities of the brain’s limbic
centers take on a more dominant role. At such moments the habits the | emotional_intelligence.pdf |
7e05c6d76841-2 | emotional brain has learned over and over will dominate, for better or
worse.
Seeing how the brain itself is shaped by brutality—or by love—
suggests that childhood represents a special window of opportunity
for emotional lessons. These battered children have had an early and | emotional_intelligence.pdf |
6d68a001b1ef-0 | steady diet of trauma. Perhaps the most instructive paradigm for
understanding the emotional learning such abused children have
undergone is in seeing how trauma can leave a lasting imprint on the
brain—and how even these savage imprints can be mended. | emotional_intelligence.pdf |
6420e158dfd7-0 | 13
Trauma and Emotional Relearning
Som Chit, a Cambodian refugee, balked when her three sons asked her
to buy them toy AK-47 machine guns. Her sons—ages six, nine, and
eleven—wanted the toy guns to play the game some of the kids at
their school called Purdy. In the game, Purdy, the villain, uses a
submachine gun to massacre a group of children, then turns it on
himself. Sometimes, though, the children have it end differently: it is
they who kill Purdy.
Purdy was the macabre reenactment by some of the survivors of the
catastrophic events of February 17, 1989, at Cleveland Elementary
School in Stockton, California. There, during the school’s late-morning
recess for first, second, and third graders, Patrick Purdy—who had
himself attended those grades at Cleveland Elementary some twenty
years earlier—stood at the playground’s edge and fired wave after
wave of 7.22 mm bullets at the hundreds of children at play. For
seven minutes Purdy sprayed bullets toward the playground, then put
a pistol to his head and shot himself. When the police arrived they
found five children dying, twenty-nine wounded.
In ensuing months, the Purdy game spontaneously appeared in the | emotional_intelligence.pdf |
6420e158dfd7-1 | In ensuing months, the Purdy game spontaneously appeared in the
play of boys and girls at Cleveland Elementary, one of many signs that
those seven minutes and their aftermath were seared into the
children’s memory. When I visited the school, just a short bike ride
from the neighborhood near the University of the Pacific where I
myself had grown up, it was five months after Purdy had turned that
recess into a nightmare. His presence was still palpable, even though
the most horrific of the grisly remnants of the shooting—swarms of
bullet holes, pools of blood, bits of flesh, skin, and scalp—were gone
by the morning after the shooting, washed away and painted over.
By then the deepest scars at Cleveland Elementary were not to the
building but to the psyches of the children and staff there, who were
trying to carry on with life as usual.
1
Perhaps most striking was how
the memory of those few minutes was revived again and again by any
small detail that was similar in the least. A teacher told me, for | emotional_intelligence.pdf |
4d0c1c7617e0-0 | example, that a wave of fright swept through the school with the
announcement that St. Patrick’s Day was coming; a number of the
children somehow got the idea that the day was to honor the killer,
Patrick Purdy.
“Whenever we hear an ambulance on its way to the rest home down
the street, everything halts,” another teacher told me. “The kids all
listen to see if it will stop here or go on.” For several weeks many
children were terrified of the mirrors in the restrooms; a rumor swept
the school that “Bloody Virgin Mary,” some kind of fantasied monster,
lurked there. Weeks after the shooting a frantic girl came running up
to the school’s principal, Pat Busher, yelling, “I hear shots! I hear
shots!” The sound was from the swinging chain on a tetherball pole.
Many children became hypervigilant, as though continually on
guard against a repetition of the terror; some boys and girls would
hover at recess next to the classroom doors, not daring to venture out
to the playground where the killings had occurred. Others would only
play in small groups, posting a designated child as lookout. Many
continued for months to avoid the “evil” areas, where children had
died. | emotional_intelligence.pdf |
4d0c1c7617e0-1 | died.
The memories lived on, too, as disturbing dreams, intruding into
the children’s unguarded minds as they slept. Apart from nightmares
repeating the shooting itself in some way, children were flooded with
anxiety dreams that left them apprehensive that they too would die
soon. Some children tried to sleep with their eyes open so they
wouldn’t dream.
