["office\timmediately. Apart\tfrom\tthe\thurtfulness\tof\tthe\toncologist\u2019s\tcoldness,\tdid\tit\tmatter medically\tthat\the\twould\tnot\tdeal\twith\this\tpatient\u2019s\tconstant\tsadness? By\t the\t time\t a\t disease\t has\t become\t so\t virulent,\t it\t would\t be\t unlikely that\t any\t emotion\t would\t have\t an\t appreciable\t effect\t on\t its\t progress. While\t the\t woman\u2019s\t depression\t most\t certainly\t dimmed\t the\t quality\t of her\t final\t months,\t the\t medical\t evidence\t that\t melancholy\t might\t affect the\t course\t of\t cancer\t is\t as\t yet\t mixed.29\t But\t cancer\t aside,\t a\t smattering of\t studies\t suggest\t a\t role\t for\t depression\t in\t many\t other\t medical conditions,\t especially\t in\t worsening\t a\t sickness\t once\t it\t has\t begun.\t The evidence\t is\t mounting\t that\t for\t patients\t with\t serious\t disease\t who\t are depressed,\tit\twould\tpay\tmedically\tto\ttreat\ttheir\tdepression\ttoo. One\t complication\t in\t treating\t depression\t in\t medical\t patients\t is\t that its\t symptoms,\t including\t loss\t of\t appetite\t and\t lethargy,\t are\t easily mistaken\t for\t signs\t of\t other\t diseases,\t particularly\t by\t physicians\t with little\t training\t in\t psychiatric\t diagnosis.\t That\t inability\t to\t diagnose depression\t may\t itself\t add\t to\t the\t problem,\t since\t it\t means\t that\t a patient\u2019s\t depression\u2014like\t that\t of\t the\t weepy\t breast-cancer\t patient\u2014 goes\t unnoticed\t and\t untreated.\t And\t that\t failure\t to\t diagnose\t and\t treat may\tadd\tto\tthe\trisk\tof\tdeath\tin\tsevere\tdisease. For\t instance,\t of\t 100\t patients\t who\t received\t bone\t marrow transplants,\t12\tof\tthe\t13\twho\thad\tbeen\tdepressed\tdied\twithin\tthe\tfirst year\t of\t the\t transplant,\t while\t 34\t of\t the\t remaining\t 87\t were\t still\t alive two\t years\t later.30\t And\t in\t patients\t with\t chronic\t kidney\t failure\t who were\t receiving\t dialysis,\t those\t who\t were\t diagnosed\t with\t major depression\t were\t most\t likely\t to\t die\t within\t the\t following\t two\t years; depression\twas\ta\tstronger\tpredictor\tof\tdeath\tthan\tany\tmedical\tsign.31 Here\t the\t route\t connecting\t emotion\t to\t medical\t status\t was\t not biological\t but\t attitudinal:\t The\t depressed\t patients\t were\t much\t worse about\t complying\t with\t their\t medical\t regimens\u2014cheating\t on\t their diets,\tfor\texample,\twhich\tput\tthem\tat\thigher\trisk. Heart\tdisease\ttoo\tseems\tto\tbe\texacerbated\tby\tdepression.\tIn\ta\tstudy of\t2,832\tmiddle-aged\tmen\tand\twomen\ttracked\tfor\ttwelve\tyears,\tthose who\tfelt\ta\tsense\tof\tnagging\tdespair\tand\thopelessness\thad\ta\theightened rate\t of\t death\t from\t heart\t disease.32\t And\t for\t the\t 3\t percent\t or\t so\t who were\t most\t severely\t depressed,\t the\t death\t rate\t from\t heart\t disease, compared\t to\t the\t rate\t for\t those\t with\t no\t feelings\t of\t depression,\t was four\ttimes\tgreater. Depression\tseems\tto\tpose\ta\tparticularly\tgrave\tmedical\trisk\tfor\theart","attack\t survivors.33\t In\t a\t study\t of\t patients\t in\t a\t Montreal\t hospital\t who were\t discharged\t after\t being\t treated\t for\t a\t first\t heart\t attack,\t depressed patients\t had\t a\t sharply\t higher\t risk\t of\t dying\t within\t the\t following\t six months.\t Among\t the\t one\t in\t eight\t patients\t who\t were\t seriously depressed,\t the\t death\t rate\t was\t five\t times\t higher\t than\t for\t others\t with comparable\t disease\u2014an\t effect\t as\t great\t as\t that\t of\t major\t medical\t risks for\t cardiac\t death,\t such\t as\t left\t ventricular\t dysfunction\t or\t a\t history\t of previous\t heart\t attacks.\t Among\t the\t possible\t mechanisms\t that\t might explain\t why\t depression\t so\t greatly\t increases\t the\t odds\t of\t a\t later\t heart attack\t are\t its\t effects\t on\t heart\t rate\t variability,\t increasing\t the\t risk\t of fatal\tarrhythmias. Depression\t has\t also\t been\t found\t to\t complicate\t recovery\t from\t hip fracture.\t In\t a\t study\t of\t elderly\t women\t with\t hip\t fracture,\t several thousand\twere\tgiven\tpsychiatric\tevaluations\ton\ttheir\tadmission\tto\tthe hospital.\t Those\t who\t were\t depressed\t on\t admission\t stayed\t an\t average of\t eight\t days\t longer\t than\t those\t with\t comparable\t injury\t but\t no depression,\t and\t were\t only\t a\t third\t as\t likely\t ever\t to\t walk\t again.\t But depressed\twomen\twho\thad\tpsychiatric\thelp\tfor\ttheir\tdepression\talong with\t other\t medical\t care\t needed\t less\t physical\t therapy\t to\t walk\t again and\t had\t fewer\t rehospitalizations\t over\t the\t three\t months\t after\t their return\thome\tfrom\tthe\thospital. Likewise,\t in\t a\t study\t of\t patients\t whose\t condition\t was\t so\t dire\t that they\twere\tamong\tthe\ttop\t10\tpercent\tof\tthose\tusing\tmedical\tservices\u2014 often\t because\t of\t having\t multiple\t illnesses,\t such\t as\t both\t heart\t disease and\t diabetes\u2014about\t one\t in\t six\t had\t serious\t depression.\t When\t these patients\t were\t treated\t for\t the\t problem,\t the\t number\t of\t days\t per\t year that\t they\t were\t disabled\t dropped\t from\t 79\t to\t 51\t for\t those\t who\t had major\t depression,\t and\t from\t 62\t days\t per\t year\t to\t just\t 18\t in\t those\t who had\tbeen\ttreated\tfor\tmild\tdepression.34 THE\tMEDICAL\tBENEFITS\tOF\tPOSITIVE\tFEELINGS The\t cumulative\t evidence\t for\t adverse\t medical\t effects\t from\t anger, anxiety,\t and\t depression,\t then,\t is\t compelling.\t Both\t anger\t and\t anxiety, when\t chronic,\t can\t make\t people\t more\t susceptible\t to\t a\t range\t of disease.\t And\t while\t depression\t may\t not\t make\t people\t more\t vulnerable to\t becoming\t ill,\t it\t does\t seem\t to\t impede\t medical\t recovery\t and heighten\t the\t risk\t of\t death,\t especially\t with\t more\t frail\t patients\t with severe\tconditions.","But\t if\t chronic\t emotional\t distress\t in\t its\t many\t forms\t is\t toxic,\t the opposite\t range\t of\t emotion\t can\t be\t tonic\u2014to\t a\t degree.\t This\t by\t no means\t says\t that\t positive\t emotion\t is\t curative,\t or\t that\t laughter\t or happiness\t alone\t will\t turn\t the\t course\t of\t a\t serious\t disease.\t The\t edge positive\t emotions\t offer\t seems\t subtle,\t but,\t by\t using\t studies\t with\t large numbers\tof\tpeople,\tcan\tbe\tteased\tout\tof\tthe\tmass\tof\tcomplex\tvariables that\taffect\tthe\tcourse\tof\tdisease. The\tPrice\tof\tPessimism\u2014and\tAdvantages\tof\tOptimism As\t with\t depression,\t there\t are\t medical\t costs\t to\t pessimism\u2014and corresponding\t benefits\t from\t optimism.\t For\t example,\t 122\t men\t who had\ttheir\tfirst\theart\tattack\twere\tevaluated\ton\ttheir\tdegree\tof\toptimism or\t pessimism.\t Eight\t years\t later,\t of\t the\t 25\t most\t pessimistic\t men,\t 21 had\t died;\t of\t the\t 25\t most\t optimistic,\t just\t 6\t had\t died.\t Their\t mental outlook\t proved\t a\t better\t predictor\t of\t survival\t than\t any\t medical\t risk factor,\tincluding\tthe\tamount\tof\tdamage\tto\tthe\theart\tin\tthe\tfirst\tattack, artery\t blockage,\t cholesterol\t level,\t or\t blood\t pressure.\t And\t in\t other research,\t patients\t going\t into\t artery\t bypass\t surgery\t who\t were\t more optimistic\t had\t a\t much\t faster\t recovery\t and\t fewer\t medical complications\t during\t and\t after\t surgery\t than\t did\t more\t pessimistic patients.35 Like\tits\tnear\tcousin\toptimism,\thope\thas\thealing\tpower.\tPeople\twho have\t a\t great\t deal\t of\t hopefulness\t are,\t understandably,\t better\t able\t to bear\t up\t under\t trying\t circumstances,\t including\t medical\t difficulties.\t In a\tstudy\tof\tpeople\tparalyzed\tfrom\tspinal\tinjuries,\tthose\twho\thad\tmore hope\twere\table\tto\tgain\tgreater\tlevels\tof\tphysical\tmobility\tcompared\tto other\tpatients\twith\tsimilar\tdegrees\tof\tinjury,\tbut\twho\tfelt\tless\thopeful. Hope\t is\t especially\t telling\t in\t paralysis\t from\t spinal\t injury,\t since\t this medical\t tragedy\t typically\t involves\t a\t man\t who\t is\t paralyzed\t in\t his twenties\tby\tan\taccident\tand\twill\tremain\tso\tfor\tthe\trest\tof\this\tlife.\tHow he\treacts\temotionally\twill\thave\tbroad\tconsequences\tfor\tthe\tdegree\tto which\t he\t will\t make\t the\t efforts\t that\t might\t bring\t him\t greater\t physical and\tsocial\tfunctioning.36 Just\t why\t an\t optimistic\t or\t pessimistic\t outlook\t should\t have\t health consequences\t is\t open\t to\t any\t of\t several\t explanations.\t One\t theory proposes\t that\t pessimism\t leads\t to\t depression,\t which\t in\t turn\t interferes with\tthe\tresistance\tof\tthe\timmune\tsystem\tto\ttumors\tand\tinfection\u2014an unproven\t speculation\t at\t present.\t Or\t it\t may\t be\t that\t pessimists\t neglect themselves\u2014some\tstudies\thave\tfound\tthat\tpessimists\tsmoke\tand\tdrink","more,\tand\texercise\tless,\tthan\toptimists,\tand\tare\tgenerally\tmuch\tmore careless\tabout\ttheir\thealth\thabits.\tOr\tit\tmay\tone\tday\tturn\tout\tthat\tthe physiology\tof\thopefulness\tis\titself\tsomehow\thelpful\tbiologically\tto\tthe body\u2019s\tfight\tagainst\tdisease. With\ta\tLittle\tHelp\tFrom\tMy\tFriends: The\tMedical\tValue\tof\tRelationships Add\tthe\tsounds\tof\tsilence\tto\tthe\tlist\tof\temotional\trisks\tto\thealth\u2014and close\temotional\tties\tto\tthe\tlist\tof\tprotective\tfactors.\tStudies\tdone\tover two\t decades\t involving\t more\t than\t thirty-seven\t thousand\t people\t show that\tsocial\tisolation\u2014the\tsense\tthat\tyou\thave\tnobody\twith\twhom\tyou can\t share\t your\t private\t feelings\t or\t have\t close\t contact\u2014doubles\t the chances\tof\tsickness\tor\tdeath.37\tIsolation\titself,\ta\t1987\treport\tin\tScience concluded,\t\u201cis\tas\tsignificant\tto\tmortality\trates\tas\tsmoking,\thigh\tblood pressure,\t high\t cholesterol,\t obesity,\t and\t lack\t of\t physical\t exercise.\u201d Indeed,\tsmoking\tincreases\tmortality\trisk\tby\ta\tfactor\tof\tjust\t1.6,\twhile social\t isolation\t does\t so\t by\t a\t factor\t of\t 2.0,\t making\t it\t a\t greater\t health risk.38 Isolation\t is\t harder\t on\t men\t than\t on\t women.\t Isolated\t men\t were\t two to\t three\t times\t more\t likely\t to\t die\t as\t were\t men\t with\t close\t social\t ties; for\tisolated\twomen,\tthe\trisk\twas\tone\tand\ta\thalf\ttimes\tgreater\tthan\tfor more\t socially\t connected\t women.\t The\t difference\t between\t men\t and women\t in\t the\t impact\t of\t isolation\t may\t be\t because\t women\u2019s relationships\t tend\t to\t be\t emotionally\t closer\t than\t men\u2019s;\t a\t few\t strands of\t such\t social\t ties\t for\t a\t woman\t may\t be\t more\t comforting\t than\t the same\tsmall\tnumber\tof\tfriendships\tfor\ta\tman. Of\t course,\t solitude\t is\t not\t the\t same\t as\t isolation;\t many\t people\t who live\ton\ttheir\town\tor\tsee\tfew\tfriends\tare\tcontent\tand\thealthy.\tRather,\tit is\tthe\tsubjective\tsense\tof\tbeing\tcut\toff\tfrom\tpeople\tand\thaving\tno\tone to\t turn\t to\t that\t is\t the\t medical\t risk.\t This\t finding\t is\t ominous\t in\t light\t of the\t increasing\t isolation\t bred\t by\t solitary\t TV-watching\t and\t the\t falling away\t of\t social\t habits\t such\t as\t clubs\t and\t visits\t in\t modern\t urban societies,\t and\t suggests\t an\t added\t value\t to\t self-help\t groups\t such\t as Alcoholics\tAnonymous\tas\tsurrogate\tcommunities. The\t power\t of\t isolation\t as\t a\t mortality\t risk\t factor\u2014and\t the\t healing power\t of\t close\t ties\u2014can\t be\t seen\t in\t the\t study\t of\t one\t hundred\t bone marrow\t transplant\t patients.39\t Among\t patients\t who\t felt\t they\t had strong\t emotional\t support\t from\t their\t spouse,\t family,\t or\t friends,\t 54 percent\t survived\t the\t transplants\t after\t two\t years,\t versus\t just\t 20","percent\t among\t those\t who\t reported\t little\t such\t support.\t Similarly, elderly\tpeople\twho\tsuffer\theart\tattacks,\tbut\thave\ttwo\tor\tmore\tpeople in\t their\t lives\t they\t can\t rely\t on\t for\t emotional\t support,\t are\t more\t than twice\t as\t likely\t to\t survive\t longer\t than\t a\t year\t after\t an\t attack\t than\t are those\tpeople\twith\tno\tsuch\tsupport.40 Perhaps\t the\t most\t telling\t testimony\t to\t the\t healing\t potency\t of emotional\t ties\t is\t a\t Swedish\t study\t published\t in\t 1993.41\t All\t the\t men living\t in\t the\t Swedish\t city\t of\t G\u00f6teborg\t who\t were\t born\t in\t 1933\t were offered\t a\t free\t medical\t exam;\t seven\t years\t later\t the\t 752\t men\t who\t had come\tfor\tthe\texam\twere\tcontacted\tagain.\tOf\tthese,\t41\thad\tdied\tin\tthe intervening\tyears. Men\t who\t had\t originally\t reported\t being\t under\t intense\t emotional stress\t had\t a\t death\t rate\t three\t times\t greater\t than\t those\t who\t said\t their lives\t were\t calm\t and\t placid.\t The\t emotional\t distress\t was\t due\t to\t events such\t as\t serious\t financial\t trouble,\t feeling\t insecure\t at\t work\t or\t being forced\tout\tof\ta\tjob,\tbeing\tthe\tobject\tof\ta\tlegal\taction,\tor\tgoing\tthrough a\tdivorce.\tHaving\thad\tthree\tor\tmore\tof\tthese\ttroubles\twithin\tthe\tyear before\tthe\texam\twas\ta\tstronger\tpredictor\tof\tdying\twithin\tthe\tensuing seven\tyears\tthan\twere\tmedical\tindicators\tsuch\tas\thigh\tblood\tpressure, high\t concentrations\t of\t blood\t triglycerides,\t or\t high\t serum\t cholesterol levels. Yet\tamong\tmen\twho\tsaid\tthey\thad\ta\tdependable\tweb\tof\tintimacy\u2014 a\t wife,\t close\t friends,\t and\t the\t like\u2014there\t was\t no\t relationship\t whatever between\t high\t stress\t levels\t and\t death\t rate.\t Having\t people\t to\t turn\t to and\t talk\t with,\t people\t who\t could\t offer\t solace,\t help,\t and\t suggestions, protected\tthem\tfrom\tthe\tdeadly\timpact\tof\tlife\u2019s\trigors\tand\ttrauma. The\tquality\tof\trelationships\tas\twell\tas\ttheir\tsheer\tnumber\tseems\tkey to\t buffering\t stress.\t Negative\t relationships\t take\t their\t own\t toll.\t Marital arguments,\t for\t example,\t have\t a\t negative\t impact\t on\t the\t immune system.42\t One\t study\t of\t college\t roommates\t found\t that\t the\t more\t they disliked\t each\t other,\t the\t more\t susceptible\t they\t were\t to\t colds\t and\t the flu,\tand\tthe\tmore\tfrequently\tthey\twent\tto\tdoctors.\tJohn\tCacioppo,\tthe Ohio\t State\t University\t psychologist\t who\t did\t the\t roommate\t study,\t told me,\t\u201cIt\u2019s\tthe\tmost\timportant\trelationships\tin\tyour\tlife,\tthe\tpeople\tyou see\t day\t in\t and\t day\t out,\t that\t seem\t to\t be\t crucial\t for\t your\t health.\t And the\t more\t significant\t the\t relationship\t is\t in\t your\t life,\t the\t more\t it matters\tfor\tyour\thealth.\u201d43 The\tHealing\tPower\tof\tEmotional\tSupport","In\t The\t Merry\t Adventures\t of\t Robin\t Hood,\t Robin\t advises\t a\t young follower:\t\u201cTell\tus\tthy\ttroubles\tand\tspeak\tfreely.\tA\tflow\tof\twords\tdoth ever\tease\tthe\theart\tof\tsorrows;\tit\tis\tlike\topening\tthe\twaste\twhere\tthe mill\t dam\t is\t overfull.\u201d\t This\t bit\t of\t folk\t wisdom\t has\t great\t merit; unburdening\t a\t troubled\t heart\t appears\t to\t be\t good\t medicine.\t The scientific\t corroboration\t of\t Robin\u2019s\t advice\t comes\t from\t James Pennebaker,\t a\t Southern\t Methodist\t University\t psychologist,\t who\t has shown\tin\ta\tseries\tof\texperiments\tthat\tgetting\tpeople\tto\ttalk\tabout\tthe thoughts\tthat\ttrouble\tthem\tmost\thas\ta\tbeneficial\tmedical\teffect.44\tHis method\t is\t remarkably\t simple:\t he\t asks\t people\t to\t write,\t for\t fifteen\t to twenty\t minutes\t a\t day\t over\t five\t or\t so\t days,\t about,\t for\t example,\t \u201cthe most\ttraumatic\texperience\tof\tyour\tentire\tlife,\u201d\tor\tsome\tpressing\tworry of\tthe\tmoment.\tWhat\tpeople\twrite\tcan\tbe\tkept\tentirely\tto\tthemselves if\tthey\tlike. The\t net\t effect\t of\t this\t confessional\t is\t striking:\t enhanced\t immune function,\t significant\t drops\t in\t health-center\t visits\t in\t the\t following\t six months,\t fewer\t days\t missed\t from\t work,\t and\t even\t improved\t liver enzyme\t function.\t Moreover,\t those\t whose\t writing\t showed\t most evidence\tof\tturbulent\tfeelings\thad\tthe\tgreatest\timprovements\tin\ttheir immune\t function.\t A\t specific\t pattern\t emerged\t as\t the\t \u201chealthiest\u201d\t way to\t ventilate\t troubling\t feelings:\t at\t first\t expressing\t a\t high\t level\t of sadness,\t anxiety,\t anger\u2014whatever\t troubling\t feelings\t the\t topic brought\t up;\t then,\t over\t the\t course\t of\t the\t next\t several\t days\t weaving\t a narrative,\tfinding\tsome\tmeaning\tin\tthe\ttrauma\tor\ttravail. That\t process,\t of\t course,\t seems\t akin\t to\t what\t happens\t when\t people explore\tsuch\ttroubles\tin\tpsychotherapy.\tIndeed,\tPennebaker\u2019s\tfindings suggest\t one\t reason\t why\t other\t studies\t show\t medical\t patients\t given psychotherapy\t in\t addition\t to\t surgery\t or\t medical\t treatment\t often\t fare better\tmedically\tthan\tdo\tthose\twho\treceive\tmedical\ttreatment\talone.45 Perhaps\t the\t most\t powerful\t demonstration\t of\t the\t clinical\t power\t of emotional\t support\t was\t in\t groups\t at\t Stanford\t University\t Medical School\t for\t women\t with\t advanced\t metastatic\t breast\t cancer.\t After\t an initial\t treatment,\t often\t including\t surgery,\t these\t women\u2019s\t cancer\t had returned\tand\twas\tspreading\tthrough\ttheir\tbodies.\tIt\twas\tonly\ta\tmatter of\ttime,\tclinically\tspeaking,\tuntil\tthe\tspreading\tcancer\tkilled\tthem.