New England Public Radio

After September 11th, social scientists really began to focus on the psychological impact of trauma, and the power of resilience. But long before that horrible event, and certainly since, there have been brutal wars, natural disasters, mass shootings, and bombings — not to mention the chronic stress of poverty, illness, or domestic abuse. An emerging field of science is looking at ways trauma of all sorts gets embedded in the body and brain, and who weathers it best. Stay with us for “Life After Stress: The Biology of Trauma and Resilience.”

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Sophie and Jessica are fraternal twins with a soft spot for needy cats. They’re sitting on a couch at their mother’s Eastern Massachusetts’ home, snuggling up to one of their feline adoptees.

Jessica: “All our pets were strays, so they kind had to figure out skills to survive and stuff.”

These quiet teenagers are glad to be talking about their scrappy animals…instead of what my interview is supposed to be about — how they cope with stress and trauma. Their parents have been in an acrimonious custody battle since they were preschoolers, and the girls have spent years in therapy trying to make peace with their estranged father. At the time of our interview, they were going through a court-mandated reconciliation process, which they hated and feared, and uncertain about where they would end up living.

Sophie: “I think about – I call it the dad situation – I think about it a lot. Like every single day. And if i try to push it down for too long, it comes up and I will literally burst into tears wherever i am…and feel so stressed out.”

Sophie has tried to create psychological walls, to compartmentalize the stress so she can live as normally as possible. She rarely succeeds. Her sister Jessica seems to have an easier time with this strategy.

Jessica: “I think i’m probably a little tougher and i don’t really get sad. I go straight to being angry and mad at everyone and not exactly nice, so I don’t really think it’s a good thing, but its kind of like I put up a wall….. so I’m prob a little tougher and a little colder than I should be.”

These girls are remarkably self-aware for young teenagers. They admire each other’s albeit imperfect method for weathering stress and worry. For being resilient. And that’s where their lives intersect with emerging science. Sophie, in particular, is fascinated by how her brain works, and what neuroscientists can learn from it. But she’s also a bit scared of what that might be.

Sophie: “Sometimes I’m afraid that like, I know this is ridiculous, but what if one day i have like really deep psychological issues, and i just, I don’t know – how it’s gonna affect me.”

PART ONE

McLaughlin: “You ready? Here we go, this first round is going to take about nine minutes, and then we’ll check back in with you. Ok?”

Dr. Kate McLaughlin speaks through a microphone – past a glass wall – into Sophie’s headphones.

McLaughlin: “Just remember to stay as still as possible while you’re doing the task, and keep up the great work.”

Sophie looks small and nervous as she lies prone inside an MRI machine at a Harvard Laboratory. For the next hour, she watches a screen with video games and flashing colors and shapes and follows directions on how to respond.

McLaughlin: “Ok, can you show me the button you’re supposed to press if the question mark is in the place you’re supposed to remember… excellent.”

While the test is going on, Sophie’s mother Carla sits in the waiting room. Carla has been taking Sophie to these brain tests for more than a year. They were recruited after Carla brought Sophie and Jessica to the hospital one night, on advice from their pediatrician.

Carla: “Both of them ended up in Children’s Hospital at the psych ER due to suicide threats made to the guidance counselor as well as other therapists.”

The suicidal thoughts were a sign, she felt, that the girls had reached a new level of stress in their embattled relationship with their father. At the same time, researchers at Harvard, including McLaughlin, were looking for subjects for a brain study.

McLaughlin: “The kind of motivating question is understanding how early experience – stress, trauma, neglect – how they impact brain development in ways that might place kids at risk for health problems, particularly mental health problems later.”  

So using the hospital records, McLaughlin’s team sent Carla an email requesting her daughters’ participation in the study. Jessica wasn’t interested, but Sophie was enticed…especially by the $50 the researchers pay every visit. Eventually, she just wanted to come.

Sophie: “I think it really is interesting. I think, the way that, if they can figure out how my brain reacts to stuff, then yeah, i guess i could figure out how to not be stressed or how to calm myself down or something.”

That’s the ultimate goal of researchers in this growing, international field of study – one that revolves around the ways early experience is embedded in the body and brain, the ways nature and nurture intersect. Charles Nelson is a researcher at Harvard’s Center for the Developing Child.