All of these reactions are well known to psychiatrists as among the
key symptoms of post-traumatic stress disorder, or PTSD. At the core
of such trauma, says Dr. Spencer Eth, a child psychiatrist who
specializes in PTSD in children, is “the intrusive memory of the
central violent action: the final blow with a fist, the plunge of a knife,
the blast of a shotgun. The memories are intense perceptual
experiences—the sight, sound, and smell of gunfire; the screams or
sudden silence of the victim; the splash of blood; the police sirens.”
These vivid, terrifying moments, neuroscientists now say, become
memories emblazoned in the emotional circuitry. The symptoms are,
in effect, signs of an overaroused amygdala impelling the vivid
memories of a traumatic moment to continue to intrude on awareness. | emotional_intelligence.pdf |
4d0c1c7617e0-2 | As such, the traumatic memories
become mental hair triggers, ready
to sound an alarm at the least hint that the dread moment is about to
happen once again. This hair-trigger phenomenon is a hallmark of | emotional_intelligence.pdf |
86d0bf560d46-0 | emotional trauma of all kinds, including suffering repeated physical
abuse in childhood.
Any traumatizing event can implant such trigger memories in the
amygdala: a fire or an auto accident, being in a natural catastrophe
such as an earthquake or a hurricane, being raped or mugged.
Hundreds of thousands of people each year endure such disasters, and
many or most come away with the kind of emotional wounding that
leaves its imprint on the brain.
Violent acts are more pernicious than natural catastrophes such as a
hurricane because, unlike victims of a natural disaster, victims of
violence feel themselves to have been intentionally selected as the
target of malevolence. That fact shatters assumptions about the
trustworthiness of people and the safety of the interpersonal world, an
assumption natural catastrophes leave untouched. Within an instant,
the social world becomes a dangerous place, one in which people are
potential threats to your safety.
Human cruelties stamp their victims’ memories with a template that
regards with fear anything vaguely similar to the assault itself. A man
who was struck on the back of his head, never seeing his attacker, was
so frightened afterward that he would try to walk down the street | emotional_intelligence.pdf |
86d0bf560d46-1 | directly in front of an old lady to feel safe from being hit on the head
again.
2
A woman who was mugged by a man who got on an elevator
with her and forced her out at knifepoint to an unoccupied floor was
fearful for weeks of going into not just elevators, but also the subway
or any other enclosed space where she might feel trapped; she ran
from her bank when she saw a man put his hand in his jacket as the
mugger had done.
The imprint of horror in memory—and the resulting hypervigilance
—can last a lifetime, as a study of Holocaust survivors found. Close to
fifty years after they had endured semistarvation, the slaughter of
their loved ones, and constant terror in Nazi death camps, the
haunting memories were still alive. A third said they felt generally
fearful. Nearly three quarters said they still became anxious at
reminders of the Nazi persecution, such as the sight of a uniform, a
knock at the door, dogs barking, or smoke rising from a chimney.
About 60 percent said they thought about the Holocaust almost daily,
even after a half century; of those with active symptoms, as many as | emotional_intelligence.pdf |
86d0bf560d46-2 | eight in ten still suffered from repeated nightmares. As one survivor
said, “If you’ve been through Auschwitz and you don’t have
nightmares, then you’re not normal.” | emotional_intelligence.pdf |
03523a91fa88-0 | HORROR FROZEN IN MEMORY
The words of a forty-eight-year-old Vietnam vet, some twenty-four
years after enduring a horrifying moment in a faraway land:
I can’t get the memories out of my mind! The images come flooding back in vivid
detail, triggered by the most inconsequential things, like a door slamming, the sight of
an Oriental woman, the touch of a bamboo mat, or the smell of stir-fried pork. Last
night I went to bed, was having a good sleep for a change. Then in the early morning a
storm front passed through and there was a bolt of crackling thunder. I awoke
instantly, frozen in fear. I am right back in Vietnam, in the middle of the monsoon
season at my guard post. I am sure I’ll get hit in the next volley and convinced I will
die. My hands are freezing, yet sweat pours from my entire body. I feel each hair on
the back of my neck standing on end. I can’t catch my breath and my heart is
pounding. I smell a damp sulfur smell. Suddenly I see what’s left of my buddy
Troy … on a bamboo platter, sent back to our camp by the Vietcong.… The next bolt | emotional_intelligence.pdf |
03523a91fa88-1 | of lightning and clap of thunder makes me jump so much that I fall to the floor.