\tDr. David\t Spiegel,\t who\t conducted\t the\t study,\t was\t himself\t stunned\t by\t the findings,\tas\twas\tthe\tmedical\tcommunity:\twomen\twith\tadvanced\tbreast cancer\t who\t went\t to\t weekly\t meetings\t with\t others\t survived\t twice\t as long\tas\tdid\twomen\twith\tthe\tsame\tdisease\twho\tfaced\tit\ton\ttheir\town.46 All\t the\t women\t received\t standard\t medical\t care;\t the\t only\t difference","was\t that\t some\t also\t went\t to\t the\t groups,\t where\t they\t were\t able\t to unburden\t themselves\t with\t others\t who\t understood\t what\t they\t faced and\t were\t willing\t to\t listen\t to\t their\t fears,\t their\t pain,\t and\t their\t anger. Often\t this\t was\t the\t only\t place\t where\t the\t women\t could\t be\t open\t about these\t emotions,\t because\t other\t people\t in\t their\t lives\t dreaded\t talking with\t them\t about\t the\t cancer\t and\t their\t imminent\t death.\t Women\t who attended\t the\t groups\t lived\t for\t thirty-seven\t additional\t months,\t on average,\t while\t those\t with\t the\t disease\t who\t did\t not\t go\t to\t the\t groups died,\t on\t average,\t in\t nineteen\t months\u2014a\t gain\t in\t life\t expectancy\t for such\t patients\t beyond\t the\t reach\t of\t any\t medication\t or\t other\t medical treatment.\t As\t Dr.\t Jimmie\t Holland,\t the\t chief\t psychiatric\t oncologist\t at Sloan-Kettering\t Memorial\t Hospital,\t a\t cancer\t treatment\t center\t in\t New York\t City,\t put\t it\t to\t me,\t \u201cEvery\t cancer\t patient\t should\t be\t in\t a\t group like\t this.\u201d\t Indeed,\t if\t it\t had\t been\t a\t new\t drug\t that\t produced\t the extended\t life\t expectancy,\t pharmaceutical\t companies\t would\t be battling\tto\tproduce\tit. BRINGING\tEMOTIONAL\tINTELLIGENCE\tTO\tMEDICAL\tCARE The\tday\ta\troutine\tcheckup\tspotted\tsome\tblood\tin\tmy\turine,\tmy\tdoctor sent\tme\tfor\ta\tdiagnostic\ttest\tin\twhich\tI\twas\tinjected\twith\ta\tradioactive dye.\tI\tlay\ton\ta\ttable\twhile\tan\toverhead\tX-ray\tmachine\ttook\tsuccessive images\t of\t the\t dye\u2019s\t progression\t through\t my\t kidneys\t and\t bladder.\t I had\t company\t for\t the\t test:\t a\t close\t friend,\t a\t physician\t himself, happened\t to\t be\t visiting\t for\t a\t few\t days\t and\t offered\t to\t come\t to\t the hospital\twith\tme.\tHe\tsat\tin\tthe\troom\twhile\tthe\tX-ray\tmachine,\ton\tan automated\ttrack,\trotated\tfor\tnew\tcamera\tangles,\twhirred\tand\tclicked; rotated,\twhirred,\tclicked. The\ttest\ttook\tan\thour\tand\ta\thalf.\tAt\tthe\tvery\tend\ta\tkidney\tspecialist hurried\tinto\tthe\troom,\tquickly\tintroduced\thimself,\tand\tdisappeared\tto scan\tthe\tX-rays.\tHe\tdidn\u2019t\treturn\tto\ttell\tme\twhat\tthey\tshowed. As\t we\t were\t leaving\t the\t exam\t room\t my\t friend\t and\t I\t passed\t the nephrologist.\t Feeling\t shaken\t and\t somewhat\t dazed\t by\t the\t test,\t I\t did not\t have\t the\t presence\t of\t mind\t to\t ask\t the\t one\t question\t that\t had\t been on\t my\t mind\t all\t morning.\t But\t my\t companion,\t the\t physician,\t did: \u201cDoctor,\u201d\t he\t said,\t \u201cmy\t friend\u2019s\t father\t died\t of\t bladder\t cancer.\t He\u2019s anxious\tto\tknow\tif\tyou\tsaw\tany\tsigns\tof\tcancer\tin\tthe\tX-rays.\u201d \u201cNo\t abnormalities,\u201d\t was\t the\t curt\t reply\t as\t the\t nephrologist\t hurried on\tto\this\tnext\tappointment.","My\t inability\t to\t ask\t the\t single\t question\t I\t cared\t about\t most\t is repeated\t a\t thousand\t times\t each\t day\t in\t hospitals\t and\t clinics everywhere.\t A\t study\t of\t patients\t in\t physicians\u2019\t waiting\t rooms\t found that\t each\t had\t an\t average\t of\t three\t or\t more\t questions\t in\t mind\t to\t ask the\t physician\t they\t were\t about\t to\t see.\t But\t when\t the\t patients\t left\t the physician\u2019s\toffice,\tan\taverage\tof\tonly\tone\tand\ta\thalf\tof\tthose\tquestions had\t been\t answered.47\t This\t finding\t speaks\t to\t one\t of\t the\t many\t ways patients\u2019\temotional\tneeds\tare\tunmet\tby\ttoday\u2019s\tmedicine.\tUnanswered questions\t feed\t uncertainty,\t fear,\t catastrophizing.\t And\t they\t lead patients\tto\tbalk\tat\tgoing\talong\twith\ttreatment\tregimes\tthey\tdon\u2019t\tfully understand. There\t are\t many\t ways\t medicine\t can\t expand\t its\t view\t of\t health\t to include\t the\t emotional\t realities\t of\t illness.\t For\t one,\t patients\t could routinely\t be\t offered\t fuller\t information\t essential\t to\t the\t decisions\t they must\tmake\tabout\ttheir\town\tmedical\tcare;\tsome\tservices\tnow\toffer\tany caller\t a\t state-of-the-art\t computer\t search\t of\t the\t medical\t literature\t on what\tails\tthem,\tso\tthat\tpatients\tcan\tbe\tmore\tequal\tpartners\twith\ttheir physicians\t in\t making\t informed\t decisions.48\t Another\t approach\t is programs\t that,\t in\t a\t few\t minutes\u2019\t time,\t teach\t patients\t to\t be\t effective questioners\t with\t their\t physicians,\t so\t that\t when\t they\t have\t three questions\t in\t mind\t as\t they\t wait\t for\t the\t doctor,\t they\t will\t come\t out\t of the\toffice\twith\tthree\tanswers.49 Moments\t when\t patients\t face\t surgery\t or\t invasive\t and\t painful\t tests are\t fraught\t with\t anxiety\u2014and\t are\t a\t prime\t opportunity\t to\t deal\t with the\t emotional\t dimension.\t Some\t hospitals\t have\t developed\t presurgery instruction\tfor\tpatients\tthat\thelp\tthem\tassuage\ttheir\tfears\tand\thandle their\t discomforts\u2014for\t example,\t by\t teaching\t patients\t relaxation techniques,\tanswering\ttheir\tquestions\twell\tin\tadvance\tof\tsurgery,\tand telling\t them\t several\t days\t ahead\t of\t surgery\t precisely\t what\t they\t are likely\tto\texperience\tduring\ttheir\trecovery.\tThe\tresult:\tpatients\trecover from\tsurgery\tan\taverage\tof\ttwo\tto\tthree\tdays\tsooner.50 Being\t a\t hospital\t patient\t can\t be\t a\t tremendously\t lonely,\t helpless experience.\t But\t some\t hospitals\t have\t begun\t to\t design\t rooms\t so\t that family\t members\t can\t stay\t with\t patients,\t cooking\t and\t caring\t for\t them as\t they\t would\t at\t home\u2014a\t progressive\t step\t that,\t ironically,\t is\t routine throughout\tthe\tThird\tWorld.51 Relaxation\ttraining\tcan\thelp\tpatients\tdeal\twith\tsome\tof\tthe\tdistress their\t symptoms\t bring,\t as\t well\t as\t with\t the\t emotions\t that\t may\t be triggering\tor\texacerbating\ttheir\tsymptoms.\tAn\texemplary\tmodel\tis\tJon Kabat-Zinn\u2019s\t Stress\t Reduction\t Clinic\t at\t the\t University\t of","Massachusetts\t Medical\t Center,\t which\t offers\t a\t ten-week\t course\t in mindfulness\tand\tyoga\tto\tpatients;\tthe\temphasis\tis\ton\tbeing\tmindful\tof emotional\t episodes\t as\t they\t are\t happening,\t and\t on\t cultivating\t a\t daily practice\tthat\toffers\tdeep\trelaxation.\tHospitals\thave\tmade\tinstructional tapes\t from\t the\t course\t available\t over\t patients\u2019\t television\t sets\u2014a\t far better\t emotional\t diet\t for\t the\t bedridden\t than\t the\t usual\t fare,\t soap operas.52 Relaxation\tand\tyoga\tare\talso\tat\tthe\tcore\tof\tthe\tinnovative\tprogram for\t treating\t heart\t disease\t developed\t by\t Dr.\t Dean\t Ornish.53\t After\t a year\t of\t this\t program,\t which\t included\t a\t low-fat\t diet,\t patients\t whose heart\t disease\t was\t severe\t enough\t to\t warrant\t a\t coronary\t bypass actually\t reversed\t the\t buildup\t of\t artery-clogging\t plaque.\t Ornish\t tells me\t that\t relaxation\t training\t is\t one\t of\t the\t most\t important\t parts\t of\t the program.\t Like\t Kabat-Zinn\u2019s,\t it\t takes\t advantage\t of\t what\t Dr.\t Herbert Benson\t calls\t the\t \u201crelaxation\t response,\u201d\t the\t physiological\t opposite\t of the\tstress\tarousal\tthat\tcontributes\tto\tsuch\ta\twide\tspectrum\tof\tmedical problems. Finally,\t there\t is\t the\t added\t medical\t value\t of\t an\t empathic\t physician or\t nurse,\t attuned\t to\t patients,\t able\t to\t listen\t and\t be\t heard.\t This\t means fostering\t \u201crelationship-centered\t care,\u201d\t recognizing\t that\t the relationship\t between\t physician\t and\t patient\t is\t itself\t a\t factor\t of significance.\t Such\t relationships\t would\t be\t fostered\t more\t readily\t if medical\teducation\tincluded\tsome\tbasic\ttools\tof\temotional\tintelligence, especially\tself-awareness\tand\tthe\tarts\tof\tempathy\tand\tlistening.54 TOWARD\tA\tMEDICINE\tTHAT\tCARES Such\t steps\t are\t a\t beginning.\t But\t for\t medicine\t to\t enlarge\t its\t vision\t to embrace\t the\t impact\t of\t emotions,\t two\t large\t implications\t of\t the scientific\tfindings\tmust\tbe\ttaken\tto\theart: 1.\tHelping\tpeople\tbetter\tmanage\ttheir\tupsetting\tfeelings\u2014anger,\tanxiety, depression,\t pessimism,\t and\t loneliness\u2014is\t a\t form\t of\t disease\t prevention. Since\tthe\tdata\tshow\tthat\tthe\ttoxicity\tof\tthese\temotions,\twhen\tchronic, is\t on\t a\t par\t with\t smoking\t cigarettes,\t helping\t people\t handle\t them better\t could\t potentially\t have\t a\t medical\t payoff\t as\t great\t as\t getting heavy\t smokers\t to\t quit.\t One\t way\t to\t do\t this\t that\t could\t have\t broad public-health\t effects\t would\t be\t to\t impart\t most\t basic\t emotional intelligence\t skills\t to\t children,\t so\t that\t they\t become\t lifelong\t habits.","Another\t high-payoff\t preventive\t strategy\t would\t be\t to\t teach\t emotion management\tto\tpeople\treaching\tretirement\tage,\tsince\temotional\twell- being\t is\t one\t factor\t that\t determines\t whether\t an\t older\t person\t declines rapidly\t or\t thrives.\t A\t third\t target\t group\t might\t be\t so-called\t at-risk populations\u2014the\t very\t poor,\t single\t working\t mothers,\t residents\t of high-crime\t neighborhoods,\t and\t the\t like\u2014who\t live\t under extraordinary\t pressure\t day\t in\t and\t day\t out,\t and\t so\t might\t do\t better medically\twith\thelp\tin\thandling\tthe\temotional\ttoll\tof\tthese\tstresses. 2.\tMany\tpatients\tcan\tbenefit\tmeasurably\twhen\ttheir\tpsychological\tneeds are\t attended\t to\t along\t with\t their\t purely\t medical\t ones.\t While\t it\t is\t a\t step toward\t more\t humane\t care\t when\t a\t physician\t or\t nurse\t offers\t a distressed\t patient\t comfort\t and\t consolation,\t more\t can\t be\t done.\t But emotional\tcare\tis\tan\topportunity\ttoo\toften\tlost\tin\tthe\tway\tmedicine\tis practiced\ttoday;\tit\tis\ta\tblind\tspot\tfor\tmedicine.\tDespite\tmounting\tdata on\tthe\tmedical\tusefulness\tof\tattending\tto\temotional\tneeds,\tas\twell\tas supporting\t evidence\t for\t connections\t between\t the\t brain\u2019s\t emotional center\tand\tthe\timmune\tsystem,\tmany\tphysicians\tremain\tskeptical\tthat their\t patients\u2019\t emotions\t matter\t clinically,\t dismissing\t the\t evidence\t for this\t as\t trivial\t and\t anecdotal,\t as\t \u201cfringe,\u201d\t or,\t worse,\t as\t the exaggerations\tof\ta\tself-promoting\tfew. Though\tmore\tand\tmore\tpatients\tseek\ta\tmore\thumane\tmedicine,\tit\tis becoming\t endangered.\t Of\t course,\t there\t remain\t dedicated\t nurses\t and physicians\t who\t give\t their\t patients\t tender,\t sensitive\t care.\t But\t the changing\t culture\t of\t medicine\t itself,\t as\t it\t becomes\t more\t responsive\t to the\timperatives\tof\tbusiness,\tis\tmaking\tsuch\tcare\tincreasingly\tdifficult to\tfind. On\t the\t other\t hand,\t there\t may\t be\t a\t business\t advantage\t to\t humane medicine:\t treating\t emotional\t distress\t in\t patients,\t early\t evidence suggests,\tcan\tsave\tmoney\u2014especially\tto\tthe\textent\tthat\tit\tprevents\tor delays\tthe\tonset\tof\tsickness,\tor\thelps\tpatients\theal\tmore\tquickly.\tIn\ta study\t of\t elderly\t patients\t with\t hip\t fracture\t at\t Mt.\t Sinai\t School\t of Medicine\t in\t New\t York\t City\t and\t at\t Northwestern\t University,\t patients who\treceived\ttherapy\tfor\tdepression\tin\taddition\tto\tnormal\torthopedic care\t left\t the\t hospital\t an\t average\t of\t two\t days\t earlier;\t total\t savings\t for the\thundred\tor\tso\tpatients\twas\t$97,361\tin\tmedical\tcosts.55 Such\t care\t also\t makes\t patients\t more\t satisfied\t with\t their\t physicians and\t medical\t treatment.\t In\t the\t emerging\t medical\t marketplace,\t where patients\t often\t have\t the\t option\t to\t choose\t between\t competing\t health","plans,\tsatisfaction\tlevels\twill\tno\tdoubt\tenter\tthe\tequation\tof\tthese\tvery personal\t decisions\u2014souring\t experiences\t can\t lead\t patients\t to\t go elsewhere\tfor\tcare,\twhile\tpleasing\tones\ttranslate\tinto\tloyalty. Finally,\tmedical\tethics\tmay\tdemand\tsuch\tan\tapproach.\tAn\teditorial in\t the\t Journal\t of\t the\t American\t Medical\t Association,\t commenting\t on\t a report\t that\t depression\t increases\t fivefold\t the\t likelihood\t of\t dying\t after being\t treated\t for\t a\t heart\t attack,\t notes:\t \u201c[T]he\t clear\t demonstration that\t psychological\t factors\t like\t depression\t and\t social\t isolation distinguish\tthe\tcoronary\theart\tdisease\tpatients\tat\thighest\trisk\tmeans\tit would\tbe\tunethical\tnot\tto\tstart\ttrying\tto\ttreat\tthese\tfactors.\u201d56 If\t the\t findings\t on\t emotions\t and\t health\t mean\t anything,\t it\t is\t that medical\t care\t that\t neglects\t how\t people\t feel\t as\t they\t battle\t a\t chronic\t or severe\t disease\t is\t no\t longer\t adequate.\t It\t is\t time\t for\t medicine\t to\t take more\t methodical\t advantage\t of\t the\t link\t between\t emotion\t and\t health. What\t is\t now\t the\t exception\t could\u2014and\t should\u2014be\t part\t of\t the mainstream,\t so\t that\t a\t more\t caring\t medicine\t is\t available\t to\t us\t all.\t At the\t least\t it\t would\t make\t medicine\t more\t humane.\t And,\t for\t some,\t it could\tspeed\tthe\tcourse\tof\trecovery.\t\u201cCompassion,\u201d\tas\tone\tpatient\tput it\t in\t an\t open\t letter\t to\t his\t surgeon,\t \u201cis\t not\t mere\t hand\t holding.\t It\t is good\tmedicine.\u201d57","PART\tFOUR WINDOWS OF OPPORTUNITY","12 The\tFamily\tCrucible It\u2019s\ta\tlow-key\tfamily\ttragedy.\tCarl\tand\tAnn\tare\tshowing\ttheir\tdaughter\tLeslie,\tjust\tfive, how\t to\t play\t a\t brand-new\t video\t game.\t But\t as\t Leslie\t starts\t to\t play,\t her\t parents\u2019\t overly eager\t attempts\t to\t \u201chelp\u201d\t her\t just\t seem\t to\t get\t in\t the\t way.\t Contradictory\t orders\t fly\t in every\tdirection. \u201cTo\t the\t right,\t to\t the\t right\u2014stop.\t Stop.\t Stop!\u201d\t Ann,\t the\t mother,\t urges,\t her\t voice growing\tmore\tintent\tand\tanxious\tas\tLeslie,\tsucking\ton\ther\tlip\tand\tstaring\twide-eyed\tat the\tvideo\tscreen,\tstruggles\tto\tfollow\tthese\tdirectives. \u201cSee,\t you\u2019re\t not\t lined\t up\t \u2026\t put\t it\t to\t the\t left!\t To\t the\t left!\u201d\t Carl,\t the\t girl\u2019s\t father, brusquely\torders. Meanwhile\tAnn,\ther\teyes\trolling\tupward\tin\tfrustration,\tyells\tover\this\tadvice,\t\u201cStop! Stop!\u201d Leslie,\t unable\t to\t please\t either\t her\t father\t or\t her\t mother,\t contorts\t her\t jaw\t in\t tension and\tblinks\tas\ther\teyes\tfill\twith\ttears. Her\t parents\t start\t bickering,\t ignoring\t Leslie\u2019s\t tears.\t \u201cShe\u2019s\t not\t moving\t the\t stick\t that much!\u201d\tAnn\ttells\tCarl,\texasperated. As\t the\t tears\t start\t rolling\t down\t Leslie\u2019s\t cheeks,\t neither\t parent\t makes\t any\t move\t that indicates\t they\t notice\t or\t care.\t As\t Leslie\t raises\t her\t hand\t to\t wipe\t her\t eyes,\t her\t father snaps,\t\u201cOkay,\tput\tyour\thand\tback\ton\tthe\tstick\t\u2026\tyou\twanna\tget\tready\tto\tshoot.\tOkay, put\tit\tover!\u201d\tAnd\ther\tmother\tbarks,\t\u201cOkay,\tmove\tit\tjust\ta\tteeny\tbit!\u201d But\tby\tnow\tLeslie\tis\tsobbing\tsoftly,\talone\twith\ther\tanguish. At\t such\t moments\t children\t learn\t deep\t lessons.\t For\t Leslie\t one conclusion\t from\t this\t painful\t exchange\t might\t well\t be\t that\t neither\t her parents,\t nor\t anyone\t else,\t for\t that\t matter,\t cares\t about\t her\t feelings.1 When\tsimilar\tmoments\tare\trepeated\tcountless\ttimes\tover\tthe\tcourse\tof childhood\t they\t impart\t some\t of\t the\t most\t fundamental\t emotional messages\t of\t a\t lifetime\u2014lessons\t that\t can\t determine\t a\t life\t course. Family\t life\t is\t our\t first\t school\t for\t emotional\t learning;\t in\t this\t intimate cauldron\t we\t learn\t how\t to\t feel\t about\t ourselves\t and\t how\t others\t will react\t to\t our\t feelings;\t how\t to\t think\t about\t these\t feelings\t and\t what","choices\twe\thave\tin\treacting;\thow\tto\tread\tand\texpress\thopes\tand\tfears. This\t emotional\t schooling\t operates\t not\t just\t through\t the\t things\t that parents\t say\t and\t do\t directly\t to\t children,\t but\t also\t in\t the\t models\t they offer\t for\t handling\t their\t own\t feelings\t and\t those\t that\t pass\t between husband\tand\twife.\tSome\tparents\tare\tgifted\temotional\tteachers,\tothers atrocious. There\tare\thundreds\tof\tstudies\tshowing\tthat\thow\tparents\ttreat\ttheir children\u2014whether\t with\t harsh\t discipline\t or\t empathic\t understanding, with\t indifference\t or\t warmth,\t and\t so\t on\u2014has\t deep\t and\t lasting consequences\t for\t the\t child\u2019s\t emotional\t life.\t Only\t recently,\t though, have\tthere\tbeen\thard\tdata\tshowing\tthat\thaving\temotionally\tintelligent parents\t is\t itself\t of\t enormous\t benefit\t to\t a\t child.\t The\t ways\t a\t couple handles\t the\t feelings\t between\t them\u2014in\t addition\t to\t their\t direct dealings\twith\ta\tchild\u2014impart\tpowerful\tlessons\tto\ttheir\tchildren,\twho are\tastute\tlearners,\tattuned\tto\tthe\tsubtlest\temotional\texchanges\tin\tthe family.\tWhen\tresearch\tteams\tled\tby\tCarole\tHooven\tand\tJohn\tGottman at\tthe\tUniversity\tof\tWashington\tdid\ta\tmicroanalysis\tof\tinteractions\tin couples\t on\t how\t the\t partners\t handled\t their\t children,\t they\t found\t that those\tcouples\twho\twere\tmore\temotionally\tcompetent\tin\tthe\tmarriage were\t also\t the\t most\t effective\t in\t helping\t their\t children\t with\t their emotional\tups\tand\tdowns.2 The\tfamilies\twere\tfirst\tseen\twhen\tone\tof\ttheir\tchildren\twas\tjust\tfive years\t old,\t and\t again\t when\t the\t child\t had\t reached\t nine.