3. The benefits for children of having emotionally adept parents: Hooven, Katz, and Gottman, "The Family as a Meta-emotion Culture."
4. Optimistic infants: T. Berry Brazelton, in the preface to Heart Start: The Emotional Foundations of School Readiness (Arlington, VA: National Center for Clinical Infant Programs, 1992).
5. Emotional predictors of school success: Heart Start.
6. Elements of school readiness: Heart Start, p. 7.
7. Infants and mothers: Heart Start, p. 9.
8. Damage from neglect: M. Erickson et al., "The Relationship Between Quality of Attachment and Behavior Problems in Preschool in a High-Risk Sample," in I. Betherton and E. Waters, eds., Monographs of the Society of Research in Child Development 50, series no. 209-
9. Lasting lessons of first four years: Heart Start, p. 13.
10. The follow-up of aggressive children: L. R. Huesman, Leonard Eron, and Patty Warnicke-Yarmel, "Intellectual Function and Aggression," The Journal of Personality and Social Psychology (Jan. 1987). Similar findings were reported by Alexander Thomas and Stella Chess, in the September 1988 issue of Child Development, in their study of seventy-five children who were assessed at regular intervals since 1956, when they were between seven and twelve years old. Alexander Thomas et al., "Longitudinal Study of Negative Emotional States and Adjustments From Early Childhood Through Adolescence," Child Development 59 (1988). A decade later the children who parents and teachers had said were the most aggressive in grade school were having the most emotional turmoil in late adolescence. These were children (about twice as many boys as girls) who not only continually picked fights, but who also were belittling or openly hostile toward other children, and even toward their families and teachers. Their hostility was unchanged over the years; as adolescents they were having trouble getting along with classmates and with their families, and were in trouble at school. And, when contacted as adults, their difficulties ranged from tangles with the law to anxiety problems and depression.
11. Lack of empathy in abused children: The day-care observations and findings are reported in Mary Main and Carol George, "Responses of Abused and Disadvantaged Toddlers to Distress in Agemates: A Study in the Day-Care Setting," Developmental Psychology 21, 3 (1985). The findings have been repeated with preschoolers as welclass="underline" Bonnie Klimes-Dougan and Janet Kistner, "Physically Abused Preschoolers' Responses to Peers' Distress," Developmental Psychology 26 (1990).
12. Difficulties of abused children: Robert Emery, "Family Violence," American Psychologist (Feb. 1989).
13. Abuse over generations: Whether abused children grow up to be abusing parents is a point of scientific debate. See, for example, Cathy Spatz Widom, "Child Abuse, Neglect and Adult Behavior," American Journal of Orthopsychiatry (July 1989).
Chapter 13. Trauma and Emotional Relearning
1. I wrote about the lasting trauma of the killings at Cleveland Elementary School in The New York Times "Education Life" section (Jan. 7, 1990).
2. The examples of PTSD in crime victims were offered by Dr. Shelly Niederbach, a psychologist at the Victims' Counseling Service, Brooklyn.
3. The Vietnam memory is from M. Davis, "Analysis of Aversive Memories Using the Fear-Potentiated Startle Paradigm," in N. Butters and L. R Squire, eds., The Neuro-psychology of Memory (New York: Guilford Press, 1992).
4. LeDoux makes the scientific case for these memories being especially enduring in "Indelibility of Subcortical Emotional Memories," Journal of Cognitive Neuroscience (1989), vol. 1, 238-43.
5. I interviewed Dr. Charney in The New York Times (June 12, 1990).
6. The experiments with paired laboratory animals were described to me by Dr. John Krystal, and have been repeated at several scientific laboratories. The major studies were done by Dr. Jay Weiss at Duke University.
7. The best account of the brain changes underlying PTSD, and the role of the amygdala in them, is in Dennis Charney et al., "Psychobiologic Mechanisms of Posttraumatic Stress Disorder," Archives of General Psychiatry 50 (April 1993), 294-305.
8. Some of the evidence for trauma-induced changes in this brain network comes from experiments in which Vietnam vets with PTSD were injected with yohimbine, a drug used on the tips of arrows by South American Indians to render their prey helpless. In tiny doses yohimbine blocks the action of a specific receptor (the point on a neuron that receives a neurotransmitter) that ordinarily acts as a brake on the catecholamines. Yohimbine takes the brakes off, keeping these receptors from sensing the secretion of catecholamines; the result is increasing catecholamine levels. With the neural brakes on anxiety disarmed by the drug injections, the yohimbine triggered panic in 9 of 15 PTSD patients, and lifelike flashbacks in 6. One vet had a hallucination of a helicopter being shot down in a trail of smoke and a bright flash; another saw the explosion by a land mine of a Jeep with his buddies in it—the same scene that had haunted his nightmares and appeared as flashbacks for more than 20 years. The yohimbine study was conducted by Dr. John Krystal, director of the Laboratory of Clinical Psychopharmacology at the National Center for PTSD at the West Haven, Conn., VA Hospital.
9. Fewer alpha-2 receptors in men with PTSD: see Charney, "Psychobiologic Mechanisms."
10. The brain, trying to lower the rate of CRF secretion, compensates by decreasing the number of receptors that release it. One telltale sign that this is what happens in people with PTSD comes from a study in which eight patients being treated for the problem were injected with CRF. Ordinarily, an injection of CRF triggers a flood of ACTH, the hormone that streams through the body to trigger catecholamines. But in the PTSD patients, unlike a comparison group of people without PTSD, there was no discernible change in levels of ACTH—a sign that their brains had cut back on CRF receptors because they already were overloaded with the stress hormone. The research was described to me by Charles Nemeroff, a Duke University psychiatrist.
11. I interviewed Dr. Nemeroff in The New York Times (June 12, 1990).
12. Something similar seems to occur in PTSD: For instance, in one experiment Vietnam vets with a PTSD diagnosis were shown a specially edited 15-minute film of graphic combat scenes from the movie Platoon. In one group, the vets were injected with naloxone, a substance that blocks endorphins; after watching the movie, these vets showed no change in their sensitivity to pain. But in the group without the endorphin blocker, the men's pain sensitivity decreased 30 percent, indicating an increase in endorphin secretion. The same scene had no such effect on veterans who did not have PTSD, suggesting that in the PTSD victims the nerve pathways that regulate endorphins were overly sensitive or hyperactive—an effect that became apparent only when they were reexposed to something reminiscent of the original trauma. In this sequence the amygdala first evaluates the emotional importance of what we see. The study was done by Dr. Roger Pitman, a Harvard psychiatrist. As with other symptoms of PTSD, this brain change is not only learned under duress, but can be triggered once again if there is something reminiscent of the original terrible event. For example, Pitman found that when laboratory rats were shocked in a cage, they developed the same endorphin-based analgesia found in the Vietnam vets shown Platoon. Weeks later, when the rats were put into the cages where they had been shocked—but without any current being turned on—they once again became insensitive to pain, as they originally had been when shocked. See Roger Pitman, "Naloxone-Reversible Analgesic Response to Combat-Related Stimuli in Posttraumatic Stress Disorder," Archives ofGeneral Medicine (June 1990). See also Hillel Glover, "Emotional Numbing: A Possible Endorphin-Mediated Phenomenon Associated with Post-Traumatic Stress Disorders and Other Allied Psychopathologic States," Journal of Traumatic Stress 5, 4 (1992).