Research on why some abuse victims are more resilient in recovery


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Posted by moonshiner on April 30, 2006 at 16:02:36

A Question of Resilience
By EMILY BAZELON
NY Times April 30, 2006

In the spring of 1993, when I was an intern at The New Haven Advocate, a local weekly, I met two girls named La'Tanya and Tichelle. La'Tanya was 13, Tichelle was 11 and, along with their two younger sisters, they had recently returned from a year in foster care to live with their mother, Jean. (I have used middle names to protect the family's privacy.) I was supposed to spend an hour or two with them and write an article for the paper about families that reunite. But I liked the girls, and I decided I needed to interview them again — the joy of being an intern, after all, is that no one really cares when you finish your article. The next time I showed up, about a week later, a worried-looking woman was talking to the girls. She was a prosecutor who was about to try Jean's boyfriend, Earl Osborn, for sexually abusing La'Tanya and Tichelle over several years and their 7-year-old sister, Charnelle, for a shorter period. The girls were her chief witnesses.

At the trial that May in a courtroom in New Haven, La'Tanya testified that Osborn started touching her when she was in kindergarten. She told her mother, and Jean put him out of the house. But somehow, though he wasn't violent, she couldn't make him stay out. She would later say that this was the greatest mistake of her life, but in court, she said as little as possible.

During the next five years, Jean warned Osborn to keep away from her daughters. He didn't. When La'Tanya and Tichelle were about 10 and 8, Jean testified, she put a lock on the door of their bedroom. Osborn broke the lock three times. Jean would find him lying on top of the girls, rubbing against them and putting his hands down their pajamas, or next to them masturbating. She gave her daughters a stick to sleep with. But she never banished him from their home.

In June 1991, after being tipped off that there might be a problem at home, a school social worker pulled La'Tanya out of her sixth-grade graduation party and asked if anyone was bothering her. La'Tanya shook her head no and then started to cry, and to talk. Jean lost custody of La'Tanya, Tichelle, Charnelle and their youngest sister, Chanté. That's when the girls lived in foster care, first with a family and then for several months with their grandmother. Osborn was arrested. In May 1993, on the strength of La'Tanya and Tichelle's testimony, a jury in New Haven convicted him of nine charges of sexual assault. Osborn was sentenced to 85 years in prison. The jury foreman was Jon Butler, a history professor, who is dean of the Yale Graduate School of Arts and Sciences. "The verdict hinged overwhelmingly on the credibility of the girls," he told me recently. "They were so good because they weren't so good. They weren't acting, this wasn't contrived, what happened had been deeply disturbing to them. They conveyed this with the kind of precision that made it completely believable."

During the summer after the trial, I spent time with the girls, taking them to the playground and the pool. I wrote about them for The Advocate. Then I left, as interns do. I did stay in touch with La'Tanya and Tichelle, because I was worried about them and because I admired them. They took care of each other, and they were resourceful. "They're very appealing kids, and I don't think anyone expected that, considering what they've been up against," Cecilia Wiederhold, the prosecutor, said in my Advocate article.

As the girls grew up, they kept exceeding my expectations. Study after study has shown that sexually-abused children — especially those who grow up in the sort of low-income, messy surroundings that the girls did — are more likely to develop a raft of emotional and health problems, including depression, post-traumatic stress disorder and suicidal thoughts. As adults, they are more likely to be unemployed, homeless, addicted to drugs or alcohol and alone. Now, at ages 26 and 24 respectively, La'Tanya and Tichelle are none of those things. La'Tanya works as a certified nursing assistant at St. Raphael's Hospital. She has her own apartment in a small town on the Connecticut shore. She is raising her two sons, who are 10 and 5. Tichelle is a computer operator for the city of Bridgeport. She lives with her 1-year-old son in the same apartment complex as La'Tanya. Both sisters graduated from high school and have their own cars.

By middle-class standards, these accomplishments seem modest. But financial independence and stability are rare and hard-won for anyone in the poor black New Haven neighborhood where the sisters grew up. Jean raised her children on welfare and never learned to drive. La'Tanya and Tichelle's fathers have been almost entirely absent. On the blocks of row houses and vacant lots where they were raised, teenage mothers far outnumber married ones.

Over the years, I've wondered what accounts for their relative success. Were La'Tanya and Tichelle different, and if so, why? Weren't their lives supposed to have fallen into chaos? How is it that some children show a certain resilience after experiencing a trauma and others do not?