\t In\t addition\t to observing\t the\t parents\t talk\t with\t each\t other,\t the\t research\t team\t also watched\t families\t (including\t Leslie\u2019s)\t as\t the\t father\t or\t mother\t tried\t to show\t their\t young\t child\t how\t to\t operate\t a\t new\t video\t game\u2014a seemingly\tinnocuous\tinteraction,\tbut\tquite\ttelling\tabout\tthe\temotional currents\tthat\trun\tbetween\tparent\tand\tchild. Some\t mothers\t and\t fathers\t were\t like\t Ann\t and\t Carl:\t overbearing, losing\t patience\t with\t their\t child\u2019s\t ineptness,\t raising\t their\t voices\t in disgust\t or\t exasperation,\t some\t even\t putting\t their\t child\t down\t as \u201cstupid\u201d\u2014in\t short,\t falling\t prey\t to\t the\t same\t tendencies\t toward contempt\t and\t disgust\t that\t eat\t away\t at\t a\t marriage.\t Others,\t however, were\t patient\t with\t their\t child\u2019s\t errors,\t helping\t the\t child\t figure\t the game\t out\t in\t his\t or\t her\t own\t way\t rather\t than\t imposing\t the\t parents\u2019 will.\tThe\tvideo\tgame\tsession\twas\ta\tsurprisingly\tpowerful\tbarometer\tof the\tparents\u2019\temotional\tstyle. The\t three\t most\t common\t emotionally\t inept\t parenting\t styles\t proved to\tbe:","\u2022\t Ignoring\t feelings\t altogether.\t Such\t parents\t treat\t a\t child\u2019s\t emotional upset\tas\ttrivial\tor\ta\tbother,\tsomething\tthey\tshould\twait\tto\tblow\tover. They\t fail\t to\t use\t emotional\t moments\t as\t a\t chance\t to\t get\t closer\t to\t the child\tor\tto\thelp\tthe\tchild\tlearn\tlessons\tin\temotional\tcompetence. \u2022\tBeing\ttoo\tlaissez-faire.\t These\t parents\t notice\t how\t a\t child\t feels,\t but hold\tthat\thowever\ta\tchild\thandles\tthe\temotional\tstorm\tis\tfine\u2014even, say,\t hitting.\t Like\t those\t who\t ignore\t a\t child\u2019s\t feelings,\t these\t parents rarely\t step\t in\t to\t try\t to\t show\t their\t child\t an\t alternative\t emotional response.\t They\t try\t to\t soothe\t all\t upsets,\t and\t will,\t for\t instance,\t use bargaining\tand\tbribes\tto\tget\ttheir\tchild\tto\tstop\tbeing\tsad\tor\tangry. \u2022\tBeing\t contemptuous,\t showing\t no\t respect\t for\t how\t the\t child\t feels.\t Such parents\t are\t typically\t disapproving,\t harsh\t in\t both\t their\t criticisms\t and their\tpunishments.\tThey\tmight,\tfor\tinstance,\tforbid\tany\tdisplay\tof\tthe child\u2019s\t anger\t at\t all,\t and\t become\t punitive\t at\t the\t least\t sign\t of irritability.\t These\t are\t the\t parents\t who\t angrily\t yell\t at\t a\t child\t who\t is trying\tto\ttell\this\tside\tof\tthe\tstory,\t\u201cDon\u2019t\tyou\ttalk\tback\tto\tme!\u201d Finally,\t there\t are\t parents\t who\t seize\t the\t opportunity\t of\t a\t child\u2019s upset\t to\t act\t as\t what\t amounts\t to\t an\t emotional\t coach\t or\t mentor.\t They take\t their\t child\u2019s\t feelings\t seriously\t enough\t to\t try\t to\t understand exactly\t what\t is\t upsetting\t them\t (\u201cAre\t you\t angry\t because\t Tommy\t hurt your\t feelings?\u201d)\t and\t to\t help\t the\t child\t find\t positive\t ways\t to\t soothe their\t feelings\t (\u201cInstead\t of\t hitting\t him,\t why\t don\u2019t\t you\t find\t a\t toy\t to play\twith\ton\tyour\town\tuntil\tyou\tfeel\tlike\tplaying\twith\thim\tagain?\u201d). In\t order\t for\t parents\t to\t be\t effective\t coaches\t in\t this\t way,\t they\t must have\t a\t fairly\t good\t grasp\t of\t the\t rudiments\t of\t emotional\t intelligence themselves.\t One\t of\t the\t basic\t emotional\t lessons\t for\t a\t child,\t for example,\t is\t how\t to\t distinguish\t among\t feelings;\t a\t father\t who\t is\t too tuned\tout\tof,\tsay,\this\town\tsadness\tcannot\thelp\this\tson\tunderstand\tthe difference\t between\t grieving\t over\t a\t loss,\t feeling\t sad\t in\t a\t sad\t movie, and\t the\t sadness\t that\t arises\t when\t something\t bad\t happens\t to\t someone the\t child\t cares\t about.\t Beyond\t this\t distinction,\t there\t are\t more sophisticated\tinsights,\tsuch\tas\tthat\tanger\tis\tso\toften\tprompted\tby\tfirst feeling\thurt. As\tchildren\tgrow\tthe\tspecific\temotional\tlessons\tthey\tare\tready\tfor\u2014 and\tin\tneed\tof\u2014shift.\tAs\twe\tsaw\tin\tChapter\t7\tthe\tlessons\tin\tempathy begin\t in\t infancy,\t with\t parents\t who\t attune\t to\t their\t baby\u2019s\t feelings. Though\t some\t emotional\t skills\t are\t honed\t with\t friends\t through\t the years,\t emotionally\t adept\t parents\t can\t do\t much\t to\t help\t their\t children","with\t each\t of\t the\t basics\t of\t emotional\t intelligence:\t learning\t how\t to recognize,\t manage,\t and\t harness\t their\t feelings;\t empathizing;\t and handling\tthe\tfeelings\tthat\tarise\tin\ttheir\trelationships. The\t impact\t on\t children\t of\t such\t parenting\t is\t extraordinarily sweeping.3\t The\t University\t of\t Washington\t team\t found\t that\t when parents\tare\temotionally\tadept,\tcompared\tto\tthose\twho\thandle\tfeelings poorly,\t their\t children\u2014understandably\u2014get\t along\t better\t with,\t show more\taffection\ttoward,\tand\thave\tless\ttension\taround\ttheir\tparents.\tBut beyond\t that,\t these\t children\t also\t are\t better\t at\t handling\t their\t own emotions,\t are\t more\t effective\t at\t soothing\t themselves\t when\t upset,\t and get\t upset\t less\t often.\t The\t children\t are\t also\t more\t relaxed\t biologically, with\t lower\t levels\t of\t stress\t hormones\t and\t other\t physiological indicators\t of\t emotional\t arousal\t (a\t pattern\t that,\t if\t sustained\t through life,\t might\t well\t augur\t better\t physical\t health,\t as\t we\t saw\t in\t Chapter 11).\t Other\t advantages\t are\t social:\t these\t children\t are\t more\t popular with\tand\tare\tbetter-liked\tby\ttheir\tpeers,\tand\tare\tseen\tby\ttheir\tteachers as\t more\t socially\t skilled.\t Their\t parents\t and\t teachers\t alike\t rate\t these children\t as\t having\t fewer\t behavioral\t problems\t such\t as\t rudeness\t or aggressiveness.\t Finally,\t the\t benefits\t are\t cognitive;\t these\t children\t can pay\t attention\t better,\t and\t so\t are\t more\t effective\t learners.\t Holding\t IQ constant,\t the\t five-year-olds\t whose\t parents\t were\t good\t coaches\t had higher\t achievement\t scores\t in\t math\t and\t reading\t when\t they\t reached third\tgrade\t(a\tpowerful\targument\tfor\tteaching\temotional\tskills\tto\thelp prepare\t children\t for\t learning\t as\t well\t as\t life).\t Thus\t the\t payoff\t for children\t whose\t parents\t are\t emotionally\t adept\t is\t a\t surprising\u2014almost astounding\u2014range\tof\tadvantages\tacross,\tand\tbeyond,\tthe\tspectrum\tof emotional\tintelligence. HEART\tSTART The\timpact\tof\tparenting\ton\temotional\tcompetence\tstarts\tin\tthe\tcradle. Dr.\tT.\tBerry\tBrazelton,\tthe\teminent\tHarvard\tpediatrician,\thas\ta\tsimple diagnostic\t test\t of\t a\t baby\u2019s\t basic\t outlook\t toward\t life.\t He\t offers\t two blocks\tto\tan\teight-month-old,\tand\tthen\tshows\tthe\tbaby\thow\the\twants her\tto\tput\tthe\ttwo\tblocks\ttogether.\tA\tbaby\twho\tis\thopeful\tabout\tlife, who\thas\tconfidence\tin\ther\town\tabilities,\tsays\tBrazelton, will\t pick\t up\t one\t block,\t mouth\t it,\t rub\t it\t in\t her\t hair,\t drop\t it\t over\t the\t side\t of\t the\t table, watching\t to\t see\t whether\t you\t will\t retrieve\t it\t for\t her.\t When\t you\t do,\t she\t finally","completes\tthe\trequested\ttask\u2014place\tthe\ttwo\tblocks\ttogether.\tThen\tshe\tlooks\tup\tat\tyou with\ta\tbright-eyed\tlook\tof\texpectancy\tthat\tsays,\t\u201cTell\tme\thow\tgreat\tI\tam!\u201d4 Babies\t like\t these\t have\t gotten\t a\t goodly\t dose\t of\t approval\t and encouragement\t from\t the\t adults\t in\t their\t lives;\t they\t expect\t to\t succeed in\t life\u2019s\t little\t challenges.\t By\t contrast,\t babies\t who\t come\t from\t homes too\tbleak,\tchaotic,\tor\tneglectful\tgo\tabout\tthe\tsame\tsmall\ttask\tin\ta\tway that\t signals\t they\t already\t expect\t to\t fail.\t It\t is\t not\t that\t these\t babies\t fail to\tbring\tthe\tblocks\ttogether;\tthey\tunderstand\tthe\tinstruction\tand\thave the\tcoordination\tto\tcomply.\tBut\teven\twhen\tthey\tdo,\treports\tBrazelton, their\tdemeanor\tis\t\u201changdog,\u201d\ta\tlook\tthat\tsays,\t\u201cI\u2019m\tno\tgood.\tSee,\tI\u2019ve failed.\u201d\t Such\t children\t are\t likely\t to\t go\t through\t life\t with\t a\t defeatist outlook,\t expecting\t no\t encouragement\t or\t interest\t from\t teachers, finding\tschool\tjoyless,\tperhaps\teventually\tdropping\tout. The\t difference\t between\t the\t two\t outlooks\u2014children\t who\t are confident\t and\t optimistic\t versus\t those\t who\t expect\t to\t fail\u2014starts\t to take\tshape\tin\tthe\tfirst\tfew\tyears\tof\tlife.\tParents,\tsays\tBrazelton,\t\u201cneed to\tunderstand\thow\ttheir\tactions\tcan\thelp\tgenerate\tthe\tconfidence,\tthe curiosity,\t the\t pleasure\t in\t learning\t and\t the\t understanding\t of\t limits\u201d that\thelp\tchildren\tsucceed\tin\tlife.\tHis\tadvice\tis\tinformed\tby\ta\tgrowing body\t of\t evidence\t showing\t that\t success\t in\t school\t depends\t to\t a surprising\t extent\t on\t emotional\t characteristics\t formed\t in\t the\t years before\ta\tchild\tenters\tschool.\tAs\twe\tsaw\tin\tChapter\t6,\tfor\texample,\tthe ability\t of\t four-year-olds\t to\t control\t the\t impulse\t to\t grab\t for\t a marshmallow\t predicted\t a\t 210-point\t advantage\t in\t their\t SAT\t scores fourteen\tyears\tlater. The\t first\t opportunity\t for\t shaping\t the\t ingredients\t of\t emotional intelligence\tis\tin\tthe\tearliest\tyears,\tthough\tthese\tcapacities\tcontinue\tto form\t throughout\t the\t school\t years.\t The\t emotional\t abilities\t children acquire\t in\t later\t life\t build\t on\t those\t of\t the\t earliest\t years.\t And\t these abilities,\t as\t we\t saw\t in\t Chapter\t 6,\t are\t the\t essential\t foundation\t for\t all learning.\t A\t report\t from\t the\t National\t Center\t for\t Clinical\t Infant Programs\t makes\t the\t point\t that\t school\t success\t is\t not\t predicted\t by\t a child\u2019s\t fund\t of\t facts\t or\t a\t precocious\t ability\t to\t read\t so\t much\t as\t by emotional\t and\t social\t measures:\t being\t self-assured\t and\t interested; knowing\t what\t kind\t of\t behavior\t is\t expected\t and\t how\t to\t rein\t in\t the impulse\tto\tmisbehave;\tbeing\table\tto\twait,\tto\tfollow\tdirections,\tand\tto turn\t to\t teachers\t for\t help;\t and\t expressing\t needs\t while\t getting\t along with\tother\tchildren.5 Almost\t all\t students\t who\t do\t poorly\t in\t school,\t says\t the\t report,\t lack","one\tor\tmore\tof\tthese\telements\tof\temotional\tintelligence\t(regardless\tof whether\t they\t also\t have\t cognitive\t difficulties\t such\t as\t learning disabilities).\t The\t magnitude\t of\t the\t problem\t is\t not\t minor;\t in\t some states\tclose\tto\tone\tin\tfive\tchildren\thave\tto\trepeat\tfirst\tgrade,\tand\tthen as\t the\t years\t go\t on\t fall\t further\t behind\t their\t peers,\t becoming increasingly\tdiscouraged,\tresentful,\tand\tdisruptive. A\t child\u2019s\t readiness\t for\t school\t depends\t on\t the\t most\t basic\t of\t all knowledge,\thow\tto\tlearn.\tThe\treport\tlists\tthe\tseven\tkey\tingredients\tof this\tcrucial\tcapacity\u2014all\trelated\tto\temotional\tintelligence:6 1.\t Confidence.\t A\t sense\t of\t control\t and\t mastery\t of\t one\u2019s\t body, behavior,\t and\t world;\t the\t child\u2019s\t sense\t that\t he\t is\t more\t likely\t than\t not to\tsucceed\tat\twhat\the\tundertakes,\tand\tthat\tadults\twill\tbe\thelpful. 2.\t Curiosity.\t The\t sense\t that\t finding\t out\t about\t things\t is\t positive\t and leads\tto\tpleasure. 3.\tIntentionality.\t The\t wish\t and\t capacity\t to\t have\t an\t impact,\t and\t to act\t upon\t that\t with\t persistence.\t This\t is\t related\t to\t a\t sense\t of competence,\tof\tbeing\teffective. 4.\t Self-control.\t The\t ability\t to\t modulate\t and\t control\t one\u2019s\t own actions\tin\tage-appropriate\tways;\ta\tsense\tof\tinner\tcontrol. 5.\tRelatedness.\tThe\tability\tto\tengage\twith\tothers\tbased\ton\tthe\tsense of\tbeing\tunderstood\tby\tand\tunderstanding\tothers. 6.\t Capacity\t to\t communicate.\t The\t wish\t and\t ability\t to\t verbally exchange\tideas,\tfeelings,\tand\tconcepts\twith\tothers.\tThis\tis\trelated\tto\ta sense\t of\t trust\t in\t others\t and\t of\t pleasure\t in\t engaging\t with\t others, including\tadults. 7.\t Cooperativeness.\t The\t ability\t to\t balance\t one\u2019s\t own\t needs\t with those\tof\tothers\tin\tgroup\tactivity. Whether\t or\t not\t a\t child\t arrives\t at\t school\t on\t the\t first\t day\t of kindergarten\twith\tthese\tcapabilities\tdepends\tgreatly\ton\thow\tmuch\ther parents\u2014and\tpreschool\tteachers\u2014have\tgiven\ther\tthe\tkind\tof\tcare\tthat amounts\tto\ta\t\u201cHeart\tStart,\u201d\tthe\temotional\tequivalent\tof\tthe\tHead\tStart programs. GETTING\tTHE\tEMOTIONAL\tBASICS Say\t a\t two-month-old\t baby\t wakes\t up\t at\t 3\t A.M.\t and\t starts\t crying.\t Her mother\t comes\t in\t and,\t for\t the\t next\t half\t hour,\t the\t baby\t contentedly","nurses\t in\t her\t mother\u2019s\t arms\t while\t her\t mother\t gazes\t at\t her affectionately,\t telling\t her\t that\t she\u2019s\t happy\t to\t see\t her,\t even\t in\t the middle\t of\t the\t night.\t The\t baby,\t content\t in\t her\t mother\u2019s\t love,\t drifts back\tto\tsleep. Now\t say\t another\t two-month-old\t baby,\t who\t also\t awoke\t crying\t in the\twee\thours,\tis\tmet\tinstead\tby\ta\tmother\twho\tis\ttense\tand\tirritable, having\t fallen\t asleep\t just\t an\t hour\t before\t after\t a\t fight\t with\t her husband.\tThe\tbaby\tstarts\tto\ttense\tup\tthe\tmoment\this\tmother\tabruptly picks\t him\t up,\t telling\t him,\t \u201cJust\t be\t quiet\u2014I\t can\u2019t\t stand\t one\t more thing!\tCome\ton,\tlet\u2019s\tget\tit\tover\twith.\u201d\tAs\tthe\tbaby\tnurses\this\tmother stares\t stonily\t ahead,\t not\t looking\t at\t him,\t reviewing\t her\t fight\t with\t his father,\t getting\t more\t agitated\t herself\t as\t she\t mulls\t it\t over.\t The\t baby, sensing\t her\t tension,\t squirms,\t stiffens,\t and\t stops\t nursing.\t \u201cThat\u2019s\t all you\t want?\u201d\t his\t mother\t says.\t \u201cThen\t don\u2019t\t eat.\u201d\t With\t the\t same abruptness\t she\t puts\t him\t back\t in\t his\t crib\t and\t stalks\t out,\t letting\t him cry\tuntil\the\tfalls\tback\tto\tsleep,\texhausted. The\t two\t scenarios\t are\t presented\t by\t the\t report\t from\t the\t National Center\t for\t Clinical\t Infant\t Programs\t as\t examples\t of\t the\t kinds\t of interaction\t that,\t if\t repeated\t over\t and\t over,\t instill\t very\t different feelings\tin\ta\ttoddler\tabout\thimself\tand\this\tclosest\trelationships.7\t The first\t baby\t is\t learning\t that\t people\t can\t be\t trusted\t to\t notice\t her\t needs and\tcounted\ton\tto\thelp,\tand\tthat\tshe\tcan\tbe\teffective\tin\tgetting\thelp; the\t second\t is\t finding\t that\t no\t one\t really\t cares,\t that\t people\t can\u2019t\t be counted\ton,\tand\tthat\this\tefforts\tto\tget\tsolace\twill\tmeet\twith\tfailure.\tOf course,\t most\t babies\t get\t at\t least\t a\t taste\t of\t both\t kinds\t of\t interaction. But\tto\tthe\tdegree\tthat\tone\tor\tthe\tother\tis\ttypical\tof\thow\tparents\ttreat a\tchild\tover\tthe\tyears,\tbasic\temotional\tlessons\twill\tbe\timparted\tabout how\t secure\t a\t child\t is\t in\t the\t world,\t how\t effective\t he\t feels,\t and\t how dependable\tothers\tare.\tErik\tErikson\tput\tit\tin\tterms\tof\twhether\ta\tchild comes\tto\tfeel\ta\t\u201cbasic\ttrust\u201d\tor\ta\tbasic\tmistrust. Such\t emotional\t learning\t begins\t in\t life\u2019s\t earliest\t moments,\t and continues\t throughout\t childhood.\t All\t the\t small\t exchanges\t between parent\t and\t child\t have\t an\t emotional\t subtext,\t and\t in\t the\t repetition\t of these\t messages\t over\t the\t years\t children\t form\t the\t core\t of\t their emotional\t outlook\t and\t capabilities.\t A\t little\t girl\t who\t finds\t a\t puzzle frustrating\t and\t asks\t her\t busy\t mother\t to\t help\t gets\t one\t message\t if\t the reply\tis\tthe\tmother\u2019s\tclear\tpleasure\tat\tthe\trequest,\tand\tquite\tanother\tif it\u2019s\t a\t curt\t \u201cDon\u2019t\t bother\t me\u2014I\u2019ve\t got\t important\t work\t to\t do.\u201d\t When such\t encounters\t become\t typical\t of\t child\t and\t parent,\t they\t mold\t the child\u2019s\t emotional\t expectations\t about\t relationships,\t outlooks\t that\t will","flavor\ther\tfunctioning\tin\tall\trealms\tof\tlife,\tfor\tbetter\tor\tworse. The\t risks\t are\t greatest\t for\t those\t children\t whose\t parents\t are\t grossly inept\u2014immature,\t abusing\t drugs,\t depressed\t or\t chronically\t angry,\t or simply\taimless\tand\tliving\tchaotic\tlives.\tSuch\tparents\tare\tfar\tless\tlikely to\t give\t adequate\t care,\t let\t alone\t attune\t to\t their\t toddler\u2019s\t emotional needs.\t Simple\t neglect,\t studies\t find,\t can\t be\t more\t damaging\t than outright\t abuse.8\t A\t survey\t of\t maltreated\t children\t found\t the\t neglected youngsters\t doing\t the\t worst\t of\t all:\t they\t were\t the\t most\t anxious, inattentive,\t and\t apathetic,\t alternately\t aggressive\t and\t withdrawn.\t The rate\tfor\thaving\tto\trepeat\tfirst\tgrade\tamong\tthem\twas\t65\tpercent. The\t first\t three\t or\t four\t years\t of\t life\t are\t a\t period\t when\t the\t toddler\u2019s brain\tgrows\tto\tabout\ttwo\tthirds\tits\tfull\tsize,\tand\tevolves\tin\tcomplexity at\t a\t greater\t rate\t than\t it\t ever\t will\t again.\t During\t this\t period\t key\t kinds of\t learning\t take\t place\t more\t readily\t than\t later\t in\t life\u2014emotional learning\t foremost\t among\t them.\t During\t this\t time\t severe\t stress\t can impair\t the\t brain\u2019s\t learning\t centers\t (and\t so\t be\t damaging\t to\t the intellect).