Nelson: “An interest in what happens early and its impact on what happens later has been around for at least 30 or 40 years. But it didn’t say how that actually occurred.”

Nelson has spent years studying the effects of neglect and abuse on orphans in Romania.

Nelson: “So the new literature deals with the biological part. How do these experiences weave — get together under the skin?”

PART TWO

This happens to be a field that I find personally compelling – For one, my husband experienced a number of traumas in childhood, including abuse, neglect, a parent’s alcoholism, and I’ve always wondered how they might explain health problems he’s had in adulthood, including depression and epilepsy. At the same time, my own children have had to cope with their father’s illnesses and my own diagnosis with breast cancer. How can one predict who will be resilient in the face of adversity, and what can we – as parents, as a society – do to improve those odds?

As part of my research into these questions, I met up with Sir Michael Rutter, who works at the Institute of Psychiatry in a suburb of London. He’s considered a pioneer of child psychiatry and the study of resilience.  In a tweed cap and overcoat, Rutter greets me at the train station.

Rutter spearheaded the Isle of Wight study in the 1960s, which followed 2000 boys over several years, and monitored who became delinquent and who didn’t. Early stress and deprivation seemed to play a critical role. He later studied maternal deprivation – how those without close relationships with their mothers fared later in life. He was among the first to look into the interaction between the body and experience.

Rutter: “And I speculated at that time that genetic factors may play a role in susceptibility in the environment.”

Those types of studies have multiplied in the past few decades. One of the most prominent was called the Adverse Childhood Experience – or ACE — study, a joint effort by CDC and Kaiser Permanente from 1998. It found children who’ve been through abuse or extreme stress have higher rates of depression, anxiety and other mental and physical problems. But like many before it, the ACE study didn’t explore what was happening in the brain. Michael Rutter:

Rutter: “The role of neuroscience has certainly been something that was not really on the scene in the beginning,”

Now, a growing arsenal of brain imaging technologies has changed the focus. Harvard’s Charles Nelson says the notion of early brain plasticity is particularly compelling.

Nelson: “By plasticity, we simply mean the brain’s ability to be molded by experience. And we have this expression that plasticity cuts both ways, meaning that it’ it’s good experience, it’s probably good for the brain. But if it’s bad experience, it may be bad for the brain.”

There are many theories on how bad experiences rewire the brain. Some think excessive production of stress hormones – like cortisol and adrenalin – overload the brain and disrupt development. Others suggest it comes down to telomeres – the end parts of chromosomes that can become frayed with age or, it turns out, with stress. Nelson found the kids who grew up neglected in Romanian institutions had less electrical activity in the brain, and smaller brains; they’d lost brain cells as well as the connections between those cells.

Nelson: “So a lot of post-natal brain development relies heavily on experiences occurring during particular points in development. If the experiences don’t occur, the brain doesn’t know how to wire itself.’”

But one of the biggest mysteries that remains is  – why do some people withstand profound early adversity and seem to come out just fine? Could it be their genes, their family upbringing, a fluke of anatomy?

Elliott: “We all know people, you look at what ‘s happened in their lives, you think, how are you so positive?  how are you so resilient?

That’s psychology researcher Rebecca Elliott of the University of Manchester in England who studies the characteristics of resilient people.

Elliott: “Is there something we can identify in their cognitive performance, in their brain function, that marks those individuals out?”

PART THREE

Resilience can be a slippery concept. It’s sometimes defined as bouncing back to a baseline after a traumatic experience. Or being able to

adapt and function well when faced with overwhelming challenges. Some consider resilience a relative term – doing better than expected, given excruciating conditions. But to understand what is expected, scientists want to learn what trauma can do to a typical brain.

McLaughlin: “Hey sophie, how’s it going in there? ‘good’ You’re doing a fantastic job. You’re already a quarter through the task….”

Dr. McLaughlin recruited 60 adolescent subjects for her brain imaging study. Half of them, including Sophie, reported surviving trauma.  The other half was the control group.

McLaughlin: “We’re just getting ready to load up the memory task and we’ll be back with you in just one second.”

McLaughlin expects to find a difference in how the two groups do on cognitive and emotional tasks – and she’ll compare what their brains and nervous systems are doing at the time. Sophie, for instance, took a battery of artificially frustrating tests – while hooked up to neural sensors.