3
This horrible memory, vividly fresh and detailed though more than
two decades old, still holds the power to induce the same fear in this
ex-soldier that he felt on that fateful day. PTSD represents a perilous
lowering of the neural setpoint for alarm, leaving the person to react
to life’s ordinary moments as though they were emergencies. The
hijacking circuit discussed in
Chapter 2
seems critical in leaving such
a powerful brand on memory: the more brutal, shocking, and
horrendous the events that trigger the amygdala hijacking, the more
indelible the memory. The neural basis for these memories appears to
be a sweeping alteration in the chemistry of the brain set in motion by
a single instance of overwhelming terror.
4
While the PTSD findings
are typically based on the impact of a single episode, similar results
can come from cruelties inflicted over a period of years, as is the case
with children who are sexually, physically, or emotionally abused.
The most detailed work on these brain changes is being done at the
National Center for Post-Traumatic Stress Disorder, a network of | emotional_intelligence.pdf |
03523a91fa88-2 | research sites based at Veterans’ Administration hospitals where there
are large pools of those who suffer from PTSD among the veterans of
Vietnam and other wars. It is from studies on vets such as these that
most of our knowledge of PTSD has come. But these insights apply as
well to children who have suffered severe emotional trauma, such as
those at Cleveland Elementary. | emotional_intelligence.pdf |
bfc2dacba938-0 | “Victims of a devastating trauma may never be the same
biologically,” Dr. Dennis Charney told me.
5
A Yale psychiatrist,
Charney is director of clinical neuroscience at the National Center. “It
does not matter if it was the incessant terror of combat, torture, or
repeated abuse in childhood, or a one-time experience, like being
trapped in a hurricane or nearly dying in an auto accident. All
uncontrollable stress can have the same biological impact.”
The operative word is
uncontrollable
. If people feel there is
something they can do in a catastrophic situation, some control they
can exert, no matter how minor, they fare far better emotionally than
do those who feel utterly helpless. The element of helplessness is what
makes a given event
subjectively
overwhelming. As Dr. John Krystal,
director of the center’s Laboratory of Clinical Psychopharmacology,
told me, “Say someone being attacked with a knife knows how to
defend himself and takes action, while another person in the same
predicament thinks, ‘I’m dead.’ The helpless person is the one more
susceptible to PTSD afterward. It’s the feeling that your life is in
danger | emotional_intelligence.pdf |
bfc2dacba938-1 | danger
and there’s nothing you can do to escape it
—that’s the moment
the brain change begins.”
Helplessness as the wild card in triggering PTSD has been shown in
dozens of studies on pairs of laboratory rats, each in a different cage,
each being given mild—but, to a rat, very stressful—electric shocks of
identical severity. Only one rat has a lever in its cage; when the rat
pushes the lever, the shock stops for both cages. Over days and weeks,
both rats get precisely the same amount of shock. But the rat with the
power to turn the shocks off comes through without lasting signs of
stress. It is only in the helpless one of the pair that the stress-induced
brain changes occur.
6
For a child being shot at on a playground,
seeing his playmates bleeding and dying—or for a teacher there,
unable to stop the carnage—that helplessness must have been
palpable.
PTSD AS A
LIMBIC DISORDER
It had been months since a huge earthquake shook her out of bed and
sent her yelling in panic through the darkened house to find her four-
year-old son. They huddled for hours in the Los Angeles night cold | emotional_intelligence.pdf |
bfc2dacba938-2 | under a protective doorway, pinned there without food, water, or
light while wave after wave of aftershocks tumbled the ground | emotional_intelligence.pdf |
aa55c011283c-0 | beneath them. Now, months later, she had largely recovered from the
ready panic that gripped her for the first few days afterward, when a
door slamming could start her shivering with fear. The one
lingering
symptom was her inability to sleep, a problem that struck only on
those nights her husband was away—as he had been the night of the
quake.
The main symptoms of such learned fearfulness—including the most
intense kind, PTSD—can be accounted for by changes in the limbic
circuitry focusing on the amygdala.