\tThough\tas\twe\tshall\tsee,\tthis\tcan\tbe\tremedied\tto\tsome\textent by\t experiences\t later\t in\t life,\t the\t impact\t of\t this\t early\t learning\t is profound.\t As\t one\t report\t sums\t up\t the\t key\t emotional\t lesson\t of\t life\u2019s first\tfour\tyears,\tthe\tlasting\tconsequences\tare\tgreat: A\t child\t who\t cannot\t focus\t his\t attention,\t who\t is\t suspicious\t rather\t than\t trusting,\t sad\t or angry\t rather\t than\t optimistic,\t destructive\t rather\t than\t respectful\t and\t one\t who\t is overcome\t with\t anxiety,\t preoccupied\t with\t frightening\t fantasy\t and\t feels\t generally unhappy\t about\t himself\u2014such\t a\t child\t has\t little\t opportunity\t at\t all,\t let\t alone\t equal opportunity,\tto\tclaim\tthe\tpossibilities\tof\tthe\tworld\tas\this\town.9 HOW\tTO\tRAISE\tA\tBULLY Much\t can\t be\t learned\t about\t the\t lifelong\t effects\t of\t emotionally\t inept parenting\u2014particularly\t its\t role\t in\t making\t children\t aggressive\u2014from longitudinal\t studies\t such\t as\t one\t of\t 870\t children\t from\t upstate\t New York\t who\t were\t followed\t from\t the\t time\t they\t were\t eight\t until\t they were\t thirty.10\t The\t most\t belligerent\t among\t the\t children\u2014those quickest\tto\tstart\tfights\tand\twho\thabitually\tused\tforce\tto\tget\ttheir\tway \u2014were\t the\t most\t likely\t to\t have\t dropped\t out\t of\t school\t and,\t by\t age thirty,\tto\thave\ta\trecord\tfor\tcrimes\tof\tviolence.\tThey\talso\tseemed\tto\tbe handing\t down\t their\t propensity\t to\t violence:\t their\t children\t were,\t in grade\t school,\t just\t like\t the\t troublemakers\t their\t delinquent\t parent\t had","been. There\tis\ta\tlesson\tin\thow\taggressiveness\tis\tpassed\tfrom\tgeneration\tto generation.\t Any\t inherited\t propensities\t aside,\t the\t troublemakers\t as grownups\tacted\tin\ta\tway\tthat\tmade\tfamily\tlife\ta\tschool\tfor\taggression. As\tchildren,\tthe\ttroublemakers\thad\tparents\twho\tdisciplined\tthem\twith arbitrary,\t relentless\t severity;\t as\t parents\t they\t repeated\t the\t pattern. This\t was\t true\t whether\t it\t had\t been\t the\t father\t or\t the\t mother\t who\t had been\t identified\t in\t childhood\t as\t highly\t aggressive.\t Aggressive\t little girls\t grew\t up\t to\t be\t just\t as\t arbitrary\t and\t harshly\t punitive\t when\t they became\t mothers\t as\t the\t aggressive\t boys\t were\t as\t fathers.\t And\t while they\tpunished\ttheir\tchildren\twith\tspecial\tseverity,\tthey\totherwise\ttook little\tinterest\tin\ttheir\tchildren\u2019s\tlives,\tin\teffect\tignoring\tthem\tmuch\tof the\ttime.\tAt\tthe\tsame\ttime\tthe\tparents\toffered\tthese\tchildren\ta\tvivid\u2014 and\t violent\u2014example\t of\t aggressiveness,\t a\t model\t the\t children\t took with\t them\t to\t school\t and\t to\t the\t playground,\t and\t followed\t throughout life.\t The\t parents\t were\t not\t necessarily\t mean-spirited,\t nor\t did\t they\t fail to\t wish\t the\t best\t for\t their\t children;\t rather,\t they\t seemed\t to\t be\t simply repeating\t the\t style\t of\t parenting\t that\t had\t been\t modeled\t for\t them\t by their\town\tparents. In\t this\t model\t for\t violence,\t these\t children\t were\t disciplined capriciously:\t if\t their\t parents\t were\t in\t a\t bad\t mood,\t they\t would\t be severely\t punished;\t if\t their\t parents\t were\t in\t a\t good\t mood,\t they\t could get\taway\twith\tmayhem\tat\thome.\tThus\tpunishment\tcame\tnot\tso\tmuch because\t of\t what\t the\t child\t had\t done,\t but\t by\t virtue\t of\t how\t the\t parent felt.\tThis\tis\ta\trecipe\tfor\tfeelings\tof\tworthlessness\tand\thelplessness,\tand for\tthe\tsense\tthat\tthreats\tare\teverywhere\tand\tmay\tstrike\tat\tany\ttime. Seen\t in\t light\t of\t the\t home\t life\t that\t spawns\t it,\t such\t children\u2019s combative\t and\t defiant\t posture\t toward\t the\t world\t at\t large\t makes\t a certain\tsense,\tunfortunate\tthough\tit\tremains.\tWhat\tis\tdisheartening\tis how\t early\t these\t dispiriting\t lessons\t can\t be\t learned,\t and\t how\t grim\t the costs\tfor\ta\tchild\u2019s\temotional\tlife\tcan\tbe. ABUSE:\tTHE\tEXTINCTION\tOF\tEMPATHY In\t the\t rough-and-tumble\t play\t of\t the\t day-care\t center,\t Martin,\t just\t two\t and\t a\t half, brushed\tup\tagainst\ta\tlittle\tgirl,\twho,\tinexplicably,\tbroke\tout\tcrying.\tMartin\treached\tfor her\thand,\tbut\tas\tthe\tsobbing\tgirl\tmoved\taway,\tMartin\tslapped\ther\ton\tthe\tarm. As\ther\ttears\tcontinued\tMartin\tlooked\taway\tand\tyelled,\t\u201cCut\tit\tout!\tCut\tit\tout!\u201d\tover and\tover,\teach\ttime\tfaster\tand\tlouder.","When\t Martin\t then\t made\t another\t attempt\t to\t pat\t her,\t again\t she\t resisted.\t This\t time Martin\tbared\this\tteeth\tlike\ta\tsnarling\tdog,\thissing\tat\tthe\tsobbing\tgirl. Once\t more\t Martin\t started\t patting\t the\t crying\t girl,\t but\t the\t pats\t on\t the\t back\t quickly turned\t into\t pounding,\t and\t Martin\t went\t on\t hitting\t and\t hitting\t the\t poor\t little\t girl despite\ther\tscreams. That\t disturbing\t encounter\t testifies\t to\t how\t abuse\u2014being\t beaten repeatedly,\t at\t the\t whim\t of\t a\t parent\u2019s\t moods\u2014warps\t a\t child\u2019s\t natural bent\ttoward\tempathy.11\tMartin\u2019s\tbizarre,\talmost\tbrutal\tresponse\tto\this playmate\u2019s\t distress\t is\t typical\t of\t children\t like\t him,\t who\t have themselves\t been\t the\t victims\t of\t beatings\t and\t other\t physical\t abuse since\t their\t infancy.\t The\t response\t stands\t in\t stark\t contrast\t to\t toddlers\u2019 usual\t sympathetic\t entreaties\t and\t attempts\t to\t console\t a\t crying playmate,\treviewed\tin\tChapter\t7.\tMartin\u2019s\tviolent\tresponse\tto\tdistress at\tthe\tday-care\tcenter\tmay\twell\tmirror\tthe\tlessons\the\tlearned\tat\thome about\t tears\t and\t anguish:\t crying\t is\t met\t at\t first\t with\t a\t peremptory consoling\t gesture,\t but\t if\t it\t continues,\t the\t progression\t is\t from\t nasty looks\t and\t shouts,\t to\t hitting,\t to\t outright\t beating.\t Perhaps\t most troubling,\t Martin\t already\t seems\t to\t lack\t the\t most\t primitive\t sort\t of empathy,\tthe\tinstinct\tto\tstop\taggression\tagainst\tsomeone\twho\tis\thurt. At\t two\t and\t a\t half\t he\t displays\t the\t budding\t moral\t impulses\t of\t a\t cruel and\tsadistic\tbrute. Martin\u2019s\t meanness\t in\t place\t of\t empathy\t is\t typical\t of\t other\t children like\t him\t who\t are\t already,\t at\t their\t tender\t age,\t scarred\t by\t severe physical\tand\temotional\tabuse\tat\thome.\tMartin\twas\tpart\tof\ta\tgroup\tof nine\t such\t toddlers,\t ages\t one\t to\t three,\t witnessed\t in\t a\t two-hour observation\t at\t his\t day-care\t center.\t The\t abused\t toddlers\t were compared\t with\t nine\t others\t at\t the\t day-care\t center\t from\t equally impoverished,\thigh-stress\thomes,\tbut\twho\twere\tnot\tphysically\tabused. The\t differences\t in\t how\t the\t two\t groups\t of\t toddlers\t reacted\t when another\t child\t was\t hurt\t or\t upset\t were\t stark.\t Of\t twenty-three\t such incidents,\t five\t of\t the\t nine\t nonabused\t toddlers\t responded\t to\t the distress\t of\t a\t child\t nearby\t with\t concern,\t sadness,\t or\t empathy.\t But\t in the\t twenty-seven\t instances\t where\t the\t abused\t children\t could\t have done\t so,\t not\t one\t showed\t the\t least\t concern;\t instead\t they\t reacted\t to\t a crying\tchild\twith\texpressions\tof\tfear,\tanger,\tor,\tlike\tMartin,\ta\tphysical attack. One\t abused\t little\t girl,\t for\t instance,\t made\t a\t ferocious,\t threatening face\tat\tanother\twho\thad\tbroken\tout\tinto\ttears.\tOne-year-old\tThomas, another\tof\tthe\tabused\tchildren,\tfroze\tin\tterror\twhen\the\theard\ta\tchild","crying\t across\t the\t room;\t he\t sat\t completely\t still,\t his\t face\t full\t of\t fear, back\tstiffly\tstraight,\this\ttension\tincreasing\tas\tthe\tcrying\tcontinued\u2014as though\t bracing\t for\t an\t attack\t himself.\t And\t twenty-eight-month-old Kate,\t also\t abused,\t was\t almost\t sadistic:\t picking\t on\t Joey,\t a\t smaller infant,\t she\t knocked\t him\t to\t the\t ground\t with\t her\t feet,\t and\t as\t he\t lay there\t looked\t tenderly\t at\t him\t and\t began\t patting\t him\t gently\t on\t the back\u2014only\t to\t intensify\t the\t pats\t into\t hitting\t him\t harder\t and\t harder, ignoring\this\tmisery.\tShe\tkept\tswinging\taway\tat\thim,\tleaning\tin\tto\tslug him\tsix\tor\tseven\ttimes\tmore,\tuntil\the\tcrawled\taway. These\tchildren,\tof\tcourse,\ttreat\tothers\tas\tthey\tthemselves\thave\tbeen treated.\tAnd\tthe\tcallousness\tof\tthese\tabused\tchildren\tis\tsimply\ta\tmore extreme\t version\t of\t that\t seen\t in\t children\t whose\t parents\t are\t critical, threatening,\t and\t harsh\t in\t their\t punishments.\t Such\t children\t also\t tend to\t lack\t concern\t when\t playmates\t get\t hurt\t or\t cry;\t they\t seem\t to represent\t one\t end\t of\t a\t continuum\t of\t coldness\t that\t peaks\t with\t the brutality\tof\tthe\tabused\tchildren.\tAs\tthey\tgo\ton\tthrough\tlife,\tthey\tare, as\ta\tgroup,\tmore\tlikely\tto\thave\tcognitive\tdifficulties\tin\tlearning,\tmore likely\tto\tbe\taggressive\tand\tunpopular\twith\ttheir\tpeers\t(small\twonder, if\ttheir\tpreschool\ttoughness\tis\ta\tharbinger\tof\tthe\tfuture),\tmore\tprone to\t depression,\t and,\t as\t adults,\t more\t likely\t to\t get\t into\t trouble\t with\t the law\tand\tcommit\tmore\tcrimes\tof\tviolence.12 This\t failure\t of\t empathy\t is\t sometimes,\t if\t not\t often,\t repeated\t over generations,\twith\tbrutal\tparents\thaving\tthemselves\tbeen\tbrutalized\tby their\town\tparents\tin\tchildhood.13\tIt\tstands\tin\tdramatic\tcontrast\tto\tthe empathy\t ordinarily\t displayed\t by\t children\t of\t parents\t who\t are nurturing,\t encouraging\t their\t toddlers\t to\t show\t concern\t for\t others\t and to\tunderstand\thow\tmeanness\tmakes\tother\tchildren\tfeel.\tLacking\tsuch lessons\tin\tempathy,\tthese\tchildren\tseem\tnot\tto\tlearn\tit\tat\tall. What\t is\t perhaps\t most\t troubling\t about\t the\t abused\t toddlers\t is\t how early\tthey\tseem\tto\thave\tlearned\tto\trespond\tlike\tminiature\tversions\tof their\t own\t abusive\t parents.\t But\t given\t the\t physical\t beatings\t they received\t as\t a\t sometimes\t daily\t diet,\t the\t emotional\t lessons\t are\t all\t too clear.\t Remember\t that\t it\t is\t in\t moments\t when\t passions\t run\t high\t or\t a crisis\t is\t upon\t us\t that\t the\t primitive\t proclivities\t of\t the\t brain\u2019s\t limbic centers\ttake\ton\ta\tmore\tdominant\trole.\tAt\tsuch\tmoments\tthe\thabits\tthe emotional\tbrain\thas\tlearned\tover\tand\tover\twill\tdominate,\tfor\tbetter\tor worse. Seeing\t how\t the\t brain\t itself\t is\t shaped\t by\t brutality\u2014or\t by\t love\u2014 suggests\t that\t childhood\t represents\t a\t special\t window\t of\t opportunity for\t emotional\t lessons.\t These\t battered\t children\t have\t had\t an\t early\t and","steady\t diet\t of\t trauma.\t Perhaps\t the\t most\t instructive\t paradigm\t for understanding\t the\t emotional\t learning\t such\t abused\t children\t have undergone\tis\tin\tseeing\thow\ttrauma\tcan\tleave\ta\tlasting\timprint\ton\tthe brain\u2014and\thow\teven\tthese\tsavage\timprints\tcan\tbe\tmended.","13 Trauma\tand\tEmotional\tRelearning Som\tChit,\ta\tCambodian\trefugee,\tbalked\twhen\ther\tthree\tsons\tasked\ther to\t buy\t them\t toy\t AK-47\t machine\t guns.\t Her\t sons\u2014ages\t six,\t nine,\t and eleven\u2014wanted\t the\t toy\t guns\t to\t play\t the\t game\t some\t of\t the\t kids\t at their\t school\t called\t Purdy.\t In\t the\t game,\t Purdy,\t the\t villain,\t uses\t a submachine\t gun\t to\t massacre\t a\t group\t of\t children,\t then\t turns\t it\t on himself.\t Sometimes,\t though,\t the\t children\t have\t it\t end\t differently:\t it\t is they\twho\tkill\tPurdy. Purdy\twas\tthe\tmacabre\treenactment\tby\tsome\tof\tthe\tsurvivors\tof\tthe catastrophic\t events\t of\t February\t 17,\t 1989,\t at\t Cleveland\t Elementary School\tin\tStockton,\tCalifornia.\tThere,\tduring\tthe\tschool\u2019s\tlate-morning recess\t for\t first,\t second,\t and\t third\t graders,\t Patrick\t Purdy\u2014who\t had himself\t attended\t those\t grades\t at\t Cleveland\t Elementary\t some\t twenty years\t earlier\u2014stood\t at\t the\t playground\u2019s\t edge\t and\t fired\t wave\t after wave\t of\t 7.22\t mm\t bullets\t at\t the\t hundreds\t of\t children\t at\t play.\t For seven\tminutes\tPurdy\tsprayed\tbullets\ttoward\tthe\tplayground,\tthen\tput a\t pistol\t to\t his\t head\t and\t shot\t himself.\t When\t the\t police\t arrived\t they found\tfive\tchildren\tdying,\ttwenty-nine\twounded. In\t ensuing\t months,\t the\t Purdy\t game\t spontaneously\t appeared\t in\t the play\tof\tboys\tand\tgirls\tat\tCleveland\tElementary,\tone\tof\tmany\tsigns\tthat those\t seven\t minutes\t and\t their\t aftermath\t were\t seared\t into\t the children\u2019s\t memory.\t When\t I\t visited\t the\t school,\t just\t a\t short\t bike\t ride from\t the\t neighborhood\t near\t the\t University\t of\t the\t Pacific\t where\t I myself\thad\tgrown\tup,\tit\twas\tfive\tmonths\tafter\tPurdy\thad\tturned\tthat recess\t into\t a\t nightmare.\t His\t presence\t was\t still\t palpable,\t even\t though the\t most\t horrific\t of\t the\t grisly\t remnants\t of\t the\t shooting\u2014swarms\t of bullet\t holes,\t pools\t of\t blood,\t bits\t of\t flesh,\t skin,\t and\t scalp\u2014were\t gone by\tthe\tmorning\tafter\tthe\tshooting,\twashed\taway\tand\tpainted\tover. By\t then\t the\t deepest\t scars\t at\t Cleveland\t Elementary\t were\t not\t to\t the building\t but\t to\t the\t psyches\t of\t the\t children\t and\t staff\t there,\t who\t were trying\t to\t carry\t on\t with\t life\t as\t usual.1\t Perhaps\t most\t striking\t was\t how the\tmemory\tof\tthose\tfew\tminutes\twas\trevived\tagain\tand\tagain\tby\tany small\t detail\t that\t was\t similar\t in\t the\t least.\t A\t teacher\t told\t me,\t for","example,\t that\t a\t wave\t of\t fright\t swept\t through\t the\t school\t with\t the announcement\t that\t St.\t Patrick\u2019s\t Day\t was\t coming;\t a\t number\t of\t the children\t somehow\t got\t the\t idea\t that\t the\t day\t was\t to\t honor\t the\t killer, Patrick\tPurdy. \u201cWhenever\twe\thear\tan\tambulance\ton\tits\tway\tto\tthe\trest\thome\tdown the\t street,\t everything\t halts,\u201d\t another\t teacher\t told\t me.\t \u201cThe\t kids\t all listen\t to\t see\t if\t it\t will\t stop\t here\t or\t go\t on.\u201d\t For\t several\t weeks\t many children\twere\tterrified\tof\tthe\tmirrors\tin\tthe\trestrooms;\ta\trumor\tswept the\tschool\tthat\t\u201cBloody\tVirgin\tMary,\u201d\tsome\tkind\tof\tfantasied\tmonster, lurked\tthere.\tWeeks\tafter\tthe\tshooting\ta\tfrantic\tgirl\tcame\trunning\tup to\t the\t school\u2019s\t principal,\t Pat\t Busher,\t yelling,\t \u201cI\t hear\t shots!\t I\t hear shots!\u201d\tThe\tsound\twas\tfrom\tthe\tswinging\tchain\ton\ta\ttetherball\tpole. Many\t children\t became\t hypervigilant,\t as\t though\t continually\t on guard\t against\t a\t repetition\t of\t the\t terror;\t some\t boys\t and\t girls\t would hover\tat\trecess\tnext\tto\tthe\tclassroom\tdoors,\tnot\tdaring\tto\tventure\tout to\tthe\tplayground\twhere\tthe\tkillings\thad\toccurred.\tOthers\twould\tonly play\t in\t small\t groups,\t posting\t a\t designated\t child\t as\t lookout.\t Many continued\t for\t months\t to\t avoid\t the\t \u201cevil\u201d\t areas,\t where\t children\t had died. The\t memories\t lived\t on,\t too,\t as\t disturbing\t dreams,\t intruding\t into the\t children\u2019s\t unguarded\t minds\t as\t they\t slept.\t Apart\t from\t nightmares repeating\tthe\tshooting\titself\tin\tsome\tway,\tchildren\twere\tflooded\twith anxiety\t dreams\t that\t left\t them\t apprehensive\t that\t they\t too\t would\t die soon.\t Some\t children\t tried\t to\t sleep\t with\t their\t eyes\t open\t so\t they wouldn\u2019t\tdream. All\tof\tthese\treactions\tare\twell\tknown\tto\tpsychiatrists\tas\tamong\tthe key\t symptoms\t of\t post-traumatic\t stress\t disorder,\t or\t PTSD.\t At\t the\t core of\t such\t trauma,\t says\t Dr.\t Spencer\t Eth,\t a\t child\t psychiatrist\t who specializes\t in\t PTSD\t in\t children,\t is\t \u201cthe\t intrusive\t memory\t of\t the central\tviolent\taction:\tthe\tfinal\tblow\twith\ta\tfist,\tthe\tplunge\tof\ta\tknife, the\t blast\t of\t a\t shotgun.\t The\t memories\t are\t intense\t perceptual experiences\u2014the\t sight,\t sound,\t and\t smell\t of\t gunfire;\t the\t screams\t or sudden\tsilence\tof\tthe\tvictim;\tthe\tsplash\tof\tblood;\tthe\tpolice\tsirens.\u201d These\t vivid,\t terrifying\t moments,\t neuroscientists\t now\t say,\t become memories\t emblazoned\t in\t the\t emotional\t circuitry.\t The\t symptoms\t are, in\t effect,\t signs\t of\t an\t overaroused\t amygdala\t impelling\t the\t vivid memories\tof\ta\ttraumatic\tmoment\tto\tcontinue\tto\tintrude\ton\tawareness. As\t such,\t the\t traumatic\t memories\t become\t mental\t hair\t triggers,\t ready to\tsound\tan\talarm\tat\tthe\tleast\thint\tthat\tthe\tdread\tmoment\tis\tabout\tto happen\t once\t again.\t This\t hair-trigger\t phenomenon\t is\t a\t hallmark\t of","emotional\t trauma\t of\t all\t kinds,\t including\t suffering\t repeated\t physical abuse\tin\tchildhood. Any\t traumatizing\t event\t can\t implant\t such\t trigger\t memories\t in\t the amygdala:\t a\t fire\t or\t an\t auto\t accident,\t being\t in\t a\t natural\t catastrophe such\t as\t an\t earthquake\t or\t a\t hurricane,\t being\t raped\t or\t mugged. Hundreds\tof\tthousands\tof\tpeople\teach\tyear\tendure\tsuch\tdisasters,\tand many\t or\t most\t come\t away\t with\t the\t kind\t of\t emotional\t wounding\t that leaves\tits\timprint\ton\tthe\tbrain. Violent\tacts\tare\tmore\tpernicious\tthan\tnatural\tcatastrophes\tsuch\tas\ta hurricane\t because,\t unlike\t victims\t of\t a\t natural\t disaster,\t victims\t of violence\t feel\t themselves\t to\t have\t been\t intentionally\t selected\t as\t the target\t of\t malevolence.