 Sophie: “Like there was this video game that I had to do, and they purposely – when I pressed the right answer, they said it was wrong, and I take my video games very seriously, so I got very very upset and I was like what is going on?!”

While Sophie was getting stressed out, McLaughlin’s research team noted which parts of her brain were more active and how fast or regular her heart rate was. Without divulging Sophie’s particular results, McLaughlin – who is now at the University of Washington — did make some general findings. One —  that the pre-frontal cortex – just behind the forehead — functions differently in children who’ve been traumatized – especially if a task involves both cognitive and emotional components. She has also found heightened activity in the amygdala – an emotional center of the brain — during emotional tasks.

McLaughlin: “They just have stronger emotional reactions in general. They see the same picture as kids who haven’t been exposed to trauma, … and they just have a stronger emotional reaction to it. So kids who are traumatized are maybe just less able in terms of how their brains functions to sort of dampen that initial emotional reactivity.”

PART FOUR

Suomi: “Here are our guys.”

Psychologist Stephen Suomi introduces me to the hairy subjects of his long-running study on trauma and resilience.

Suomi: “These are rhesus monkeys.”

They live on the sprawling, rural Maryland campus of the National Institute of Child and Maternal Health.

Suomi: “These are four year olds, so they’re like teenagers. And they’re about to get fed, which is why everyone’s making so much noise.”

Suomi studies the interplay of genes and the environment. His team observes monkeys in different early experiences – some reared by their mothers, and others taken away from their mothers and reared by other in a nursery.  Over time, the researchers take blood, saliva and hair samples, to determine the monkeys’ genetic make-up and measure how much of the stress hormone, cortisol, builds up in their system. They line up the various environmental and biological factors and stack them up against the monkeys’ personalities as adults.

Suomi: “What we have found is that, early experience is really important, and what happens to you socially in the first couple of years of life if you’re human and first six months of life if you’re monkey will affect just about everything, behaviorally and biologically.”

As he explains this phenomenon, we walk by a few cages of monkeys – and witness one of them become agitated and lash out at another.

Suomi: “It was the start of what could’ve been a fight. But the monkeys —  the well socialized ones – know how to stop fights before they really get out of hand… There are some monkeys who would not back down, and then you get a fight. And those are the monkeys with low seratonin.”

Seratonin is a brain chemical connected to pleasure; the serotonin transporter gene determines how efficiently that chemical is delivered. Each gene has two alleles, and those can be some combination of long or short versions. Suomi and other researchers have suggested that monkeys and humans who have two short alleles show an interesting behavior. They appear to be more sensitive to both bad experiences and good experiences. That means some people are more likely to be psychologically harmed from a stressful environment. But when put in a nurturing environment – those same people are most likely to thrive. Suomi sees this in his monkeys – depending on if they’re raised in a nursery or with their mother.

Suomi: “If you have short version of the gene and you grow up in the nursery you tend to have high levels of aggression when you get older. Monkeys getting into fights and being excessively impulsive. If you have that same short version of the gene but you grow up with a good mother, you see less aggression than normal.”

Lately, Suomi has also been excited by the notion that, while we are all born with a set group of genes, the way they are expressed can be affected by our experiences or environment. For instance, what a mother ate while pregnant. Or how children were treated – or mistreated – early in development. That’s called Epigenetics, and it’s one of the fastest developing areas in biology.

Suomi: “We used to think you inherited genes, you were stuck with them, and then you had to live with the consequences.  And we now know you can change – not the genes – but the way they work.”

This can be both good and bad. Scientists following survivors of the Dutch famine of World War II have attributed some of their later health problems– and those of their descendants – to epigenetic changes from severe hunger. But Suomi says there’s also evidence that genes can change back after trauma. He leads us to a bigger cage of small monkeys who – at first – are terrified of me, and later, move closer and seem cautiously curious. Suomi says his researchers have brought into this group an older monkey couple as sort of foster grandparents meant to give social support.

Suomi: “The old female will provide comfort to those infants who are a bit scared or need cuddling. The old male breaks up fights, keeps the peace. And that’s the kind of manipulation that we’ve already found that changes lots of genes. Or normalizes lots of gene expression.”

Suomi says this concept could also explain why some people who’ve gone through trauma feel a lot better after certain activities.

Things like yoga, things like meditation, things like exercise, even if pp your age and mine, can change the way your brain is wired and can improve your health.