7
Some of the key changes are in
the locus ceruleus, a structure that regulates the brain’s secretion of
two substances called
catecholamines:
adrenaline and noradrenaline.
These neurochemicals mobilize the body for an emergency; the same
catecholamine surge stamps memories with special strength. In PTSD
this system becomes hyperreactive, secreting extra-large doses of
these brain chemicals in response to situations that hold little or no
threat but somehow are reminders of the original trauma, like the
children at Cleveland Elementary School who panicked when they
heard an ambulance siren similar to those they had heard at their
school after the shooting. | emotional_intelligence.pdf |
aa55c011283c-1 | school after the shooting.
The locus ceruleus and the amygdala are closely linked, along with
other limbic structures such as the hippocampus and hypothalamus;
the circuitry for the catecholamines extends into the cortex. Changes
in these circuits are thought to underlie PTSD symptoms, which
include anxiety, fear, hypervigilance, being easily upset and aroused,
readiness for fight or flight, and the indelible encoding of intense
emotional memories.
8
Vietnam vets with PTSD, one study found, had
40 percent fewer catecholamine-stopping receptors than did men
without the symptoms—suggesting that their brains had undergone a
lasting change, with their catecholamine secretion poorly controlled.
9
Other changes occur in the circuit linking the limbic brain with the
pituitary gland, which regulates release of CRF, the main stress
hormone the body secretes to mobilize the emergency fight-or-flight
response. The changes lead this hormone to be oversecreted—
particularly in the amygdala, hippocampus, and locus ceruleus—
alerting the body for an emergency that is not there in reality.
10
As Dr. Charles Nemeroff, a Duke University psychiatrist, told me, | emotional_intelligence.pdf |
aa55c011283c-2 | “Too much CRF makes you overreact. For example, if you’re a
Vietnam vet with PTSD and a car backfires at the mall parking lot, it
is the triggering of CRF that floods you with the same feelings as in
the original trauma: you start sweating, you’re scared, you have chills | emotional_intelligence.pdf |
090908d6719c-0 | and the shakes, you may have flashbacks. In people who hypersecrete
CRF, the startle response is overactive. For example, if you sneak up
behind most people and suddenly clap your hands, you’ll see a
startled jump the first time, but not by the third or fourth repetition.
But people with too much CRF don’t habituate: they’ll respond as
much to the fourth clap as to the first.”
11
A third set of changes occurs in the brain’s opioid system, which
secretes endorphins to blunt the feeling of pain. It also becomes
hyperactive. This neural circuit again involves the amygdala, this time
in concert with a region in the cerebral cortex. The opioids are brain
chemicals that are powerful numbing agents, like opium and other
narcotics that are chemical cousins. When experiencing high levels of
opioids (“the brain’s own morphine”), people have a heightened
tolerance for pain—an effect that has been noted by battlefield
surgeons, who found severely wounded soldiers needed lower doses of
narcotics to handle their pain than did civilians with far less serious
injuries.
Something similar seems to occur in PTSD.
12
Endorphin changes | emotional_intelligence.pdf |
090908d6719c-1 | 12
Endorphin changes
add a new dimension to the neural mix triggered by reexposure to
trauma: a
numbing
of certain feelings. This appears to explain a set of
“negative” psychological symptoms long noted in PTSD: anhedonia
(the inability to feel pleasure) and a general emotional numbness, a
sense of being cut off from life or from concern about others’ feelings.
Those close to such people may experience this indifference as a lack
of empathy. Another possible effect may be dissociation, including the
inability to remember crucial minutes, hours, or even days of the
traumatic event.
The neural changes of PTSD also seem to make a person more
susceptible to further traumatizing. A number of studies with animals
have found that when they were exposed even to
mild
stress when
young, they were far more vulnerable than unstressed animals to
trauma-induced brain changes later in life (suggesting the urgent need
to treat children with PTSD). This seems a reason that, exposed to the
same catastrophe, one person goes on to develop PTSD and another
does not: the amygdala is primed to find danger, and when life
presents it once again with real danger, its alarm rises to a higher
pitch. | emotional_intelligence.pdf |
090908d6719c-2 | pitch.