\t That\t fact\t shatters\t assumptions\t about\t the trustworthiness\tof\tpeople\tand\tthe\tsafety\tof\tthe\tinterpersonal\tworld,\tan assumption\t natural\t catastrophes\t leave\t untouched.\t Within\t an\t instant, the\tsocial\tworld\tbecomes\ta\tdangerous\tplace,\tone\tin\twhich\tpeople\tare potential\tthreats\tto\tyour\tsafety. Human\tcruelties\tstamp\ttheir\tvictims\u2019\tmemories\twith\ta\ttemplate\tthat regards\twith\tfear\tanything\tvaguely\tsimilar\tto\tthe\tassault\titself.\tA\tman who\twas\tstruck\ton\tthe\tback\tof\this\thead,\tnever\tseeing\this\tattacker,\twas so\t frightened\t afterward\t that\t he\t would\t try\t to\t walk\t down\t the\t street directly\tin\tfront\tof\tan\told\tlady\tto\tfeel\tsafe\tfrom\tbeing\thit\ton\tthe\thead again.2\tA\twoman\twho\twas\tmugged\tby\ta\tman\twho\tgot\ton\tan\televator with\ther\tand\tforced\ther\tout\tat\tknifepoint\tto\tan\tunoccupied\tfloor\twas fearful\tfor\tweeks\tof\tgoing\tinto\tnot\tjust\televators,\tbut\talso\tthe\tsubway or\t any\t other\t enclosed\t space\t where\t she\t might\t feel\t trapped;\t she\t ran from\t her\t bank\t when\t she\t saw\t a\t man\t put\t his\t hand\t in\t his\t jacket\t as\t the mugger\thad\tdone. The\timprint\tof\thorror\tin\tmemory\u2014and\tthe\tresulting\thypervigilance \u2014can\tlast\ta\tlifetime,\tas\ta\tstudy\tof\tHolocaust\tsurvivors\tfound.\tClose\tto fifty\t years\t after\t they\t had\t endured\t semistarvation,\t the\t slaughter\t of their\t loved\t ones,\t and\t constant\t terror\t in\t Nazi\t death\t camps,\t the haunting\t memories\t were\t still\t alive.\t A\t third\t said\t they\t felt\t generally fearful.\t Nearly\t three\t quarters\t said\t they\t still\t became\t anxious\t at reminders\t of\t the\t Nazi\t persecution,\t such\t as\t the\t sight\t of\t a\t uniform,\t a knock\t at\t the\t door,\t dogs\t barking,\t or\t smoke\t rising\t from\t a\t chimney. About\t60\tpercent\tsaid\tthey\tthought\tabout\tthe\tHolocaust\talmost\tdaily, even\t after\t a\t half\t century;\t of\t those\t with\t active\t symptoms,\t as\t many\t as eight\t in\t ten\t still\t suffered\t from\t repeated\t nightmares.\t As\t one\t survivor said,\t \u201cIf\t you\u2019ve\t been\t through\t Auschwitz\t and\t you\t don\u2019t\t have nightmares,\tthen\tyou\u2019re\tnot\tnormal.\u201d","HORROR\tFROZEN\tIN\tMEMORY The\t words\t of\t a\t forty-eight-year-old\t Vietnam\t vet,\t some\t twenty-four years\tafter\tenduring\ta\thorrifying\tmoment\tin\ta\tfaraway\tland: I\t can\u2019t\t get\t the\t memories\t out\t of\t my\t mind!\t The\t images\t come\t flooding\t back\t in\t vivid detail,\ttriggered\tby\tthe\tmost\tinconsequential\tthings,\tlike\ta\tdoor\tslamming,\tthe\tsight\tof an\t Oriental\t woman,\t the\t touch\t of\t a\t bamboo\t mat,\t or\t the\t smell\t of\t stir-fried\t pork.\t Last night\tI\twent\tto\tbed,\twas\thaving\ta\tgood\tsleep\tfor\ta\tchange.\tThen\tin\tthe\tearly\tmorning\ta storm\t front\t passed\t through\t and\t there\t was\t a\t bolt\t of\t crackling\t thunder.\t I\t awoke instantly,\t frozen\t in\t fear.\t I\t am\t right\t back\t in\t Vietnam,\t in\t the\t middle\t of\t the\t monsoon season\t at\t my\t guard\t post.\t I\t am\t sure\t I\u2019ll\t get\t hit\t in\t the\t next\t volley\t and\t convinced\t I\t will die.\t My\t hands\t are\t freezing,\t yet\t sweat\t pours\t from\t my\t entire\t body.\t I\t feel\t each\t hair\t on the\t back\t of\t my\t neck\t standing\t on\t end.\t I\t can\u2019t\t catch\t my\t breath\t and\t my\t heart\t is pounding.\t I\t smell\t a\t damp\t sulfur\t smell.\t Suddenly\t I\t see\t what\u2019s\t left\t of\t my\t buddy Troy\t\u2026\ton\ta\tbamboo\tplatter,\tsent\tback\tto\tour\tcamp\tby\tthe\tVietcong.\u2026\tThe\tnext\tbolt of\tlightning\tand\tclap\tof\tthunder\tmakes\tme\tjump\tso\tmuch\tthat\tI\tfall\tto\tthe\tfloor.3 This\thorrible\tmemory,\tvividly\tfresh\tand\tdetailed\tthough\tmore\tthan two\tdecades\told,\tstill\tholds\tthe\tpower\tto\tinduce\tthe\tsame\tfear\tin\tthis ex-soldier\t that\t he\t felt\t on\t that\t fateful\t day.\t PTSD\t represents\t a\t perilous lowering\t of\t the\t neural\t setpoint\t for\t alarm,\t leaving\t the\t person\t to\t react to\t life\u2019s\t ordinary\t moments\t as\t though\t they\t were\t emergencies.\t The hijacking\t circuit\t discussed\t in\t Chapter\t 2\t seems\t critical\t in\t leaving\t such a\t powerful\t brand\t on\t memory:\t the\t more\t brutal,\t shocking,\t and horrendous\t the\t events\t that\t trigger\t the\t amygdala\t hijacking,\t the\t more indelible\tthe\tmemory.\tThe\tneural\tbasis\tfor\tthese\tmemories\tappears\tto be\ta\tsweeping\talteration\tin\tthe\tchemistry\tof\tthe\tbrain\tset\tin\tmotion\tby a\t single\t instance\t of\t overwhelming\t terror.4\t While\t the\t PTSD\t findings are\t typically\t based\t on\t the\t impact\t of\t a\t single\t episode,\t similar\t results can\tcome\tfrom\tcruelties\tinflicted\tover\ta\tperiod\tof\tyears,\tas\tis\tthe\tcase with\tchildren\twho\tare\tsexually,\tphysically,\tor\temotionally\tabused. The\tmost\tdetailed\twork\ton\tthese\tbrain\tchanges\tis\tbeing\tdone\tat\tthe National\t Center\t for\t Post-Traumatic\t Stress\t Disorder,\t a\t network\t of research\tsites\tbased\tat\tVeterans\u2019\tAdministration\thospitals\twhere\tthere are\tlarge\tpools\tof\tthose\twho\tsuffer\tfrom\tPTSD\tamong\tthe\tveterans\tof Vietnam\t and\t other\t wars.\t It\t is\t from\t studies\t on\t vets\t such\t as\t these\t that most\tof\tour\tknowledge\tof\tPTSD\thas\tcome.\tBut\tthese\tinsights\tapply\tas well\t to\t children\t who\t have\t suffered\t severe\t emotional\t trauma,\t such\t as those\tat\tCleveland\tElementary.","\u201cVictims\t of\t a\t devastating\t trauma\t may\t never\t be\t the\t same biologically,\u201d\t Dr.\t Dennis\t Charney\t told\t me.5\t A\t Yale\t psychiatrist, Charney\tis\tdirector\tof\tclinical\tneuroscience\tat\tthe\tNational\tCenter.\t\u201cIt does\t not\t matter\t if\t it\t was\t the\t incessant\t terror\t of\t combat,\t torture,\t or repeated\t abuse\t in\t childhood,\t or\t a\t one-time\t experience,\t like\t being trapped\t in\t a\t hurricane\t or\t nearly\t dying\t in\t an\t auto\t accident.\t All uncontrollable\tstress\tcan\thave\tthe\tsame\tbiological\timpact.\u201d The\t operative\t word\t is\t uncontrollable.\t If\t people\t feel\t there\t is something\t they\t can\t do\t in\t a\t catastrophic\t situation,\t some\t control\t they can\texert,\tno\tmatter\thow\tminor,\tthey\tfare\tfar\tbetter\temotionally\tthan do\tthose\twho\tfeel\tutterly\thelpless.\tThe\telement\tof\thelplessness\tis\twhat makes\t a\t given\t event\t subjectively\t overwhelming.\t As\t Dr.\t John\t Krystal, director\t of\t the\t center\u2019s\t Laboratory\t of\t Clinical\t Psychopharmacology, told\t me,\t \u201cSay\t someone\t being\t attacked\t with\t a\t knife\t knows\t how\t to defend\t himself\t and\t takes\t action,\t while\t another\t person\t in\t the\t same predicament\t thinks,\t \u2018I\u2019m\t dead.\u2019\t The\t helpless\t person\t is\t the\t one\t more susceptible\t to\t PTSD\t afterward.\t It\u2019s\t the\t feeling\t that\t your\t life\t is\t in danger\tand\t there\u2019s\t nothing\t you\t can\t do\t to\t escape\t it\u2014that\u2019s\tthe\tmoment the\tbrain\tchange\tbegins.\u201d Helplessness\tas\tthe\twild\tcard\tin\ttriggering\tPTSD\thas\tbeen\tshown\tin dozens\tof\tstudies\ton\tpairs\tof\tlaboratory\trats,\teach\tin\ta\tdifferent\tcage, each\tbeing\tgiven\tmild\u2014but,\tto\ta\trat,\tvery\tstressful\u2014electric\tshocks\tof identical\t severity.\t Only\t one\t rat\t has\t a\t lever\t in\t its\t cage;\t when\t the\t rat pushes\tthe\tlever,\tthe\tshock\tstops\tfor\tboth\tcages.\tOver\tdays\tand\tweeks, both\trats\tget\tprecisely\tthe\tsame\tamount\tof\tshock.\tBut\tthe\trat\twith\tthe power\t to\t turn\t the\t shocks\t off\t comes\t through\t without\t lasting\t signs\t of stress.\tIt\tis\tonly\tin\tthe\thelpless\tone\tof\tthe\tpair\tthat\tthe\tstress-induced brain\t changes\t occur.6\t For\t a\t child\t being\t shot\t at\t on\t a\t playground, seeing\t his\t playmates\t bleeding\t and\t dying\u2014or\t for\t a\t teacher\t there, unable\t to\t stop\t the\t carnage\u2014that\t helplessness\t must\t have\t been palpable. PTSD\tAS\tA\tLIMBIC\tDISORDER It\thad\tbeen\tmonths\tsince\ta\thuge\tearthquake\tshook\ther\tout\tof\tbed\tand sent\ther\tyelling\tin\tpanic\tthrough\tthe\tdarkened\thouse\tto\tfind\ther\tfour- year-old\t son.\t They\t huddled\t for\t hours\t in\t the\t Los\t Angeles\t night\t cold under\t a\t protective\t doorway,\t pinned\t there\t without\t food,\t water,\t or light\t while\t wave\t after\t wave\t of\t aftershocks\t tumbled\t the\t ground","beneath\tthem.\tNow,\tmonths\tlater,\tshe\thad\tlargely\trecovered\tfrom\tthe ready\tpanic\tthat\tgripped\ther\tfor\tthe\tfirst\tfew\tdays\tafterward,\twhen\ta door\t slamming\t could\t start\t her\t shivering\t with\t fear.\t The\t one\t lingering symptom\t was\t her\t inability\t to\t sleep,\t a\t problem\t that\t struck\t only\t on those\t nights\t her\t husband\t was\t away\u2014as\t he\t had\t been\t the\t night\t of\t the quake. The\tmain\tsymptoms\tof\tsuch\tlearned\tfearfulness\u2014including\tthe\tmost intense\t kind,\t PTSD\u2014can\t be\t accounted\t for\t by\t changes\t in\t the\t limbic circuitry\t focusing\t on\t the\t amygdala.7\t Some\t of\t the\t key\t changes\t are\t in the\t locus\t ceruleus,\t a\t structure\t that\t regulates\t the\t brain\u2019s\t secretion\t of two\t substances\t called\t catecholamines:\t adrenaline\t and\t noradrenaline. These\t neurochemicals\t mobilize\t the\t body\t for\t an\t emergency;\t the\t same catecholamine\t surge\t stamps\t memories\t with\t special\t strength.\t In\t PTSD this\t system\t becomes\t hyperreactive,\t secreting\t extra-large\t doses\t of these\t brain\t chemicals\t in\t response\t to\t situations\t that\t hold\t little\t or\t no threat\t but\t somehow\t are\t reminders\t of\t the\t original\t trauma,\t like\t the children\t at\t Cleveland\t Elementary\t School\t who\t panicked\t when\t they heard\t an\t ambulance\t siren\t similar\t to\t those\t they\t had\t heard\t at\t their school\tafter\tthe\tshooting. The\tlocus\tceruleus\tand\tthe\tamygdala\tare\tclosely\tlinked,\talong\twith other\t limbic\t structures\t such\t as\t the\t hippocampus\t and\t hypothalamus; the\t circuitry\t for\t the\t catecholamines\t extends\t into\t the\t cortex.\t Changes in\t these\t circuits\t are\t thought\t to\t underlie\t PTSD\t symptoms,\t which include\t anxiety,\t fear,\t hypervigilance,\t being\t easily\t upset\t and\t aroused, readiness\t for\t fight\t or\t flight,\t and\t the\t indelible\t encoding\t of\t intense emotional\tmemories.8\tVietnam\tvets\twith\tPTSD,\tone\tstudy\tfound,\thad 40\t percent\t fewer\t catecholamine-stopping\t receptors\t than\t did\t men without\t the\t symptoms\u2014suggesting\t that\t their\t brains\t had\t undergone\t a lasting\tchange,\twith\ttheir\tcatecholamine\tsecretion\tpoorly\tcontrolled.9 Other\tchanges\toccur\tin\tthe\tcircuit\tlinking\tthe\tlimbic\tbrain\twith\tthe pituitary\t gland,\t which\t regulates\t release\t of\t CRF,\t the\t main\t stress hormone\t the\t body\t secretes\t to\t mobilize\t the\t emergency\t fight-or-flight response.\t The\t changes\t lead\t this\t hormone\t to\t be\t oversecreted\u2014 particularly\t in\t the\t amygdala,\t hippocampus,\t and\t locus\t ceruleus\u2014 alerting\tthe\tbody\tfor\tan\temergency\tthat\tis\tnot\tthere\tin\treality.10 As\t Dr.\t Charles\t Nemeroff,\t a\t Duke\t University\t psychiatrist,\t told\t me, \u201cToo\t much\t CRF\t makes\t you\t overreact.\t For\t example,\t if\t you\u2019re\t a Vietnam\tvet\twith\tPTSD\tand\ta\tcar\tbackfires\tat\tthe\tmall\tparking\tlot,\tit is\t the\t triggering\t of\t CRF\t that\t floods\t you\t with\t the\t same\t feelings\t as\t in the\toriginal\ttrauma:\tyou\tstart\tsweating,\tyou\u2019re\tscared,\tyou\thave\tchills","and\tthe\tshakes,\tyou\tmay\thave\tflashbacks.\tIn\tpeople\twho\thypersecrete CRF,\t the\t startle\t response\t is\t overactive.\t For\t example,\t if\t you\t sneak\t up behind\t most\t people\t and\t suddenly\t clap\t your\t hands,\t you\u2019ll\t see\t a startled\t jump\t the\t first\t time,\t but\t not\t by\t the\t third\t or\t fourth\t repetition. But\t people\t with\t too\t much\t CRF\t don\u2019t\t habituate:\t they\u2019ll\t respond\t as much\tto\tthe\tfourth\tclap\tas\tto\tthe\tfirst.\u201d11 A\t third\t set\t of\t changes\t occurs\t in\t the\t brain\u2019s\t opioid\t system,\t which secretes\t endorphins\t to\t blunt\t the\t feeling\t of\t pain.\t It\t also\t becomes hyperactive.\tThis\tneural\tcircuit\tagain\tinvolves\tthe\tamygdala,\tthis\ttime in\t concert\t with\t a\t region\t in\t the\t cerebral\t cortex.\t The\t opioids\t are\t brain chemicals\t that\t are\t powerful\t numbing\t agents,\t like\t opium\t and\t other narcotics\tthat\tare\tchemical\tcousins.\tWhen\texperiencing\thigh\tlevels\tof opioids\t (\u201cthe\t brain\u2019s\t own\t morphine\u201d),\t people\t have\t a\t heightened tolerance\t for\t pain\u2014an\t effect\t that\t has\t been\t noted\t by\t battlefield surgeons,\twho\tfound\tseverely\twounded\tsoldiers\tneeded\tlower\tdoses\tof narcotics\t to\t handle\t their\t pain\t than\t did\t civilians\t with\t far\t less\t serious injuries. Something\t similar\t seems\t to\t occur\t in\t PTSD.12\t Endorphin\t changes add\t a\t new\t dimension\t to\t the\t neural\t mix\t triggered\t by\t reexposure\t to trauma:\ta\tnumbing\tof\tcertain\tfeelings.\tThis\tappears\tto\texplain\ta\tset\tof \u201cnegative\u201d\t psychological\t symptoms\t long\t noted\t in\t PTSD:\t anhedonia (the\t inability\t to\t feel\t pleasure)\t and\t a\t general\t emotional\t numbness,\t a sense\tof\tbeing\tcut\toff\tfrom\tlife\tor\tfrom\tconcern\tabout\tothers\u2019\tfeelings. Those\tclose\tto\tsuch\tpeople\tmay\texperience\tthis\tindifference\tas\ta\tlack of\tempathy.\tAnother\tpossible\teffect\tmay\tbe\tdissociation,\tincluding\tthe inability\t to\t remember\t crucial\t minutes,\t hours,\t or\t even\t days\t of\t the traumatic\tevent. The\t neural\t changes\t of\t PTSD\t also\t seem\t to\t make\t a\t person\t more susceptible\tto\tfurther\ttraumatizing.\tA\tnumber\tof\tstudies\twith\tanimals have\t found\t that\t when\t they\t were\t exposed\t even\t to\t mild\t stress\t when young,\t they\t were\t far\t more\t vulnerable\t than\t unstressed\t animals\t to trauma-induced\tbrain\tchanges\tlater\tin\tlife\t(suggesting\tthe\turgent\tneed to\ttreat\tchildren\twith\tPTSD).\tThis\tseems\ta\treason\tthat,\texposed\tto\tthe same\t catastrophe,\t one\t person\t goes\t on\t to\t develop\t PTSD\t and\t another does\t not:\t the\t amygdala\t is\t primed\t to\t find\t danger,\t and\t when\t life presents\t it\t once\t again\t with\t real\t danger,\t its\t alarm\t rises\t to\t a\t higher pitch. All\t these\t neural\t changes\t offer\t short-term\t advantages\t for\t dealing with\t the\t grim\t and\t dire\t emergencies\t that\t prompt\t them.\t Under\t duress, it\t is\t adaptive\t to\t be\t highly\t vigilant,\t aroused,\t ready\t for\t anything,","impervious\t to\t pain,\t the\t body\t primed\t for\t sustained\t physical\t demands, and\u2014for\t the\t moment\u2014indifferent\t to\t what\t might\t otherwise\t be intensely\t disturbing\t events.\t These\t short-term\t advantages,\t however, become\tlasting\tproblems\twhen\tthe\tbrain\tchanges\tso\tthat\tthey\tbecome predispositions,\t like\t a\t car\t stuck\t in\t perpetual\t high\t gear.\t When\t the amygdala\t and\t its\t connected\t brain\t regions\t take\t on\t a\t new\t setpoint during\t a\t moment\t of\t intense\t trauma,\t this\t change\t in\t excitability\u2014this heightened\treadiness\tto\ttrigger\ta\tneural\thijacking\u2014means\tall\tof\tlife\tis on\t the\t verge\t of\t becoming\t an\t emergency,\t and\t even\t an\t innocent moment\tis\tsusceptible\tto\tan\texplosion\tof\tfear\trun\tamok. EMOTIONAL\tRELEARNING Such\ttraumatic\tmemories\tseem\tto\tremain\tas\tfixtures\tin\tbrain\tfunction because\t they\t interfere\t with\t subsequent\t learning\u2014specifically,\t with relearning\t a\t more\t normal\t response\t to\t those\t traumatizing\t events.\t In acquired\tfear\tsuch\tas\tPTSD,\tthe\tmechanisms\tof\tlearning\tand\tmemory have\tgone\tawry;\tagain,\tit\tis\tthe\tamygdala\tthat\tis\tkey\tamong\tthe\tbrain regions\tinvolved.\tBut\tin\tovercoming\tthe\tlearned\tfear,\tthe\tneocortex\tis critical. Fear\t conditioning\t is\t the\t name\t psychologists\t use\t for\t the\t process whereby\t something\t that\t is\t not\t in\t the\t least\t threatening\t becomes dreaded\t as\t it\t is\t associated\t in\t someone\u2019s\t mind\t with\t something frightening.\t When\t such\t frights\t are\t induced\t in\t laboratory\t animals, Charney\t notes,\t the\t fears\t can\t last\t for\t years.13\t The\t key\t region\t of\t the brain\t that\t learns,\t retains,\t and\t acts\t on\t this\t fearful\t response\t is\t the circuit\t between\t the\t thalamus,\t amygdala,\t and\t prefrontal\t lobe\u2014the pathway\tof\tneural\thijacking. Ordinarily,\t when\t someone\t learns\t to\t be\t frightened\t by\t something through\t fear\t conditioning,\t the\t fear\t subsides\t with\t time.\t This\t seems\t to happen\t through\t a\t natural\t relearning,\t as\t the\t feared\t object\t is encountered\tagain\tin\tthe\tabsence\tof\tanything\ttruly\tscary.\tThus\ta\tchild who\t acquires\t a\t fear\t of\t dogs\t because\t of\t being\t chased\t by\t a\t snarling German\t shepherd\t gradually\t and\t naturally\t loses\t that\t fear\t if,\t say,\t she moves\t next\t door\t to\t someone\t who\t owns\t a\t friendly\t shepherd,\t and spends\ttime\tplaying\twith\tthe\tdog. In\t PTSD\t spontaneous\t relearning\t fails\t to\t occur.\t Charney\t proposes that\t this\t may\t be\t due\t to\t the\t brain\t changes\t of\t PTSD,\t which\t are\t so strong\t that,\t in\t effect,\t the\t amygdala\t hijacking\t occurs\t every\t time","something\t even\t vaguely\t reminiscent\t of\t the\t original\t trauma\t comes along,\tstrengthening\tthe\tfear\tpathway.