PART FIVE

Like the monkey research, there’s continuing science on how to build resilience in children – before and after traumatic events. Many books and papers have come out in the past decade on factors that give young people strength to cope – chief among them, healthy social connections…something that Sophie and Jessica seem to have intuited on their own.

A few times a week, they come to this neighborhood diner with their good friend Maggie – to eat Greek food, and talk about  life.

Jessica: “We had to write this thing about, who’s a mockingbird and what does the mockingbird represent…”

Today, they’re brainstorming paper topics on the classic book, To Kill a Mockingbird. To hear them chatting, these girls seem well put together and emotionally stable, but in fact, on this day, they’re anxiously waiting for a judge’s order on whether they have to leave their mother’s house to live in a boarding school. The uncertainty has been overwhelming, they say.

Jessica: “It’s very stressful to think about it. And then on top of like schoolwork, because I have like 5 million projects.”

Sophie:  “I can usually put it away during school, but then … i have these awful nightmare stress dreams… and I wake up crying….and I have to call my grandmother or like hug a cat.”

Another thing Sophie does…is lean on Maggie, whom she’s known since kindergarten. Occassionally, Maggie will wake up on a weekend to find Sophie has visited early in the morning, and crawled into her bed for comfort.

Maggie: “She starts crying and I start crying and crying everywhere. And it doesn’t seem fair that they have to go through all this stuff.”

What they may not realize, though, is all this stuff they’re going through – may actually be making them MORE able to cope in the future. One branch of resilience studies looks at the constructive role of mild adversity. Sir Michael Rutter – the child psychiatrist– likes to think about this the same way you’d think about infectious disease.

Rutter: “How do you develop a resilience in relation to infections?  should you be protected from experiencing it?  Well it’s obvious not. It’s exposure – controlled exposure, of course — to infections that provides you with the strength of dealing with new infections, when they come along.”

Rutter says he became fascinated by this theory in the sixties, from research done in rodents by a scientist named Gig Levine.

Rutter: ‘The expectation was you’d expose them to stress and they’d be worse off.  And so he did dreadful, physical things, like putting them in the centrifuge, and to his surprise & everybody else’s surprise, the animals developed an increased size of the neuro endocrine system & an increased resistance to stress.”  

To translate that into humans, Rutter says, it’s possible that suffering some hardship and stress early may inoculate children against really crashing if a worse trauma occurs later in life, because they learn strategies to cope. Rutter himself was separated from his family in London during World War II, and raised by another family for several years in America. When I asked him if that affected his later emotional health, he shrugged it off.

Rutter: “There have been people who have seen it as the goal of removing from children all stresses, challenges, & adversity.  And I think that’s a totally wrong headed notion.”

Carla: “If they make it, and they will, into happy adulthood, they will have coping skills that I didn’t have.”

That’s Sophie and Jessica’s mother, Carla. She describes her own childhood as happy and stable.

 Carla: “So when i hit my first crisis, i didn’t know how to cope with it. and they will.

PART SIX

It’s hard to know where the cut-off is between constructive stress – and so much trauma that it weakens your ability to ward off mental health problems. Kate McLaughlin – the researcher who was testing Sophie’s brain – used her collective data to show that victims of childhood abuse were more likely to develop PTSD after the Boston marathon bombings than those who were not abused. A 2012 Danish study of war veterans showed a higher susceptibility to PTSD among soldiers who reported childhood trauma. An ongoing study at Harvard is looking at the same question, in conjunction with the military, to help predict who will fare best in combat.

Elliott: Most people have a tipping point. 

Rebecca Elliott of the University of Manchester is in the middle of a large study on resilience to depression.

Elliott: And everybody’s tipping point is different & there are some people, who can fall into depression with relatively little in the way of obvious provoking factors.  And there are some people who need quite a strong trigger but will then develop depression.” 

The people whom Elliot is most fascinated by are a third group — those who seem to shrug off the worst kinds of stress.

Elliott: “And they have life histories that will make your hair curl.  I’ve certainly interviewed people and thought, you know, if all that had happened to me, I think I’d be depressed.  And yet they’re not.”

So Elliott and her research team are looking for a biological smoking gun… some sort of physical, chemical, genetic or cognitive difference that can filter out the copers from those who fall apart.

Trotter: ‘I want you to identify the emotion you think each face is displaying…..anger, disgust, fear….’

