MENTAL TOUGHNESS: Develop a Resilient Brain

2009-01-09T10:53:00.000-08:00

If I had a formula for bypassing trouble, I wouldn't pass it around. Wouldn't be doing anybody a favor. Trouble creates a capacity to handle it.

---Oliver Wendell Holmes

“People are like stained-glass windows. They sparkle and shine when the sun is out, but when the darkness sets in, their beauty is revealed only if there is a light from within."
Elizabeth Kubler-Ross

Chris had struggled with anxiety and trouble breathing when he first came to see me. He was sixteen years old and had a condition known as Golden Harse Syndrome, which meant he was born without his left jaw bone. He had undergone 21 operations to fix his deformity, which included bone grafts from his own body. His face was severely scarred like an old railroad yard. The sense of panic started when he was on the operating room table being intubated for the last two surgeries. His mother, Maria, was concerned, as Chris had been a very resilient boy, and brought him to see me. He had at least two more surgeries to go. A few sessions of relaxation training and hypnosis easily cleared up his anxiety.

As I got to know Chris, I came to believe that despite his anxiety reaction, which didn’t occur until his twentieth surgery, he was the healthiest person I had ever met. He was president of his tenth grade class. He was a straight A student and had a girlfriend he adored. He also had very clear goals for his future and a great attitude, despite having 21 surgeries and a distorted face. After his anxiety abated, I continued to see him for a few months without cost. I felt driven to understand why he was so healthy, despite his circumstances. I had other patients, who had not faced nearly his stress and challenges, but were emotional wrecks. For the most part, psychiatrists study illness, not mental health. I came to believe that there were four reasons for Chris’ resilience: he had no excuses, a strong peer group, an optimistic attitude and a great brain.

First, Chris’ mother never allowed his illness to be an excuse for anything. Maria was loving but firm. Inside, Chris’ illness deeply pained Maria. Like all good mothers, she hurt for her son, but early in Chris’ illness she realized that babying him would only handicap him and she would have none of it. He still did chores, was expected to excel at his schoolwork and participate with other kids even when they made fun of him. She helped him rehearse what to say when they were cruel, which they were. When the other kids found that Chris did not get upset by the teasing, but expected it and laughed along with them, they stopped and started to befriend and admire him. Their petty complaints seemed small compared to what Chris endured. Second, because of Chris’ behavior, he had a strong peer group. His group of friends often came to the hospital to see him after his surgeries and he spent a lot of time with them. He was a good friend. Third, Chris was an optimist. In listening to his speech, he almost always saw the upbeat side of issues. He did not see his condition as a handicap. When we talked about it, he said everyone has something. “This is my problem,” he said. “At least I do not have cancer or something that will kill me.” Lastly, I did not need a SPECT scan to know that Chris had a great brain. He was flexible, goal oriented, focused, passionate about his life and positive and honest in his thinking. I often wish, I could bottle Chris’ attitude and give it away to my children, patients and even take a dose or two myself.

Psychiatrist Robert Pasnau, past president of the American Psychiatric Association, once said at a lecture to the residents in my training program that coping requires three things: information, a sense of control and self esteem. Chris clearly had a high self esteem. He also knew what was happening, he was very informed about his condition and what must be done. His anxiety started when he was felt as though he was losing control. He was not supposed to be aware of being intubated (this is where a metal tube is placed in your throat to keep your airway open for breathing during the anesthesia and surgery). The anesthesiologist had not given him enough medication on the 20^th surgery and he was aware of the tube in his throat and felt panicky and out of control.

How Childhood Sets Up Resilience or Vulnerability in the Brain

Evidence from both animal and human studies show that children who experience extreme, uncontrollable stress, such as physical or sexual abuse, are more likely to suffer from anxiety and depression and are more vulnerable to stress later in life. At birth there is substantial flexibility in brain’s ability to respond and adapt to stressful events. Some research suggests that there may be a critical period in the first few weeks of life, during which traumas are particularly harmful to the brain’s ability to handle stress. Studies of humans who survive child abuse have found changes in the functioning of the brain circuits responsible for handling stress. A study of women who were abused as children found that they had an increase in their stress hormones compared to those who were not abused. Long term exposure to stress hormones have been found to kill cells in the hippocampus, part of the limbic brain deep in the temporal lobes, involved with memory, learning and emotion. Smaller hippocampal volumes are found in people with depression and chronic stress disorders. Early abuse or stress can cause longstanding changes in brain circuits associated with resilience and learning. Women who are abused are more likely to stay with men who are abusive, in part because of their own anxiety, erratic memory and low self confidence. These findings suggest that child abuse can lead to long-term changes in the brain and may help to explain why mistreatment is passed down generation after generation.

An interesting twist on the research, however, occurs when children are exposed to milder, more manageable forms of stress. It appears that these stresses actually aid in building resilience. Some stress, it seems, is good, even important. This is known as “stress inoculation”, based on the analogy to vaccinations against infections. The theory is that when a person is presented with a mild form of an infectious disease, he or she develops immunity by learning how to fight it off. Children who are faced with and overcome moderately stressful events, such as family moves, parental illnesses or losing friendships, are better able to deal with adversity later in life than people who were never exposed to trouble as children. Children who learn to cope with stress seem to have a better ability to deal with hardships over the long term. In one study, teenage boys who survived stressful childhood events experienced less overt signs of stress, such as increased heart rate and blood pressure changes, when performing challenging tasks compared to their counterparts who had not struggled with earlier trouble. Research on animals lend credence to the stress inoculation theory and provides insight into its brain mechanism. Young monkeys separated from their mothers for one hour every week (a manageable stressor) experienced acute distress during the separation periods, and temporarily increased levels of cortisol, the stress hormone. Later in life, however, the same monkeys demonstrate lower anxiety and lower baseline cortisol levels than monkeys who had never been separated from their mothers. Furthermore, these “stress inoculated” monkeys demonstrate improved performance on tests that measure prefrontal cortex function. Poor control of prefrontal cortex function has been associated with depression and impulsivity in humans.

It seems that it is the amount of early stress that matters. Too much is clearly a problem, but too little leaves you without the skill to manage trouble later on. This research highlights an important point. Try not to protect your children from every hardship they may face. As a father of three children, I never wanted my children to suffer, yet if I did everything for them and never allow them to experience stress, they will not develop the ability to deal with the hardships that will inevitably come their way. It would be as though I never vaccinated them against stress. Likely, this is why Chris did so well. His mother never allowed his handicap to be used as an excuse. Even when he was stressed by being teased by the other children, he had to keep dealing with it, and as such, learned how to deal with it. Social skills are now his strength.

Dr. Daniel G. Amen's Blog

MENTAL TOUGHNESS: Develop a Resilient Brain