\tThis\tmeans\tthat\tthere\tis\tnever a\t time\t when\t what\t is\t feared\t is\t paired\t with\t a\t feeling\t of\t calm\u2014the amygdala\t never\t relearns\t a\t more\t mild\t reaction.\t \u201cExtinction\u201d\t of\t the fear,\t he\t observes,\t \u201cappears\t to\t involve\t an\t active\t learning\t process,\u201d which\t is\t itself\t impaired\t in\t people\t with\t PTSD,\t \u201cleading\t to\t the abnormal\tpersistence\tof\temotional\tmemories.\u201d14 But\t given\t the\t right\t experiences,\t even\t PTSD\t can\t lift;\t strong emotional\t memories,\t and\t the\t patterns\t of\t thought\t and\t reaction\t that they\ttrigger,\tcan\tchange\twith\ttime.\tThis\trelearning,\tCharney\tproposes, is\t cortical.\t The\t original\t fear\t ingrained\t in\t the\t amygdala\t does\t not\t go away\tcompletely;\trather,\tthe\tprefrontal\tcortex\tactively\tsuppresses\tthe amygdala\u2019s\tcommand\tto\tthe\trest\tof\tthe\tbrain\tto\trespond\twith\tfear. \u201cThe\t question\t is,\t how\t quickly\t do\t you\t let\t go\t of\t learned\t fear?\u201d\t asks Richard\t Davidson,\t the\t University\t of\t Wisconsin\t psychologist\t who discovered\t the\t role\t of\t the\t left\t prefrontal\t cortex\t as\t a\t damper\t on distress.\t In\t a\t laboratory\t experiment\t in\t which\t people\t first\t learned\t an aversion\t to\t a\t loud\t noise\u2014a\t paradigm\t for\t learned\t fear,\t and\t a\t lower- key\t parallel\t of\t PTSD\u2014Davidson\t found\t that\t people\t who\t had\t more activity\t in\t the\t left\t prefrontal\t cortex\t got\t over\t the\t acquired\t fear\t more quickly,\t again\t suggesting\t a\t cortical\t role\t in\t letting\t go\t of\t learned distress.15 REEDUCATING\tTHE\tEMOTIONAL\tBRAIN One\tof\tthe\tmore\tencouraging\tfindings\tabout\tPTSD\tcame\tfrom\ta\tstudy of\t Holocaust\t survivors,\t about\t three\t quarters\t of\t whom\t were\t found\t to have\t active\t PTSD\t symptoms\t even\t a\t half\t century\t later.\t The\t positive finding\t was\t that\t a\t quarter\t of\t the\t survivors\t who\t once\t had\t been troubled\tby\tsuch\tsymptoms\tno\tlonger\thad\tthem;\tsomehow\tthe\tnatural events\t of\t their\t lives\t had\t counteracted\t the\t problem.\t Those\t who\t still had\t the\t symptoms\t showed\t evidence\t of\t the\t catecholamine-related brain\t changes\t typical\t of\t PTSD\u2014but\t those\t who\t had\t recovered\t had\t no such\t changes.16\t This\t finding,\t and\t others\t like\t it,\t hold\t out\t the\t promise that\tthe\tbrain\tchanges\tin\tPTSD\tare\tnot\tindelible,\tand\tthat\tpeople\tcan recover\tfrom\teven\tthe\tmost\tdire\temotional\timprinting\u2014in\tshort,\tthat the\t emotional\t circuitry\t can\t be\t reeducated.\t The\t good\t news,\t then,\t is that\ttraumas\tas\tprofound\tas\tthose\tcausing\tPTSD\tcan\theal,\tand\tthat\tthe route\tto\tsuch\thealing\tis\tthrough\trelearning.","One\t way\t this\t emotional\t healing\t seems\t to\t occur\t spontaneously\u2014at least\t in\t children\u2014is\t through\t such\t games\t as\t Purdy.\t These\t games, played\t over\t and\t over\t again,\t let\t children\t relive\t a\t trauma\t safely,\t as play.\t This\t allows\t two\t avenues\t for\t healing:\t on\t the\t one\t hand,\t the memory\t repeats\t in\t a\t context\t of\t low\t anxiety,\t desensitizing\t it\t and allowing\ta\tnontraumatized\tset\tof\tresponses\tto\tbecome\tassociated\twith it.\t Another\t route\t to\t healing\t is\t that,\t in\t their\t minds,\t children\t can magically\t give\t the\t tragedy\t another,\t better\t outcome:\t sometimes\t in playing\t Purdy,\t the\t children\t kill\t him,\t boosting\t their\t sense\t of\t mastery over\tthat\ttraumatic\tmoment\tof\thelplessness. Games\t like\t Purdy\t are\t predictable\t in\t younger\t children\t who\t have been\t through\t such\t overwhelming\t violence.\t These\t macabre\t games\t in traumatized\t children\t were\t first\t noted\t by\t Dr.\t Lenore\t Terr,\t a\t child psychiatrist\tin\tSan\tFrancisco.17\tShe\tfound\tsuch\tgames\tamong\tchildren in\tChowchilla,\tCalifornia\u2014just\ta\tlittle\tover\tan\thour\tdown\tthe\tCentral Valley\t from\t Stockton,\t where\t Purdy\t wreaked\t such\t havoc\u2014who\t in 1973\t had\t been\t kidnapped\t as\t they\t rode\t a\t bus\t home\t from\t a\t summer day\t camp.\t The\t kidnappers\t buried\t the\t bus,\t children\t and\t all,\t in\t an ordeal\tthat\tlasted\ttwenty-seven\thours. Five\t years\t later\t Terr\t found\t the\t kidnapping\t still\t being\t reenacted\t in the\t victims\u2019\t games.\t Girls,\t for\t example,\t played\t symbolic\t kidnapping games\t with\t their\t Barbie\t dolls.\t One\t girl,\t who\t had\t hated\t the\t feeling\t of other\t children\u2019s\t urine\t on\t her\t skin\t as\t they\t lay\t huddled\t together\t in terror,\t washed\t her\t Barbie\t over\t and\t over\t again.\t Another\t played Traveling\t Barbie,\t in\t which\t Barbie\t travels\t somewhere\u2014it\t doesn\u2019t matter\t where\u2014and\t returns\t safely,\t which\t is\t the\t point\t of\t the\t game.\t A third\tgirl\u2019s\tfavorite\twas\ta\tscenario\tin\twhich\tthe\tdoll\tis\tstuck\tin\ta\thole and\tsuffocates. While\t adults\t who\t have\t been\t through\t overwhelming\t trauma\t can suffer\t a\t psychic\t numbing,\t blocking\t out\t memory\t of\t or\t feeling\t about the\t catastrophe,\t children\u2019s\t psyches\t often\t handle\t it\t differently.\t They less\toften\tbecome\tnumb\tto\tthe\ttrauma,\tTerr\tbelieves,\tbecause\tthey\tuse fantasy,\tplay,\tand\tdaydreams\tto\trecall\tand\trethink\ttheir\tordeals.\tSuch voluntary\t replays\t of\t trauma\t seem\t to\t head\t off\t the\t need\t for\t damming them\t up\t in\t potent\t memories\t that\t can\t later\t burst\t through\t as flashbacks.\t If\t the\t trauma\t is\t minor,\t such\t as\t going\t to\t the\t dentist\t for\t a filling,\t just\t once\t or\t twice\t may\t be\t enough.\t But\t if\t it\u2019s\t overwhelming,\t a child\t needs\t endless\t repetitions,\t replaying\t the\t trauma\t over\t and\t over again\tin\ta\tgrim,\tmonotonous\tritual. One\tway\tto\tget\tat\tthe\tpicture\tfrozen\tin\tthe\tamygdala\tis\tthrough\tart,","which\t itself\t is\t a\t medium\t of\t the\t unconscious.\t The\t emotional\t brain\t is highly\t attuned\t to\t symbolic\t meanings\t and\t to\t the\t mode\t Freud\t called the\t \u201cprimary\t process\u201d:\t the\t messages\t of\t metaphor,\t story,\t myth,\t the arts.\t This\t avenue\t is\t often\t used\t in\t treating\t traumatized\t children. Sometimes\tart\tcan\topen\tthe\tway\tfor\tchildren\tto\ttalk\tabout\ta\tmoment of\thorror\tthat\tthey\twould\tnot\tdare\tspeak\tof\totherwise. Spencer\t Eth,\t the\t Los\t Angeles\t child\t psychiatrist\t who\t specializes\t in treating\t such\t children,\t tells\t of\t a\t five-year-old\t boy\t who\t had\t been kidnapped\twith\this\tmother\tby\ther\tex-lover.\tThe\tman\tbrought\tthem\tto a\tmotel\troom,\twhere\the\tordered\tthe\tboy\tto\thide\tunder\ta\tblanket\twhile he\t beat\t the\t mother\t to\t death.\t The\t boy\t was,\t understandably,\t reluctant to\t talk\t with\t Eth\t about\t the\t mayhem\t he\t had\t heard\t and\t seen\t while underneath\t the\t blanket.\t So\t Eth\t asked\t him\t to\t draw\t a\t picture\u2014any picture. The\tdrawing\twas\tof\ta\trace-car\tdriver\twho\thad\ta\tstrikingly\tlarge\tpair of\teyes,\tEth\trecalls.\tThe\thuge\teyes\tEth\ttook\tto\trefer\tto\tthe\tboy\u2019s\town daring\t in\t peeking\t at\t the\t killer.\t Such\t hidden\t references\t to\t the traumatic\t scene\t almost\t always\t appear\t in\t the\t artwork\t of\t traumatized children;\t Eth\t has\t made\t having\t such\t children\t draw\t a\t picture\t the opening\tgambit\tin\ttherapy.\tThe\tpotent\tmemories\tthat\tpreoccupy\tthem intrude\t in\t their\t art\t just\t as\t in\t their\t thoughts.\t Beyond\t that,\t the\t act\t of drawing\t is\t itself\t therapeutic,\t beginning\t the\t process\t of\t mastering\t the trauma. EMOTIONAL\tRELEARNING\tAND\tRECOVERY\tFROM\tTRAUMA Irene\thad\tgone\ton\ta\tdate\tthat\tended\tin\tattempted\trape.\tThough\tshe\thad\tfought\toff\tthe attacker,\t he\t continued\t to\t plague\t her:\t harassing\t her\t with\t obscene\t phone\t calls,\t making threats\t of\t violence,\t calling\t in\t the\t middle\t of\t the\t night,\t stalking\t her\t and\t watching\t her every\tmove.\tOnce,\twhen\tshe\ttried\tto\tget\tthe\tpolice\tto\thelp,\tthey\tdismissed\ther\tproblem as\ttrivial,\tsince\t\u201cnothing\thad\treally\thappened.\u201d\tBy\tthe\ttime\tshe\tcame\tfor\ttherapy\tIrene had\tsymptoms\tof\tPTSD,\thad\tgiven\tup\tsocializing\tat\tall,\tand\tfelt\ta\tprisoner\tin\ther\town house. Irene\u2019s\t case\t is\t cited\t by\t Dr.\t Judith\t Lewis\t Herman,\t a\t Harvard psychiatrist\twhose\tgroundbreaking\twork\toutlines\tthe\tsteps\tto\trecovery from\t trauma.\t Herman\t sees\t three\t stages:\t attaining\t a\t sense\t of\t safety, remembering\t the\t details\t of\t the\t trauma\t and\t mourning\t the\t loss\t it\t has brought,\tand\tfinally\treestablishing\ta\tnormal\tlife.\tThere\tis\ta\tbiological","logic\t to\t the\t ordering\t of\t these\t steps,\t as\t we\t shall\t see:\t this\t sequence seems\t to\t reflect\t how\t the\t emotional\t brain\t learns\t once\t again\t that\t life need\tnot\tbe\tregarded\tas\tan\temergency\tabout\tto\thappen. The\t first\t step,\t regaining\t a\t sense\t of\t safety,\t presumably\t translates\t to finding\t ways\t to\t calm\t the\t too-fearful,\t too\t easily\t triggered\t emotional circuits\t enough\t to\t allow\t relearning.18\t Often\t this\t begins\t with\t helping patients\t understand\t that\t their\t jumpiness\t and\t nightmares, hypervigilance\t and\t panics,\t are\t part\t of\t the\t symptoms\t of\t PTSD.\t This understanding\tmakes\tthe\tsymptoms\tthemselves\tless\tfrightening. Another\t early\t step\t is\t to\t help\t patients\t regain\t some\t sense\t of\t control over\t what\t is\t happening\t to\t them,\t a\t direct\t unlearning\t of\t the\t lesson\t of helplessness\t that\t the\t trauma\t itself\t imparted.\t Irene,\t for\t example, mobilized\ther\tfriends\tand\tfamily\tto\tform\ta\tbuffer\tbetween\ther\tand\ther stalker,\tand\twas\table\tto\tget\tthe\tpolice\tto\tintervene. The\t sense\t in\t which\t PTSD\t patients\t feel\t \u201cunsafe\u201d\t goes\t beyond\t fears that\t dangers\t lurk\t around\t them;\t their\t insecurity\t begins\t more intimately,\t in\t the\t feeling\t that\t they\t have\t no\t control\t over\t what\t is happening\tin\ttheir\tbody\tand\tto\ttheir\temotions.\tThis\tis\tunderstandable, given\t the\t hair\t trigger\t for\t emotional\t hijacking\t that\t PTSD\t creates\t by hypersensitizing\tthe\tamygdala\tcircuitry. Medication\t offers\t one\t way\t to\t restore\t patients\u2019\t sense\t that\t they\t need not\t be\t so\t at\t the\t mercy\t of\t the\t emotional\t alarms\t that\t flood\t them\t with inexplicable\t anxiety,\t keep\t them\t sleepless,\t or\t pepper\t their\t sleep\t with nightmares.\tPharmacologists\tare\thoping\tone\tday\tto\ttailor\tmedications that\t will\t target\t precisely\t the\t effects\t of\t PTSD\t on\t the\t amygdala\t and connected\t neurotransmitter\t circuits.\t For\t now,\t though,\t there\t are medications\t that\t counter\t only\t some\t of\t these\t changes,\t notably\t the antidepressants\t that\t act\t on\t the\t serotonin\t system,\t and\t beta-blockers like\t propranolol,\t which\t block\t the\t activation\t of\t the\t sympathetic nervous\t system.\t Patients\t also\t may\t learn\t relaxation\t techniques\t that give\t them\t the\t ability\t to\t counter\t their\t edginess\t and\t nervousness.\t A physiological\t calm\t opens\t a\t window\t for\t helping\t the\t brutalized emotional\t circuitry\t rediscover\t that\t life\t is\t not\t a\t threat\t and\t for\t giving back\t to\t patients\t some\t of\t the\t sense\t of\t security\t they\t had\t in\t their\t lives before\tthe\ttrauma\thappened. Another\t step\t in\t healing\t involves\t retelling\t and\t reconstructing\t the story\t of\t the\t trauma\t in\t the\t harbor\t of\t that\t safety,\t allowing\t the emotional\t circuitry\t to\t acquire\t a\t new,\t more\t realistic\t understanding\t of and\t response\t to\t the\t traumatic\t memory\t and\t its\t triggers.\t As\t patients retell\t the\t horrific\t details\t of\t the\t trauma,\t the\t memory\t starts\t to\t be","transformed,\t both\t in\t its\t emotional\t meaning\t and\t in\t its\t effects\t on\t the emotional\t brain.\t The\t pace\t of\t this\t retelling\t is\t delicate;\t ideally\t it mimics\tthe\tpace\tthat\toccurs\tnaturally\tin\tthose\tpeople\twho\tare\table\tto recover\t from\t trauma\t without\t suffering\t PTSD.\t In\t these\t cases\t there often\t seems\t to\t be\t an\t inner\t clock\t that\t \u201cdoses\u201d\t people\t with\t intrusive memories\tthat\trelive\tthe\ttrauma,\tintercut\twith\tweeks\tor\tmonths\twhen they\tremember\thardly\tanything\tof\tthe\thorrible\tevents.19 This\t alternation\t of\t reimmersion\t and\t respite\t seems\t to\t allow\t for\t a spontaneous\t review\t of\t the\t trauma\t and\t relearning\t of\t emotional response\t to\t it.\t For\t those\t whose\t PTSD\t is\t more\t intractable,\t says Herman,\t retelling\t their\t tale\t can\t sometimes\t trigger\t overwhelming fears,\t in\t which\t case\t the\t therapist\t should\t ease\t the\t pace\t to\t keep\t the patient\u2019s\t reactions\t within\t a\t bearable\t range,\t one\t that\t will\t not\t disrupt the\trelearning. The\t therapist\t encourages\t the\t patient\t to\t retell\t the\t traumatic\t events as\t vividly\t as\t possible,\t like\t a\t horror\t home\t video,\t retrieving\t every sordid\t detail.\t This\t includes\t not\t just\t the\t specifics\t of\t what\t they\t saw, heard,\t smelled,\t and\t felt,\t but\t also\t their\t reactions\u2014the\t dread,\t disgust, nausea.\t The\t goal\t here\t is\t to\t put\t the\t entire\t memory\t into\t words,\t which means\tcapturing\tparts\tof\tthe\tmemory\tthat\tmay\thave\tbeen\tdissociated and\tso\tare\tabsent\tfrom\tconscious\trecall.\tBy\tputting\tsensory\tdetails\tand feelings\t into\t words,\t presumably\t memories\t are\t brought\t more\t under control\t of\t the\t neocortex,\t where\t the\t reactions\t they\t kindle\t can\t be rendered\t more\t understandable\t and\t so\t more\t manageable.\t The emotional\t relearning\t at\t this\t point\t is\t largely\t accomplished\t through reliving\t the\t events\t and\t their\t emotions,\t but\t this\t time\t in\t surroundings of\t safety\t and\t security,\t in\t the\t company\t of\t a\t trusted\t therapist.\t This begins\t to\t impart\t a\t telling\t lesson\t to\t the\t emotional\t circuitry\u2014that security,\trather\tthan\tunremitting\tterror,\tcan\tbe\texperienced\tin\ttandem with\tthe\ttrauma\tmemories. The\t five-year-old\t who\t drew\t the\t picture\t of\t the\t giant\t eyes\t after\t he witnessed\t the\t grisly\t murder\t of\t his\t mother\t did\t not\t make\t any\t more drawings\tafter\tthat\tfirst\tone;\tinstead\the\tand\this\ttherapist,\tSpencer\tEth, played\tgames,\tcreating\ta\tbond\tof\trapport.\tOnly\tslowly\tdid\the\tbegin\tto retell\t the\t story\t of\t the\t murder,\t at\t first\t in\t a\t stereotyped\t way,\t reciting each\t detail\t exactly\t the\t same\t in\t each\t telling.\t Gradually,\t though,\t his narrative\t became\t more\t open\t and\t free-flowing,\t his\t body\t less\t tense\t as he\t told\t it.\t At\t the\t same\t time\t his\t nightmares\t of\t the\t scene\t came\t less often,\t an\t indication,\t says\t Eth,\t of\t some\t \u201ctrauma\t mastery.\u201d\t Gradually their\t talk\t moved\t away\t from\t the\t fears\t left\t by\t the\t trauma\t to\t more\t of","what\t was\t happening\t in\t the\t boy\u2019s\t day-to-day\t life\t as\t he\t adjusted\t to\t a new\t home\t with\t his\t father.\t And\t finally\t the\t boy\t was\t able\t to\t talk\t just about\this\tdaily\tlife\tas\tthe\thold\tof\tthe\ttrauma\tfaded. Finally,\t Herman\t finds\t that\t patients\t need\t to\t mourn\t the\t loss\t the trauma\t brought\u2014whether\t an\t injury,\t the\t death\t of\t a\t loved\t one\t or\t a rupture\t in\t a\t relationship,\t regret\t over\t some\t step\t not\t taken\t to\t save someone,\t or\t just\t the\t shattering\t of\t confidence\t that\t people\t can\t be trusted.\tThe\tmourning\tthat\tensues\twhile\tretelling\tsuch\tpainful\tevents serves\t a\t crucial\t purpose:\t it\t marks\t the\t ability\t to\t let\t go\t of\t the\t trauma itself\t to\t some\t degree.\t It\t means\t that\t instead\t of\t being\t perpetually captured\tby\tthis\tmoment\tin\tthe\tpast,\tpatients\tcan\tstart\tto\tlook\tahead, even\tto\thope,\tand\tto\trebuild\ta\tnew\tlife\tfree\tof\tthe\ttrauma\u2019s\tgrip.\tIt\tis as\t if\t the\t constant\t recycling\t and\t reliving\t of\t the\t trauma\u2019s\t terror\t by\t the emotional\t circuitry\t were\t a\t spell\t that\t could\t finally\t be\t lifted.\t Every siren\tneed\tnot\tbring\ta\tflood\tof\tfear;\tevery\tsound\tin\tthe\tnight\tneed\tnot compel\ta\tflashback\tto\tterror. Aftereffects\t or\t occasional\t recurrences\t of\t symptoms\t often\t persist, says\t Herman,\t but\t there\t are\t specific\t signs\t that\t the\t trauma\t has\t largely been\tovercome.\tThese\tinclude\treducing\tthe\tphysiological\tsymptoms\tto a\t manageable\t level,\t and\t being\t able\t to\t bear\t the\t feelings\t associated with\t memories\t of\t the\t trauma.\t Especially\t significant\t is\t no\t longer having\ttrauma\tmemories\terupt\tat\tuncontrollable\tmoments,\tbut\trather being\t able\t to\t revisit\t them\t voluntarily,\t like\t any\t other\t memory\u2014and, perhaps\t more\t important,\t to\t put\t them\t aside\t like\t any\t other\t memory. Finally,\t it\t means\t rebuilding\t a\t new\t life,\t with\t strong,\t trusting relationships\t and\t a\t belief\t system\t that\t finds\t meaning\t even\t in\t a\t world where\tsuch\tinjustice\tcan\thappen.20\t All\t of\t these\t together\t are\t markers of\tsuccess\tin\treeducating\tthe\temotional\tbrain. PSYCHOTHERAPY\tAS\tAN\tEMOTIONAL\tTUTORIAL Fortunately,\t the\t catastrophic\t moments\t in\t which\t traumatic\t memories are\t emblazoned\t are\t rare\t during\t the\t course\t of\t life\t for\t most\t of\t us.\t But the\t same\t circuitry\t that\t can\t be\t seen\t so\t boldly\t imprinting\t traumatic memories\t is\t presumably\t at\t work\t in\t life\u2019s\t quieter\t moments,\t too.