To give me a sense of the study, Elliott’s colleague, Paula Trotter, put ME through some of their cognitive tests…. starting with one that rates your ability to remember emotionally charged words or recognize facial expressions.

Elliott: “The idea is, someone who is depressed is biased towards picking up negative emotion and away from positive emotion…and we expect to see the reverse in people who are resilient.”

Next, she asked me to move around digital balls to fit into a puzzle. ‘you tap on the ball, it’s circled…’ It’s meant to test problem solving skills – and the ability to be flexible in your thinking – both signs of resilience.

Elliott: “To be honest, actually, you did really well. Clearly, your pre-frontal cortex is working just fine.”

An even more dastardly test – which Elliott didn’t give me – directly manipulates the stress level of subjects. Her team asks people to unscramble five-letter anagrams – but in the middle of the test, they make the puzzles impossible to solve. When they re-introduce easier anagrams, Elliott found that resilient people do better than they did before.

Elliott: “So it seems like the stress in the middle, their response to it is to maybe concentrate harder, to really try harder. so that when they’re back on the soluble ones, they do really well.”

Whereas the less resilient groups seemed to get demoralized and do worse. At the same time, Elliot is careful to point out that reacting to stress per se is not a disorder. If you take that to an extreme, NOT reacting to a bad experience at all could be a sign of psychopathology.

Elliott: “We did wonder whether actually the people that we found who were apparently super resilient might be people with just a relatively limited emotional range.  And therefore not much affects them  …  and that’s not actually what we’ve found.  Most of the people that we’ve interviewed who’ve fallen into our resilient category have been absolutely lovely individuals.”

PART SEVEN – CONCLUSION

So is there a genetic profile or brain structure that makes some apt to cope well with life’s challenges? Is it congenital optimism and intelligence, as some psychologists say? Social supports? Or a combination of many small factors, as research increasingly shows. Harvard professor Charles Nelson.

Nelson: “But at the end of the day you scratch your head and say, So now what do I do with this? All you’ve done is say these are the components of a resilient person.” 

In other words, does understanding the mechanisms of resilience does more than just inform academia….and lead to actual relief? Rebecca Elliott thinks yes.

Elliott: “If we understand what makes someone resilient, potentially we could use that to help us think about better treatments for depression, potentially preventative treatments.  Perhaps there’s a point, much earlier, where we can get involved with people & help them develop resilience, if you like.”

Whether resilience is innate or actually can be developed is up for debate. So is the notion that neuroscience can improve upon existing therapies that help people move past extreme adversity. In fact, research out of Columbia University suggests that natural resilience, without any intervention, is much more common than previously thought. I’ve wondered whether any of the new brain research will help Sophie and Jessica get through their adolescence unscathed, though it’s heartening to see how many resilient traits they seem to already possess. Jessica, for one, recognizes their strength in numbers:

Jessica: “We’re lucky we have each other that we can lean on and we can protect each other.”

Sophie has decided she wants to be a brain-scientist when she grows up — her way of constructing meaning out of the pain she’s gone through, which is another sign of resilience.  But for the most part, these girls have relied on a home-grown trial and error approach to coping – one that Sophie is willing to impart on other young people going through hard experiences.

Sophie: “If they really need to just cry, they should, cuz they need to let it out. But then even if they’re the type of person who likes to be alone, they should surround themselves with the things that they love and the people that they love so they can start to heal, to just try to be as strong as possible even if that’s the hardest thing in the entire world to do sometimes.”

I took that as good advice for my own family – I’ve gone through cancer treatment and, thankfully, don’t seem too worse for the wear. My husband continues to have a hard time, in large part – I believe – because of his childhood trauma. But he’s got good friends and family pulling for him. My own kids don’t tell me much that bothers them – they’re teenagers, after all – so I may have to go on faith that they’re coping with life’s challenges. Without an MRI machine, I’ve got my fingers crossed.

The documentary “Life After Stress” was produced at New England Public Radio by Karen Brown and edited by Sam Hudzik, with production assistance from Cathleen O’Keefe. Support for this project came from the Knight Fellowship in Science Journalism and the Falcon Fund, with help from the International Society for Traumatic Stress Studies. Original music by John Townsend. To read Karen’s companion story, “What Makes A Resilient Mind” on NOVA Next, click here.