All these neural changes offer short-term advantages for dealing
with the grim and dire emergencies that prompt them. Under duress,
it is adaptive to be highly vigilant, aroused, ready for anything, | emotional_intelligence.pdf |
b0886a10f587-0 | impervious to pain, the body primed for sustained physical demands,
and—for the moment—indifferent to what might otherwise be
intensely disturbing events. These short-term advantages, however,
become lasting problems when the brain changes so that they become
predispositions, like a car stuck in perpetual high gear. When the
amygdala and its connected brain regions take on a new setpoint
during a moment of intense trauma, this change in excitability—this
heightened readiness to trigger a neural hijacking—means all of life is
on the verge
of becoming an emergency, and even an innocent
moment is susceptible to an explosion of fear run amok.
EMOTIONAL RELEARNING
Such traumatic memories seem to remain as fixtures in brain function
because they interfere with subsequent learning—specifically, with
relearning a more normal response to those traumatizing events. In
acquired fear such as PTSD, the mechanisms of learning and memory
have gone awry; again, it is the amygdala that is key among the brain
regions involved. But in overcoming the learned fear, the neocortex is
critical.
Fear conditioning
is the name psychologists use for the process
whereby something that is not in the least threatening becomes
dreaded as it is associated in someone’s mind with something | emotional_intelligence.pdf |
b0886a10f587-1 | dreaded as it is associated in someone’s mind with something
frightening. When such frights are induced in laboratory animals,
Charney notes, the fears can last for years.
13
The key region of the
brain that learns, retains, and acts on this fearful response is the
circuit between the thalamus, amygdala, and prefrontal lobe—the
pathway of neural hijacking.
Ordinarily, when someone learns to be frightened by something
through fear conditioning, the fear subsides with time. This seems to
happen through a natural relearning, as the feared object is
encountered again in the absence of anything truly scary. Thus a child
who acquires a fear of dogs because of being chased by a snarling
German shepherd gradually and naturally loses that fear if, say, she
moves next door to someone who owns a friendly shepherd, and
spends time playing with the dog.
In PTSD spontaneous relearning fails to occur. Charney proposes
that this may be due to the brain changes of PTSD, which are so
strong that, in effect, the amygdala hijacking occurs every time | emotional_intelligence.pdf |
0236bace67fa-0 | something even vaguely reminiscent of the original trauma comes
along, strengthening the fear pathway. This means that there is never
a time when what is feared is paired with a feeling of calm—the
amygdala never relearns a more mild reaction. “Extinction” of the
fear, he observes, “appears to involve an active learning process,”
which is itself impaired in people with PTSD, “leading to the
abnormal persistence of emotional memories.”
14
But given the right experiences, even PTSD can lift; strong
emotional memories, and the patterns of thought and reaction that
they trigger,
can
change with time. This relearning, Charney proposes,
is cortical. The original
fear ingrained in the amygdala does not go
away completely; rather, the prefrontal cortex actively suppresses the
amygdala’s command to the rest of the brain to respond with fear.
“The question is, how quickly do you let go of learned fear?” asks
Richard Davidson, the University of Wisconsin psychologist who
discovered the role of the left prefrontal cortex as a damper on
distress. In a laboratory experiment in which people first learned an
aversion to a loud noise—a paradigm for learned fear, and a lower- | emotional_intelligence.pdf |
0236bace67fa-1 | key parallel of PTSD—Davidson found that people who had more
activity in the left prefrontal cortex got over the acquired fear more
quickly, again suggesting a cortical role in letting go of learned
distress.
15
REEDUCATING THE EMOTIONAL BRAIN
One of the more encouraging findings about PTSD came from a study
of Holocaust survivors, about three quarters of whom were found to
have active PTSD symptoms even a half century later. The positive
finding was that a quarter of the survivors who once had been
troubled by such symptoms no longer had them; somehow the natural
events of their lives had counteracted the problem. Those who still
had the symptoms showed evidence of the catecholamine-related
brain changes typical of PTSD—but those who had recovered had no
such changes.