\t The more\tordinary\ttravails\tof\tchildhood,\tsuch\tas\tbeing\tchronically\tignored and\t deprived\t of\t attention\t or\t tenderness\t by\t one\u2019s\t parents, abandonment\t or\t loss,\t or\t social\t rejection\t may\t never\t reach\t the\t fever pitch\t of\t trauma,\t but\t they\t surely\t leave\t their\t imprint\t on\t the\t emotional","brain,\t creating\t distortions\u2014and\t tears\t and\t rages\u2014in\t intimate relationships\t later\t in\t life.\t If\t PTSD\t can\t be\t healed,\t so\t can\t the\t more muted\t emotional\t scars\t that\t so\t many\t of\t us\t bear;\t that\t is\t the\t task\t of psychotherapy.\tAnd,\tin\tgeneral,\tit\tis\tin\tlearning\tto\tdeal\tskillfully\twith these\tloaded\treactions\tthat\temotional\tintelligence\tcomes\tinto\tplay. The\t dynamic\t between\t the\t amygdala\t and\t the\t more\t fully\t informed reactions\tof\tthe\tprefrontal\tcortex\tmay\toffer\ta\tneuroanatomical\tmodel for\t how\t psychotherapy\t reshapes\t deep,\t maladaptive\t emotional patterns.\t As\t Joseph\t LeDoux,\t the\t neuroscientist\t who\t discovered\t the amygdala\u2019s\t hair-trigger\t role\t in\t emotional\t outbursts,\t conjectures, \u201cOnce\tyour\temotional\tsystem\tlearns\tsomething,\tit\tseems\tyou\tnever\tlet it\t go.\t What\t therapy\t does\t is\t teach\t you\t to\t control\t it\u2014it\t teaches\t your neocortex\t how\t to\t inhibit\t your\t amygdala.\t The\t propensity\t to\t act\t is suppressed,\t while\t your\t basic\t emotion\t about\t it\t remains\t in\t a\t subdued form.\u201d Given\t the\t brain\t architecture\t that\t underlies\t emotional\t relearning, what\t seems\t to\t remain,\t even\t after\t successful\t psychotherapy,\t is\t a vestigial\t reaction,\t a\t remnant\t of\t the\t original\t sensitivity\t or\t fear\t at\t the root\t of\t a\t troubling\t emotional\t pattern.21\t The\t prefrontal\t cortex\t can refine\t or\t put\t the\t brakes\t on\t the\t amygdala\u2019s\t impulse\t to\t rampage,\t but cannot\t keep\t it\t from\t reacting\t in\t the\t first\t place.\t Thus\t while\t we\t cannot decide\t when\t we\t have\t our\t emotional\t outbursts,\t we\t have\t more\t control over\t how\t long\t they\t last.\t A\t quicker\t recovery\t time\t from\t such\t outbursts may\twell\tbe\tone\tmark\tof\temotional\tmaturity. Over\t the\t course\t of\t therapy,\t what\t seems\t to\t change\t in\t the\t main\t are the\tresponses\tthat\tpeople\tmake\tonce\tan\temotional\treaction\tis\ttriggered \u2014but\t the\t tendency\t for\t the\t reaction\t to\t be\t triggered\t in\t the\t first\t place does\t not\t disappear\t entirely.\t Evidence\t for\t this\t comes\t from\t a\t series\t of studies\t of\t psychotherapy\t conducted\t by\t Lester\t Luborsky\t and\t his colleagues\t at\t the\t University\t of\t Pennsylvania.22\t They\t analyzed\t the main\t relationship\t conflicts\t that\t brought\t dozens\t of\t patients\t into psychotherapy\u2014issues\t such\t as\t a\t deep\t craving\t to\t be\t accepted\t or\t find intimacy,\tor\ta\tfear\tof\tbeing\ta\tfailure\tor\tbeing\toverly\tdependent.\tThey then\t carefully\t analyzed\t the\t typical\t (always\t self-defeating)\t responses the\tpatients\tmade\twhen\tthese\twishes\tand\tfears\twere\tactivated\tin\ttheir relationships\u2014responses\tsuch\tas\tbeing\ttoo\tdemanding,\twhich\tcreated a\tbacklash\tof\tanger\tor\tcoldness\tin\tthe\tother\tperson,\tor\twithdrawing\tin self-defense\t from\t an\t anticipated\t slight,\t leaving\t the\t other\t person miffed\t by\t the\t seeming\t rebuff.\t During\t such\t ill-fated\t encounters,\t the patients,\t understandably,\t felt\t flooded\t by\t upsetting\t feelings\u2014","hopelessness\t and\t sadness,\t resentment\t and\t anger,\t tension\t and\t fear, guilt\t and\t self-blame,\t and\t so\t on.\t Whatever\t the\t specific\t pattern\t of\t the patient,\t it\t seemed\t to\t show\t up\t in\t most\t every\t important\t relationship, whether\twith\ta\tspouse\tor\tlover,\ta\tchild\tor\tparent,\tor\tpeers\tand\tbosses at\twork. Over\tthe\tcourse\tof\tlong-term\ttherapy,\thowever,\tthese\tpatients\tmade two\tkinds\tof\tchanges:\ttheir\temotional\treaction\tto\tthe\ttriggering\tevents became\t less\t distressing,\t even\t calm\t or\t bemused,\t and\t their\t overt responses\t became\t more\t effective\t in\t getting\t what\t they\t truly\t wanted from\t the\t relationship.\t What\t did\t not\t change,\t however,\t was\t their underlying\twish\tor\tfear,\tand\tthe\tinitial\ttwinge\tof\tfeeling.\tBy\tthe\ttime the\tpatients\thad\tbut\ta\tfew\tsessions\tleft\tin\ttherapy,\tthe\tencounters\tthey told\t about\t showed\t they\t had\t only\t half\t as\t many\t negative\t emotional reactions\tcompared\tto\twhen\tthey\tfirst\tstarted\ttherapy,\tand\twere\ttwice as\t likely\t to\t get\t the\t positive\t response\t they\t deeply\t desired\t from\t the other\t person.\t But\t what\t did\t not\t change\t at\t all\t was\t the\t particular sensitivity\tat\tthe\troot\tof\tthese\tneeds. In\t brain\t terms,\t we\t can\t speculate,\t the\t limbic\t circuitry\t would\t send alarm\tsignals\tin\tresponse\tto\tcues\tof\ta\tfeared\tevent,\tbut\tthe\tprefrontal cortex\t and\t related\t zones\t would\t have\t learned\t a\t new,\t more\t healthy response.\t In\t short,\t emotional\t lessons\u2014even\t the\t most\t deeply implanted\thabits\tof\tthe\theart\tlearned\tin\tchildhood\u2014can\tbe\treshaped. Emotional\tlearning\tis\tlifelong.","14 Temperament\tIs\tNot\tDestiny So\t much\t for\t altering\t emotional\t patterns\t that\t have\t been\t learned.\t But what\tabout\tthose\tresponses\tthat\tare\tgivens\tof\tour\tgenetic\tendowment \u2014what\t of\t changing\t the\t habitual\t reactions\t of\t people\t who\t by\t nature are,\tsay,\thighly\tvolatile,\tor\tpainfully\tshy?\tThis\trange\tof\tthe\temotional compass\t falls\t under\t the\t sweep\t of\t temperament,\t the\t background murmur\tof\tfeelings\tthat\tmark\tour\tbasic\tdisposition.\tTemperament\tcan be\t defined\t in\t terms\t of\t the\t moods\t that\t typify\t our\t emotional\t life.\t To some\t degree\t we\t each\t have\t such\t a\t favored\t emotional\t range; temperament\t is\t a\t given\t at\t birth,\t part\t of\t the\t genetic\t lottery\t that\t has compelling\t force\t in\t the\t unfolding\t of\t life.\t Every\t parent\t has\t seen\t this: from\t birth\t a\t child\t will\t be\t calm\t and\t placid\t or\t testy\t and\t difficult.\t The question\t is\t whether\t such\t a\t biologically\t determined\t emotional\t set\t can be\tchanged\tby\texperience.\tDoes\tour\tbiology\tfix\tour\temotional\tdestiny, or\tcan\teven\tan\tinnately\tshy\tchild\tgrow\tinto\ta\tmore\tconfident\tadult? The\tclearest\tanswer\tto\tthis\tquestion\tcomes\tfrom\tthe\twork\tof\tJerome Kagan,\t the\t eminent\t developmental\t psychologist\t at\t Harvard University.1\t Kagan\t posits\t that\t there\t are\t at\t least\t four\t temperamental types\u2014timid,\tbold,\tupbeat,\tand\tmelancholy\u2014and\tthat\teach\tis\tdue\tto\ta different\t pattern\t of\t brain\t activity.\t There\t are\t likely\t innumerable differences\t in\t temperamental\t endowment,\t each\t based\t in\t innate differences\t in\t emotional\t circuitry;\t for\t any\t given\t emotion\t people\t can differ\t in\t how\t easily\t it\t triggers,\t how\t long\t it\t lasts,\t how\t intense\t it becomes.\t Kagan\u2019s\t work\t concentrates\t on\t one\t of\t these\t patterns:\t the dimension\tof\ttemperament\tthat\truns\tfrom\tboldness\tto\ttimidity. For\t decades\t mothers\t have\t been\t bringing\t their\t infants\t and\t toddlers to\t Kagan\u2019s\t Laboratory\t for\t Child\t Development\t on\t the\t fourteenth\t floor of\tHarvard\u2019s\t William\t James\t Hall\t to\t take\t part\t in\t his\t studies\t of\t child development.\t It\t was\t there\t that\t Kagan\t and\t his\t coresearchers\t noticed early\t signs\t of\t shyness\t in\t a\t group\t of\t twenty-one-month-old\t toddlers brought\t for\t experimental\t observations.\t In\t free\t play\t with\t other toddlers,\t some\t were\t bubbly\t and\t spontaneous,\t playing\t with\t other babies\t without\t the\t least\t hesitation.\t Others,\t though,\t were\t uncertain","and\t hesitant,\t hanging\t back,\t clinging\t to\t their\t mothers,\t quietly watching\tthe\tothers\tat\tplay.\tAlmost\tfour\tyears\tlater,\twhen\tthese\tsame children\t were\t in\t kindergarten,\t Kagan\u2019s\t group\t observed\t them\t again. Over\tthe\tintervening\tyears\tnone\tof\tthe\toutgoing\tchildren\thad\tbecome timid,\twhile\ttwo\tthirds\tof\tthe\ttimid\tones\twere\tstill\treticent. Kagan\tfinds\tthat\tchildren\twho\tare\toverly\tsensitive\tand\tfearful\tgrow into\t shy\t and\t timorous\t adults;\t from\t birth\t about\t 15\t to\t 20\t percent\t of children\t are\t \u201cbehaviorally\t inhibited,\u201d\t as\t he\t calls\t them.\t As\t infants, these\t children\t are\t timid\t about\t anything\t unfamiliar.\t This\t makes\t them finicky\tabout\teating\tnew\tfoods,\treluctant\tto\tapproach\tnew\tanimals\tor places,\t and\t shy\t around\t strangers.\t It\t also\t renders\t them\t sensitive\t in other\t ways\u2014for\t example,\t prone\t to\t guilt\t and\t self-reproach.\t These\t are the\t children\t who\t become\t paralyzingly\t anxious\t in\t social\t situations:\t in class\tand\ton\tthe\tplayground,\twhen\tmeeting\tnew\tpeople,\twhenever\tthe social\t spotlight\t shines\t on\t them.\t As\t adults,\t they\t are\t prone\t to\t be wallflowers,\t and\t morbidly\t afraid\t of\t having\t to\t give\t a\t speech\t or perform\tin\tpublic. Tom,\tone\tof\tthe\tboys\tin\tKagan\u2019s\tstudy,\tis\ttypical\tof\tthe\tshy\ttype.\tAt every\tmeasurement\tthrough\tchildhood\u2014two,\tfive,\tand\tseven\tyears\tof age\u2014Tom\t was\t among\t the\t most\t timid\t children.\t When\t interviewed\t at thirteen,\t Tom\t was\t tense\t and\t stiff,\t biting\t his\t lip\t and\t wringing\t his hands,\t his\t face\t impassive,\t breaking\t into\t a\t tight\t smile\t only\t when talking\t about\t his\t girlfriend;\t his\t answers\t were\t short,\t his\t manner subdued.2\tThroughout\tthe\tmiddle\tyears\tof\tchildhood,\tuntil\tabout\tage eleven,\t Tom\t remembers\t being\t painfully\t shy,\t breaking\t into\t a\t sweat whenever\t he\t had\t to\t approach\t playmates.\t He\t was\t also\t troubled\t by intense\t fears:\t of\t his\t house\t burning\t down,\t of\t diving\t into\t a\t swimming pool,\t of\t being\t alone\t in\t the\t dark.\t In\t frequent\t nightmares,\t he\t was attacked\tby\tmonsters.\tThough\the\thas\tfelt\tless\tshy\tin\tthe\tlast\ttwo\tyears or\t so,\t he\t still\t feels\t some\t anxiety\t around\t other\t children,\t and\t his worries\tnow\tcenter\ton\tdoing\twell\tat\tschool,\teven\tthough\the\tis\tin\tthe top\t5\tpercent\tof\this\tclass.\tThe\tson\tof\ta\tscientist,\tTom\tfinds\ta\tcareer\tin that\t field\t appealing,\t since\t its\t relative\t solitude\t fits\t his\t introverted inclinations. By\t contrast,\t Ralph\t was\t one\t of\t the\t boldest\t and\t most\t outgoing children\tat\tevery\tage.\tAlways\trelaxed\tand\ttalkative,\tat\tthirteen\the\tsat back\tat\tease\tin\this\tchair,\thad\tno\tnervous\tmannerisms,\tand\tspoke\tin\ta confident,\t friendly\t tone,\t as\t though\t the\t interviewer\t were\t a\t peer\u2014 though\t the\t difference\t in\t their\t ages\t was\t twenty-five\t years.\t During childhood\t he\t had\t only\t two\t short-lived\t fears\u2014one\t of\t dogs,\t after\t a\t big","dog\tjumped\ton\thim\tat\tage\tthree,\tand\tanother\tof\tflying,\twhen\the\theard about\t plane\t crashes\t at\t age\t seven.\t Sociable\t and\t popular,\t Ralph\t has never\tthought\tof\thimself\tas\tshy. The\t timid\t children\t seem\t to\t come\t into\t life\t with\t a\t neural\t circuitry that\t makes\t them\t more\t reactive\t to\t even\t mild\t stress\u2014from\t birth,\t their hearts\t beat\t faster\t than\t other\t infants\u2019\t in\t response\t to\t strange\t or\t novel situations.\t At\t twenty-one\t months,\t when\t the\t reticent\t toddlers\t were holding\t back\t from\t playing,\t heart\t rate\t monitors\t showed\t that\t their hearts\twere\tracing\twith\tanxiety.\tThat\teasily\taroused\tanxiety\tseems\tto underlie\ttheir\tlifelong\ttimidity:\tthey\ttreat\tany\tnew\tperson\tor\tsituation as\tthough\tit\twere\ta\tpotential\tthreat.\tPerhaps\tas\ta\tresult,\tmiddle-aged women\twho\tremember\thaving\tbeen\tespecially\tshy\tin\tchildhood,\twhen compared\twith\ttheir\tmore\toutgoing\tpeers,\ttend\tto\tgo\tthrough\tlife\twith more\t fears,\t worries,\t and\t guilt,\t and\t to\t suffer\t more\t from\t stress-related problems\t such\t as\t migraine\t headaches,\t irritable\t bowel,\t and\t other stomach\tproblems.3 THE\tNEUROCHEMISTRY\tOF\tTIMIDITY The\tdifference\tbetween\tcautious\tTom\tand\tbold\tRalph,\tKagan\tbelieves, lies\t in\t the\t excitability\t of\t a\t neural\t circuit\t centered\t on\t the\t amygdala. Kagan\t proposes\t that\t people\t like\t Tom,\t who\t are\t prone\t to\t fearfulness, are\tborn\twith\ta\tneurochemistry\tthat\tmakes\tthis\tcircuit\teasily\taroused, and\t so\t they\t avoid\t the\t unfamiliar,\t shy\t away\t from\t uncertainty,\t and suffer\t anxiety.\t Those\t who,\t like\t Ralph,\t have\t a\t nervous\t system calibrated\t with\t a\t much\t higher\t threshold\t for\t amygdala\t arousal,\t are less\t easily\t frightened,\t more\t naturally\t outgoing,\t and\t eager\t to\t explore new\tplaces\tand\tmeet\tnew\tpeople. An\tearly\tclue\tto\twhich\tpattern\ta\tchild\thas\tinherited\tis\thow\tdifficult and\tirritable\tshe\tis\tas\tan\tinfant,\tand\thow\tdistressed\tshe\tbecomes\twhen confronted\twith\tsomething\tor\tsomeone\tunfamiliar.\tWhile\tabout\tone\tin five\t infants\t falls\t into\t the\t timid\t category,\t about\t two\t in\t five\t have\t the bold\ttemperament\u2014at\tleast\tat\tbirth. Part\t of\t Kagan\u2019s\t evidence\t comes\t from\t observations\t of\t cats\t that\t are unusually\t timid.\t About\t one\t in\t seven\t housecats\t has\t a\t pattern\t of fearfulness\takin\tto\tthe\ttimid\tchildren\u2019s:\tthey\tdraw\taway\tfrom\tnovelty (instead\tof\texhibiting\ta\tcat\u2019s\tlegendary\tcuriosity),\tthey\tare\treluctant\tto explore\tnew\tterritory,\tand\tthey\tattack\tonly\tthe\tsmallest\trodents,\tbeing too\t timid\t to\t take\t on\t larger\t ones\t that\t their\t more\t courageous\t feline","peers\t would\t pursue\t with\t gusto.\t Direct\t brain\t probes\t have\t found\t that portions\t of\t the\t amygdala\t are\t unusually\t excitable\t in\t these\t timid\t cats, especially\t when,\t for\t instance,\t they\t hear\t a\t threatening\t howl\t from another\tcat. The\tcats\u2019\ttimidity\tblossoms\tat\tabout\tone\tmonth\tof\tage,\twhich\tis\tthe point\t when\t their\t amygdala\t matures\t enough\t to\t take\t control\t of\t the brain\t circuitry\t to\t approach\t or\t avoid.\t One\t month\t in\t kitten\t brain maturation\tis\takin\tto\teight\tmonths\tin\ta\thuman\tinfant;\tit\tis\tat\teight\tor nine\t months,\t Kagan\t notes,\t that\t \u201cstranger\u201d\t fear\t appears\t in\t babies\u2014if the\t baby\u2019s\t mother\t leaves\t a\t room\t and\t there\t is\t a\t stranger\t present,\t the result\t is\t tears.\t Timid\t children,\t Kagan\t postulates,\t may\t have\t inherited chronically\t high\t levels\t of\t norepinephrine\t or\t other\t brain\t chemicals that\t activate\t the\t amygdala\t and\t so\t create\t a\t low\t threshold\t of excitability,\tmaking\tthe\tamygdala\tmore\teasily\ttriggered. One\t sign\t of\t this\t heightened\t sensitivity\t is\t that,\t for\t example,\t when young\t men\t and\t women\t who\t were\t quite\t shy\t in\t childhood\t are measured\t in\t a\t laboratory\t while\t exposed\t to\t stresses\t such\t as\t harsh smells,\ttheir\theart\trate\tstays\televated\tmuch\tlonger\tthan\tfor\ttheir\tmore outgoing\t peers\u2014a\t sign\t that\t surging\t norepinephrine\t is\t keeping\t their amygdala\t excited\t and,\t through\t connected\t neural\t circuits,\t their sympathetic\tnervous\tsystem\taroused.4\tKagan\tfinds\tthat\ttimid\tchildren have\t higher\t levels\t of\t reactivity\t across\t the\t range\t of\t sympathetic nervous\t system\t indices,\t from\t higher\t resting\t blood\t pressure\t and greater\t dilation\t of\t the\t pupils,\t to\t higher\t levels\t of\t norepinephrine markers\tin\ttheir\turine. Silence\t is\t another\t barometer\t of\t timidity.\t Whenever\t Kagan\u2019s\t team observed\t shy\t and\t bold\t children\t in\t a\t natural\t setting\u2014in\t their kindergarten\tclasses,\twith\tother\tchildren\tthey\tdid\tnot\tknow,\tor\ttalking with\t an\t interviewer\u2014the\t timid\t children\t talked\t less.\t One\t timid kindergartener\t would\t say\t nothing\t when\t other\t children\t spoke\t to\t her, and\t spent\t most\t of\t her\t day\t just\t watching\t the\t others\t play.\t Kagan speculates\t that\t a\t timid\t silence\t in\t the\t face\t of\t novelty\t or\t a\t perceived threat\tis\ta\tsign\tof\tthe\tactivity\tof\ta\tneural\tcircuit\trunning\tbetween\tthe forebrain,\tthe\tamygdala,\tand\tnearby\tlimbic\tstructures\tthat\tcontrol\tthe ability\t to\t vocalize\t (these\t same\t circuits\t make\t us\t \u201cchoke\t up\u201d\t under stress). These\t sensitive\t children\t are\t at\t high\t risk\t for\t developing\t an\t anxiety disorder\t such\t as\t panic\t attacks,\t starting\t as\t early\t as\t sixth\t or\t seventh grade.\t In\t one\t study\t of\t 754\t boys\t and\t girls\t in\t those\t grades,\t 44\t were found\t to\t have\t already\t suffered\t at\t least\t one\t episode\t of\t panic,\t or\t to","have\thad\tseveral\tpreliminary\tsymptoms.\tThese\tanxiety\tepisodes\twere usually\ttriggered\tby\tthe\tordinary\talarms\tof\tearly\tadolescence,\tsuch\tas a\t first\t date\t or\t a\t big\t exam\u2014alarms\t that\t most\t children\t handle\t without developing\t more\t serious\t problems.\t But\t teenagers\t who\t were\t timid\t by temperament\t and\t who\t had\t been\t unusually\t frightened\t by\t new situations\tgot\tpanic\tsymptoms\tsuch\tas\theart\tpalpitations,\tshortness\tof breath,\t or\t a\t choking\t feeling,\t along\t with\t the\t feeling\t that\t something horrible\twas\tgoing\tto\thappen\tto\tthem,\tlike\tgoing\tcrazy\tor\tdying.