16
This finding, and others like it, hold out the promise
that the brain changes in PTSD are not indelible, and that people can
recover from even the most dire emotional imprinting—in short, that
the emotional circuitry can be reeducated. The good news, then, is
that traumas as profound as those causing PTSD can heal, and that the
route to such healing is through relearning. | emotional_intelligence.pdf |
5fbc8a11fb1c-0 | One way this emotional healing seems to occur spontaneously—at
least in children—is through such games as Purdy. These games,
played over and over again, let children relive a trauma safely, as
play. This allows two avenues for healing: on the one hand, the
memory repeats in a context of low anxiety, desensitizing it and
allowing a nontraumatized set of responses to become associated with
it. Another route to healing is that, in their minds, children can
magically give the tragedy another, better outcome: sometimes in
playing Purdy, the children kill him, boosting their sense of mastery
over that traumatic moment of helplessness.
Games like Purdy are predictable in younger children who have
been through such overwhelming violence. These macabre games in
traumatized
children were first noted by Dr. Lenore Terr, a child
psychiatrist in San Francisco.
17
She found such games among children
in Chowchilla, California—just a little over an hour down the Central
Valley from Stockton, where Purdy wreaked such havoc—who in
1973 had been kidnapped as they rode a bus home from a summer
day camp. The kidnappers buried the bus, children and all, in an
ordeal that lasted twenty-seven hours. | emotional_intelligence.pdf |
5fbc8a11fb1c-1 | ordeal that lasted twenty-seven hours.
Five years later Terr found the kidnapping still being reenacted in
the victims’ games. Girls, for example, played symbolic kidnapping
games with their Barbie dolls. One girl, who had hated the feeling of
other children’s urine on her skin as they lay huddled together in
terror, washed her Barbie over and over again. Another played
Traveling Barbie, in which Barbie travels somewhere—it doesn’t
matter where—and returns safely, which is the point of the game. A
third girl’s favorite was a scenario in which the doll is stuck in a hole
and suffocates.
While adults who have been through overwhelming trauma can
suffer a psychic numbing, blocking out memory of or feeling about
the catastrophe, children’s psyches often handle it differently. They
less often become numb to the trauma, Terr believes, because they use
fantasy, play, and daydreams to recall and rethink their ordeals. Such
voluntary replays of trauma seem to head off the need for damming
them up in potent memories that can later burst through as
flashbacks. If the trauma is minor, such as going to the dentist for a | emotional_intelligence.pdf |
5fbc8a11fb1c-2 | filling, just once or twice may be enough. But if it’s overwhelming, a
child needs endless repetitions, replaying the trauma over and over
again in a grim, monotonous ritual.
One way to get at the picture frozen in the amygdala is through art, | emotional_intelligence.pdf |
1fb55b840167-0 | which itself is a medium of the unconscious. The emotional brain is
highly attuned to symbolic meanings and to the mode Freud called
the “primary process”: the messages of metaphor, story, myth, the
arts. This avenue is often used in treating traumatized children.
Sometimes art can open the way for children to talk about a moment
of horror that they would not dare speak of otherwise.
Spencer Eth, the Los Angeles child psychiatrist who specializes in
treating such children, tells of a five-year-old boy who had been
kidnapped with his mother by her ex-lover. The man brought them to
a motel room, where he ordered the boy to hide under a blanket while
he beat the mother to death. The boy was, understandably, reluctant
to talk with Eth about the mayhem he had heard and seen while
underneath the blanket. So Eth asked him to draw a picture—any
picture.
The drawing was of a race-car driver who had a strikingly large pair
of
eyes, Eth recalls. The huge eyes Eth took to refer to the boy’s own
daring in peeking at the killer. Such hidden references to the
traumatic scene almost always appear in the artwork of traumatized | emotional_intelligence.pdf |
1fb55b840167-1 | traumatic scene almost always appear in the artwork of traumatized
children; Eth has made having such children draw a picture the
opening gambit in therapy. The potent memories that preoccupy them
intrude in their art just as in their thoughts. Beyond that, the act of
drawing is itself therapeutic, beginning the process of mastering the
trauma.
EMOTIONAL RELEARNING AND RECOVERY FROM TRAUMA
Irene had gone on a date that ended in attempted rape. Though she had fought off the
attacker, he continued to plague her: harassing her with obscene phone calls, making
threats of violence, calling in the middle of the night, stalking her and watching her
every move. Once, when she tried to get the police to help, they dismissed her problem
as trivial, since “nothing had really happened.” By the time she came for therapy Irene
had symptoms of PTSD, had given up socializing at all, and felt a prisoner in her own
house.
Irene’s case is cited by Dr. Judith Lewis Herman, a Harvard
psychiatrist whose groundbreaking work outlines the steps to recovery
from trauma. Herman sees three stages: attaining a sense of safety,
remembering the details of the trauma and mourning the loss it has | emotional_intelligence.pdf |
1fb55b840167-2 | remembering the details of the trauma and mourning the loss it has
brought, and finally reestablishing a normal life. There is a biological | emotional_intelligence.pdf |
a0f30c856aa5-0 | logic to the ordering of these steps, as we shall see: this sequence
seems to reflect how the emotional brain learns once again that life
need not be regarded as an emergency about to happen.
The first step, regaining a sense of safety, presumably translates to
finding ways to calm the too-fearful, too easily triggered emotional
circuits enough to allow relearning.
18
Often this begins with helping
patients understand that their jumpiness and nightmares,
hypervigilance and panics, are part of the symptoms of PTSD. This
understanding makes the symptoms themselves less frightening.
Another early step is to help patients regain some sense of control
over what is happening to them, a direct unlearning of the lesson of
helplessness that the trauma itself imparted. Irene, for example,
mobilized her friends and family to form a buffer between her and her
stalker, and was able to get the police to intervene.
The sense in which PTSD patients feel “unsafe” goes beyond fears
that
dangers lurk around them; their insecurity begins more
intimately, in the feeling that they have no control over what is
happening in their body and to their emotions. This is understandable,
given the hair trigger for emotional hijacking that PTSD creates by | emotional_intelligence.pdf |
a0f30c856aa5-1 | given the hair trigger for emotional hijacking that PTSD creates by
hypersensitizing the amygdala circuitry.
Medication offers one way to restore patients’ sense that they need
not be so at the mercy of the emotional alarms that flood them with
inexplicable anxiety, keep them sleepless, or pepper their sleep with
nightmares. Pharmacologists are hoping one day to tailor medications
that will target precisely the effects of PTSD on the amygdala and
connected neurotransmitter circuits. For now, though, there are
medications that counter only some of these changes, notably the
antidepressants that act on the serotonin system, and beta-blockers
like propranolol, which block the activation of the sympathetic
nervous system. Patients also may learn relaxation techniques that
give them the ability to counter their edginess and nervousness. A
physiological calm opens a window for helping the brutalized
emotional circuitry rediscover that life is not a threat and for giving
back to patients some of the sense of security they had in their lives
before the trauma happened.
Another step in healing involves retelling and reconstructing the
story of the trauma in the harbor of that safety, allowing the | emotional_intelligence.pdf |
a0f30c856aa5-2 | emotional circuitry to acquire a new, more realistic understanding of
and response to the traumatic memory and its triggers. As patients
retell the horrific details of the trauma, the memory starts to be | emotional_intelligence.pdf |
ee8fdbdf2fb2-0 | transformed, both in its emotional meaning and in its effects on the
emotional brain. The pace of this retelling is delicate; ideally it
mimics the pace that occurs naturally in those people who are able to
recover from trauma without suffering PTSD. In these cases there
often seems to be an inner clock that “doses” people with intrusive
memories that relive the trauma, intercut with weeks or months when
they remember hardly anything of the horrible events.
19
This alternation of reimmersion and respite seems to allow for a
spontaneous review of the trauma and relearning of emotional
response to it. For those whose PTSD is more intractable, says
Herman, retelling their tale can sometimes trigger overwhelming
fears, in which case the therapist should ease the pace to keep the
patient’s reactions within a bearable range, one that will not disrupt
the relearning.
The therapist encourages the patient to retell the traumatic events
as vividly as possible, like a horror home video, retrieving every
sordid detail. This includes not just the specifics of what they saw,
heard, smelled, and felt, but also their reactions—the dread, disgust,
nausea. The goal here is to put the entire memory into words, which | emotional_intelligence.pdf |
Subsets and Splits