\tThe researchers\t believe\t that\t while\t the\t episodes\t were\t not\t significant enough\t to\t rate\t the\t psychiatric\t diagnosis\t \u201cpanic\t disorder,\u201d\t they\t signal that\t these\t teenagers\t would\t be\t at\t greater\t risk\t for\t developing\t the disorder\t as\t the\t years\t went\t on;\t many\t adults\t who\t suffer\t panic\t attacks say\tthe\tattacks\tbegan\tduring\ttheir\tteen\tyears.5 The\t onset\t of\t the\t anxiety\t attacks\t was\t closely\t tied\t to\t puberty.\t Girls with\t few\t signs\t of\t puberty\t reponed\t no\t such\t attacks,\t but\t of\t those\t who had\tgone\tthrough\tpuberty\tabout\t8\tpercent\tsaid\tthey\thad\texperienced panic.\t Once\t they\t have\t had\t such\t an\t attack,\t they\t are\t prone\t to developing\t the\t dread\t of\t a\t recurrence\t that\t leads\t people\t with\t panic disorder\tto\tshrink\tfrom\tlife. NOTHING\tBOTHERS\tME:\tTHE\tCHEERFUL\tTEMPERAMENT In\t the\t 1920s,\t as\t a\t young\t woman,\t my\t aunt\t June\t left\t her\t home\t in Kansas\t City\t and\t ventured\t on\t her\t own\t to\t Shanghai\u2014a\t dangerous journey\t for\t a\t solitary\t woman\t in\t those\t years.\t There\t June\t met\t and married\t a\t British\t detective\t in\t the\t colonial\t police\t force\t of\t that international\t center\t of\t commerce\t and\t intrigue.\t When\t the\t Japanese captured\t Shanghai\t at\t the\t outset\t of\t World\t War\t II,\t my\t aunt\t and\t her husband\t were\t interned\t in\t the\t prison\t camp\t depicted\t in\t the\t book\t and movie\t Empire\t of\t the\t Sun.\t After\t surviving\t five\t horrific\t years\t in\t the prison\t camp,\t she\t and\t her\t husband\t had,\t literally,\t lost\t everything. Penniless,\tthey\twere\trepatriated\tto\tBritish\tColumbia. I\t remember\t as\t a\t child\t first\t meeting\t June,\t an\t ebullient\t elderly woman\t whose\t life\t had\t followed\t a\t remarkable\t course.\t In\t her\t later years\tshe\tsuffered\ta\tstroke\tthat\tleft\ther\tpartly\tparalyzed;\tafter\ta\tslow and\tarduous\trecovery\tshe\twas\table\tto\twalk\tagain,\tbut\twith\ta\tlimp.\tIn those\t years\t I\t remember\t going\t for\t an\t outing\t with\t June,\t then\t in\t her seventies.\t Somehow\t she\t wandered\t off,\t and\t after\t several\t minutes\t I heard\t a\t feeble\t yell\u2014June\t crying\t for\t help.\t She\t had\t fallen\t and\t could","not\tget\tup\ton\ther\town.\tI\trushed\tto\thelp\ther\tup,\tand\tas\tI\tdid\tso,\tinstead of\tcomplaining\tor\tlamenting\tshe\tlaughed\tat\ther\tpredicament.\tHer\tonly comment\twas\ta\tlighthearted\t\u201cWell,\tat\tleast\tI\tcan\twalk\tagain.\u201d By\tnature,\tsome\tpeople\u2019s\temotions\tseem,\tlike\tmy\taunt\u2019s,\tto\tgravitate toward\t the\t positive\t pole;\t these\t people\t are\t naturally\t upbeat\t and easygoing,\t while\t others\t are\t dour\t and\t melancholy.\t This\t dimension\t of temperament\u2014ebullience\tat\tone\tend,\tmelancholy\tat\tthe\tother\u2014seems linked\tto\tthe\trelative\tactivity\tof\tthe\tright\tand\tleft\tprefrontal\tareas,\tthe upper\t poles\t of\t the\t emotional\t brain.\t That\t insight\t has\t emerged\t largely from\t the\t work\t of\t Richard\t Davidson,\t a\t University\t of\t Wisconsin psychologist.\t He\t discovered\t that\t people\t who\t have\t greater\t activity\t in the\t left\t frontal\t lobe,\t compared\t to\t the\t right,\t are\t by\t temperament cheerful;\t they\t typically\t take\t delight\t in\t people\t and\t in\t what\t life presents\t them\t with,\t bouncing\t back\t from\t setbacks\t as\t my\t aunt\t June did.\t But\t those\t with\t relatively\t greater\t activity\t on\t the\t right\t side\t are given\t to\t negativity\t and\t sour\t moods,\t and\t are\t easily\t fazed\t by\t life\u2019s difficulties;\t in\t a\t sense,\t they\t seem\t to\t suffer\t because\t they\t cannot\t turn off\ttheir\tworries\tand\tdepressions. In\t one\t of\t Davidson\u2019s\t experiments\t volunteers\t with\t the\t most pronounced\t activity\t in\t the\t left\t frontal\t areas\t were\t compared\t with\t the fifteen\t who\t showed\t most\t activity\t on\t the\t right.\t Those\t with\t marked right\t frontal\t activity\t showed\t a\t distinctive\t pattern\t of\t negativity\t on\t a personality\t test:\t they\t fit\t the\t caricature\t portrayed\t by\t Woody\t Allen\u2019s comedy\troles,\tthe\talarmist\twho\tsees\tcatastrophe\tin\tthe\tsmallest\tthing \u2014prone\t to\t funks\t and\t moodiness,\t and\t suspicious\t of\t a\t world\t they\t saw as\t fraught\t with\t overwhelming\t difficulties\t and\t lurking\t dangers.\t By contrast\t to\t their\t melancholy\t counterparts,\t those\t with\t stronger\t left frontal\t activity\t saw\t the\t world\t very\t differently.\t Sociable\t and\t cheerful, they\t typically\t felt\t a\t sense\t of\t enjoyment,\t were\t frequently\t in\t good moods,\t had\t a\t strong\t sense\t of\t self-confidence,\t and\t felt\t rewardingly engaged\t in\t life.\t Their\t scores\t on\t psychological\t tests\t suggested\t a\t lower lifetime\trisk\tfor\tdepression\tand\tother\temotional\tdisorders.6 People\t who\t have\t a\t history\t of\t clinical\t depression,\t Davidson\t found, had\tlower\tlevels\tof\tbrain\tactivity\tin\tthe\tleft\tfrontal\tlobe,\tand\tmore\ton the\t right,\t than\t did\t people\t who\t had\t never\t been\t depressed.\t He\t found the\t same\t pattern\t in\t patients\t newly\t diagnosed\t with\t depression. Davidson\t speculates\t that\t people\t who\t overcome\t depression\t have learned\tto\tincrease\tthe\tlevel\tof\tactivity\tin\ttheir\tleft\tprefrontal\tlobe\u2014a speculation\tawaiting\texperimental\ttesting. Though\t his\t research\t is\t on\t the\t 30\t percent\t or\t so\t of\t people\t at\t the","extremes,\t just\t about\t anyone\t can\t be\t classified\t by\t their\t brain\t wave patterns\tas\ttending\ttoward\tone\tor\tthe\tother\ttype,\tsays\tDavidson.\tThe contrast\t in\t temperament\t between\t the\t morose\t and\t the\t cheerful\t shows up\t in\t many\t ways,\t large\t and\t small.\t For\t example,\t in\t one\t experiment volunteers\t watched\t short\t film\t clips.\t Some\t were\t amusing\u2014a\t gorilla taking\t a\t bath,\t a\t puppy\t at\t play.\t Others,\t like\t an\t instructional\t film\t for nurses\t featuring\t grisly\t details\t of\t surgery,\t were\t quite\t distressing.\t The right-hemisphere,\t somber\t folks\t found\t the\t happy\t movies\t only\t mildly amusing,\t but\t they\t felt\t extreme\t fear\t and\t disgust\t in\t reaction\t to\t the surgical\tblood\tand\tgore.\tThe\tcheerful\tgroup\thad\tminimal\treactions\tto the\tsurgery;\t their\t strongest\t reactions\t were\t of\t delight\t when\t they\t saw the\tupbeat\tfilms. Thus\twe\tseem\tby\ttemperament\tprimed\tto\trespond\tto\tlife\tin\teither\ta negative\t or\t a\t positive\t emotional\t register.\t The\t tendency\t toward\t a melancholy\t or\t upbeat\t temperament\u2014like\t that\t toward\t timidity\t or boldness\u2014emerges\t within\t the\t first\t year\t of\t life,\t a\t fact\t that\t strongly suggests\t it\t too\t is\t genetically\t determined.\t Like\t most\t of\t the\t brain,\t the frontal\t lobes\t are\t still\t maturing\t in\t the\t first\t few\t months\t of\t life,\t and\t so their\tactivity\tcannot\tbe\treliably\tmeasured\tuntil\tthe\tage\tof\tten\tmonths or\tso.\tBut\tin\tinfants\tthat\tyoung,\tDavidson\tfound\tthat\tthe\tactivity\tlevel of\t the\t frontal\t lobes\t predicted\t whether\t they\t would\t cry\t when\t their mothers\t left\t the\t room.\t The\t correlation\t was\t virtually\t 100\t percent:\t of dozens\t of\t infants\t tested\t this\t way,\t every\t infant\t who\t cried\t had\t more brain\t activity\t on\t the\t right\t side,\t while\t those\t who\t did\t not\t had\t more activity\ton\tthe\tleft. Still,\teven\tif\tthis\tbasic\tdimension\tof\ttemperament\tis\tlaid\tdown\tfrom birth,\t or\t very\t nearly\t from\t birth,\t those\t of\t us\t who\t have\t the\t morose pattern\t are\t not\t necessarily\t doomed\t to\t go\t through\t life\t brooding\t and crotchety.\t The\t emotional\t lessons\t of\t childhood\t can\t have\t a\t profound impact\t on\t temperament,\t either\t amplifying\t or\t muting\t an\t innate predisposition.\t The\t great\t plasticity\t of\t the\t brain\t in\t childhood\t means that\t experiences\t during\t those\t years\t can\t have\t a\t lasting\t impact\t on\t the sculpting\t of\t neural\t pathways\t for\t the\t rest\t of\t life.\t Perhaps\t the\t best illustration\tof\tthe\tkinds\tof\texperiences\tthat\tcan\talter\ttemperament\tfor the\t better\t is\t in\t an\t observation\t that\t emerged\t from\t Kagan\u2019s\t research with\ttimid\tchildren. TAMING\tTHE\tOVEREXCITABLE\tAMYGDALA","The\t encouraging\t news\t from\t Kagan\u2019s\t studies\t is\t that\t not\t all\t fearful infants\t grow\t up\t hanging\t back\t from\t life\u2014temperament\t is\t not\t destiny. The\toverexcitable\tamygdala\tcan\tbe\ttamed,\twith\tthe\tright\texperiences. What\t makes\t the\t difference\t are\t the\t emotional\t lessons\t and\t responses children\t learn\t as\t they\t grow.\t For\t the\t timid\t child,\t what\t matters\t at\t the outset\tis\thow\tthey\tare\ttreated\tby\ttheir\tparents,\tand\tso\thow\tthey\tlearn to\thandle\ttheir\tnatural\ttimidness.\tThose\tparents\twho\tengineer\tgradual emboldening\texperiences\tfor\ttheir\tchildren\toffer\tthem\twhat\tmay\tbe\ta lifelong\tcorrective\tto\ttheir\tfearfulness. About\t one\t in\t three\t infants\t who\t come\t into\t the\t world\t with\t all\t the signs\t of\t an\t overexcitable\t amygdala\t have\t lost\t their\t timidness\t by\t the time\t they\t reach\t kindergarten.7\t From\t observations\t of\t these\t once- fearful\t children\t at\t home,\t it\t is\t clear\t that\t parents,\t and\t especially mothers,\t play\t a\t major\t role\t in\t whether\t an\t innately\t timid\t child\t grows bolder\t with\t time\t or\t continues\t to\t shy\t away\t from\t novelty\t and\t become upset\t by\t challenge.\t Kagan\u2019s\t research\t team\t found\t that\t some\t of\t the mothers\t held\t to\t the\t philosophy\t that\t they\t should\t protect\t their\t timid toddlers\t from\t whatever\t was\t upsetting;\t others\t felt\t that\t it\t was\t more important\t to\t help\t their\t timid\t child\t learn\t how\t to\t cope\t with\t these upsetting\t moments,\t and\t so\t adapt\t to\t life\u2019s\t small\t struggles.\t The protective\t belief\t seems\t to\t have\t abetted\t the\t fearfulness,\t probably\t by depriving\t the\t youngsters\t of\t opportunities\t for\t learning\t how\t to overcome\ttheir\tfears.\tThe\t\u201clearn\tto\tadapt\u201d\tphilosophy\tof\tchildrearing seems\tto\thave\thelped\tfearful\tchildren\tbecome\tbraver. Observations\t in\t the\t homes\t when\t the\t babies\t were\t about\t six\t months old\t found\t that\t the\t protective\t mothers,\t trying\t to\t soothe\t their\t infants, picked\tthem\tup\tand\theld\tthem\twhen\tthey\tfretted\tor\tcried,\tand\tdid\tso longer\t than\t those\t mothers\t who\t tried\t to\t help\t their\t infants\t learn\t to master\t these\t moments\t of\t upset.\t The\t ratio\t of\t times\t the\t infants\t were held\t when\t calm\t and\t when\t upset\t showed\t that\t the\t protective\t mothers held\t their\t infants\t much\t longer\t during\t the\t upsets\t than\t the\t calm periods. Another\tdifference\temerged\twhen\tthe\tinfants\twere\taround\tone\tyear old:\t the\t protective\t mothers\t were\t more\t lenient\t and\t indirect\t in\t setting limits\t for\t their\t toddlers\t when\t they\t were\t doing\t something\t that\t might be\t harmful,\t such\t as\t mouthing\t an\t object\t they\t might\t swallow.\t The other\t mothers,\t by\t contrast,\t were\t emphatic,\t setting\t firm\t limits,\t giving direct\tcommands,\tblocking\tthe\tchild\u2019s\tactions,\tinsisting\ton\tobedience. Why\t should\t firmness\t lead\t to\t a\t reduction\t in\t fearfulness?\t Kagan speculates\tthat\tthere\tis\tsomething\tlearned\twhen\ta\tbaby\thas\this\tsteady","crawl\t toward\t what\t seems\t to\t him\t an\t intriguing\t object\t (but\t to\t his mother\ta\tdangerous\tone)\tinterrupted\tby\ther\twarning,\t\u201cGet\taway\tfrom that!\u201d\t The\t infant\t is\t suddenly\t forced\t to\t deal\t with\t a\t mild\t uncertainty. The\t repetition\t of\t this\t challenge\t hundreds\t and\t hundreds\t of\t times during\t the\t first\t year\t of\t life\t gives\t the\t infant\t continual\t rehearsals,\t in small\t doses,\t of\t meeting\t the\t unexpected\t in\t life.\t For\t fearful\t children that\t is\t precisely\t the\t encounter\t that\t has\t to\t be\t mastered,\t and manageable\t doses\t are\t just\t right\t for\t learning\t the\t lesson.\t When\t the encounter\ttakes\tplace\twith\tparents\twho,\tthough\tloving,\tdo\tnot\trush\tto pick\t up\t and\t soothe\t the\t toddler\t over\t every\t little\t upset,\t he\t gradually learns\t to\t manage\t such\t moments\t on\t his\t own.\t By\t age\t two,\t when\t these formerly\tfearful\ttoddlers\tare\tbrought\tback\tto\tKagan\u2019s\tlaboratory,\tthey are\t far\t less\t likely\t to\t break\t out\t into\t tears\t when\t a\t stranger\t frowns\t at them,\tor\tan\texperimenter\tputs\ta\tblood-pressure\tcuff\taround\ttheir\tarm. Kagan\u2019s\t conclusion:\t \u201cIt\t appears\t that\t mothers\t who\t protect\t their high[ly]\t reactive\t infants\t from\t frustration\t and\t anxiety\t in\t the\t hope\t of effecting\t a\t benevolent\t outcome\t seem\t to\t exacerbate\t the\t infant\u2019s uncertainty\t and\t produce\t the\t opposite\t effect.\u201d8\t In\t other\t words,\t the protective\t strategy\t backfires\t by\t depriving\t timid\t toddlers\t of\t the\t very opportunity\tto\tlearn\tto\tcalm\tthemselves\tin\tthe\tface\tof\tthe\tunfamiliar, and\t so\t gain\t some\t small\t mastery\t of\t their\t fears.\t At\t the\t neurological level,\t presumably,\t this\t means\t their\t prefrontal\t circuits\t missed\t the chance\t to\t learn\t alternate\t responses\t to\t knee-jerk\t fear;\t instead,\t their tendency\t for\t unbridled\t fearfulness\t may\t have\t been\t strengthened simply\tthrough\trepetition. In\tcontrast,\tas\tKagan\ttold\tme,\t\u201cThose\tchildren\twho\thad\tbecome\tless timid\t by\t kindergarten\t seem\t to\t have\t had\t parents\t who\t put\t gentle pressure\t on\t them\t to\t be\t more\t outgoing.\t Although\t this\t temperamental trait\tseems\tslightly\tharder\tthan\tothers\tto\tchange\u2014probably\tbecause\tof its\tphysiological\tbasis\u2014no\thuman\tquality\tis\tbeyond\tchange.\u201d Throughout\t childhood\t some\t timid\t children\t grow\t bolder\t as experience\t continues\t to\t mold\t the\t key\t neural\t circuitry.\t One\t of\t the signs\t that\t a\t timid\t child\t will\t be\t more\t likely\t to\t overcome\t this\t natural inhibition\t is\t having\t a\t higher\t level\t of\t social\t competence:\t being cooperative\t and\t getting\t along\t with\t other\t children;\t being\t empathic, prone\t to\t giving\t and\t sharing,\t and\t considerate;\t and\t being\t able\t to develop\tclose\tfriendships.\tThese\ttraits\tmarked\ta\tgroup\tof\tchildren\tfirst identified\tas\thaving\ta\ttimid\ttemperament\tat\tage\tfour,\twho\tshook\tit\toff by\tthe\ttime\tthey\twere\tten\tyears\told.9 By\tcontrast,\tthose\ttimid\tfour-year-olds\twhose\ttemperament\tchanged","little\t over\t the\t same\t six\t years\t tended\t to\t be\t less\t able\t emotionally: crying\t and\t falling\t apart\t under\t stress\t more\t easily;\t being\t emotionally inappropriate;\t being\t fearful,\t sulky,\t or\t whiny;\t overreacting\t to\t minor frustration\t with\t anger;\t having\t trouble\t delaying\t gratification;\t being overly\t sensitive\t to\t criticism,\t or\t mistrustful.\t These\t emotional\t lapses are,\t of\t course,\t likely\t to\t mean\t their\t relationships\t with\t other\t children will\t be\t troubled,\t should\t they\t be\t able\t to\t overcome\t their\t initial reluctance\tto\tengage. By\tcontrast,\tit\tis\teasy\tto\tsee\twhy\tthe\tmore\temotionally\tcompetent\u2014 though\t shy\t by\t temperament\u2014children\t spontaneously\t outgrew\t their timidity.\tBeing\tmore\tsocially\tskilled,\tthey\twere\tfar\tmore\tlikely\tto\thave a\t succession\t of\t positive\t experiences\t with\t other\t children.\t Even\t if\t they were\t tentative\t about,\t say,\t speaking\t to\t a\t new\t playmate,\t once\t the\t ice was\tbroken\tthey\twere\table\tto\tshine\tsocially.\tThe\tregular\trepetition\tof such\tsocial\tsuccess\tover\tmany\tyears\twould\tnaturally\ttend\tto\tmake\tthe timid\tmore\tsure\tof\tthemselves. These\tadvances\ttoward\tboldness\tare\tencouraging;\tthey\tsuggest\tthat even\t innate\t emotional\t patterns\t can\t change\t to\t some\t degree.\t A\t child who\tcomes\tinto\tthe\tworld\teasily\tfrightened\tcan\tlearn\tto\tbe\tcalmer,\tor even\toutgoing,\tin\tthe\tface\tof\tthe\tunfamiliar.\tFearfulness\u2014or\tany\tother temperament\u2014may\t be\t part\t of\t the\t biological\t givens\t of\t our\t emotional lives,\tbut\twe\tare\tnot\tnecessarily\tlimited\tto\ta\tspecific\temotional\tmenu by\t our\t inherited\t traits.\t There\t is\t a\t range\t of\t possibility\t even\t within genetic\t constraints.\t As\t behavioral\t geneticists\t observe,\t genes\t alone\t do not\t determine\t behavior;\t our\t environment,\t especially\t what\t we experience\t and\t learn\t as\t we\t grow,\t shapes\t how\t a\t temperamental predisposition\texpresses\titself\tas\tlife\tunfolds.\tOur\temotional\tcapacities are\t not\t a\t given;\t with\t the\t right\t learning,\t they\t can\t be\t improved.\t The reasons\tfor\tthis\tlie\tin\thow\tthe\thuman\tbrain\tmatures. CHILDHOOD:\tA\tWINDOW\tOF\tOPPORTUNITY The\thuman\tbrain\tis\tby\tno\tmeans\tfully\tformed\tat\tbirth.\tIt\tcontinues\tto shape\t itself\t through\t life,\t with\t the\t most\t intense\t growth\t occurring during\t childhood.\t Children\t are\t born\t with\t many\t more\t neurons\t than their\t mature\t brain\t will\t retain;\t through\t a\t process\t known\t as\t \u201cpruning\u201d the\t brain\t actually\t loses\t the\t neuronal\t connections\t that\t are\t less\t used, and\tforms\tstrong\tconnections\tin\tthose\tsynaptic\tcircuits\tthat\thave\tbeen utilized\t the\t most.\t Pruning,\t by\t doing\t away\t with\t extraneous\t synapses,"]
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