The everyday meaning of the word "resilience" extends to anything that bounces back. Estée Lauder makes Resilience Lift Eye Crème and Hanes makes Resilience Pantyhose. But in psychology, resilience has a specific meaning. It's the word for springing back from serious adversity, like abuse, war or natural disasters. You exhibit resilience (as opposed to plain competence) if you cope with terrible misfortune and live a relatively successful life as defined by mental health, success in school or at work or solid relationships. In studies of the long-term effects of physical and sexual child abuse, 20 to 40 percent of victims show few signs of behavioral or mental-health problems. And many of them don't appear damaged later in life. As Ann Masten, a resilience researcher, has written, resilient children have the benefit of "ordinary magic." When it comes to abuse victims, though, this finding is rarely trumpeted, for fear that saying abuse isn't always inevitably harmful is tantamount to saying it's not always bad.

Over the last several decades, a small group of researchers has tried to understand how a minority of maltreated children exceed expectations. The grandfather of resilience theory is Norman Garmezy, who by the 1960's had begun asking why some children of schizophrenics fared better than others. In the 1970's, Ann Masten joined Garmezy at the University of Minnesota, and the two, along with others, started a project spanning more than two decades. They looked at a child's personality, among other things, imagining resilience as a function of temperament, will or intelligence. While children of average intelligence or above were more likely to exhibit resilience, the researchers noted that good relationships with adults can exert an effect that is as powerful, if not more, in mitigating the effects of adversity.

In recent years, biological science has proposed a new paradigm. The latest research shows that resilience can best be understood as an interplay between particular genes and environment — GxE, in the lingo of the field. Researchers are discovering that a particular variation of a gene can help promote resilience in the people who have it, acting as a buffer against the ruinous effects of adversity. In the absence of an adverse environment, however, the gene doesn't express itself in this way. It drops out of the psychological picture. "We now have well-replicated findings showing that genes play a major role in influencing people's responses to adverse environments," says Sir Michael Rutter, a leading British psychiatrist and longtime resilience expert. "But the genes don't do anything much on their own."

Rutter opened a GxE research center because he was frustrated that most psychiatric studies tracked the effects either of genes or of environment rather than looking at them in tandem. Despite a few initial successes, like the discovery of the gene that causes Down syndrome, most searches for genes that fully explain psychiatric outcomes — "the alcoholism gene," "the schizophrenic gene" — have failed. Meanwhile, in the field of medicine, it's increasingly common to consider external factors when studying the effects of genes. "With heart disease and cancer, genetic researchers have always known to include factors like smoking and exercise," says Terrie Moffitt, who is on the faculty of Rutter's research center at the Institute of Psychiatry in London and of the University of Wisconsin. "We wanted to do the same thing for the study of behavior."

The breakthrough moment for GxE came in 2003, when Moffitt and her husband and co-investigator, Avshalom Caspi, published a paper in Science that discussed the relationship between the gene, 5-HTT, and childhood maltreatment in causing depression. Scientists have determined that 5-HTT is critical for the regulation of serotonin to the brain. Proper regulation of serotonin helps promote well-being and protects against depression in response to trauma or stress. In humans, each 5-HTT gene has two alleles, and each allele occurs in either a short or a long version. Scientists are still figuring out how the short allele affects serotonin delivery, but it seems that people with at least one short 5-HTT allele are more prone to depression. And since depression is associated with unemployment, struggling relationships, poor health and substance abuse, the short allele could contribute to a life going awry.

About one-third of the white population have two copies of the protective long allele. About one-half have one long allele and one short one. And about 17 percent have two short alleles. (African-Americans are less likely to have a short allele; Asians are more likely.) In their 2003 study, Caspi and Moffitt looked at 847 New Zealand adults and found a link between having at least one short 5-HTT allele and elevated rates of depression for people who had been mistreated as children or experienced several "life stresses" — defined as major setbacks with jobs, housing, relationships, health and money. Having two short alleles made it highly likely that people who had been mistreated or exposed to unhinging stress would suffer depression. One short allele posed a moderate risk of depression in these circumstances. Two long alleles, on the other hand, gave their carriers a good chance of bouncing back under negative circumstances. In other words, as a group, children with two risky alleles lost out badly when their environments failed them, children with one risky allele were at some risk and children with good resilience alleles often carried a shield. The risky variation of the gene doesn't confer vulnerability, though, if an individual who carries it never experiences abuse or serious stress — in other words, it's not a "depression gene" in any general sense. It seems that only under dire circumstances — abuse, the strife of war, chronic stress — is the gene triggered. Eventually scientists hope to understand more about other genes that most likely play a role like 5-HTT's.

Researchers who study humans cannot, of course, run controlled experiments by randomly assigning some children to abusive homes. But primatologists can. At a laboratory in rural Maryland, run by the National Institutes of Health, Stephen Suomi studies 500 rhesus monkeys. Each year, Suomi divides newborn monkeys into several groups. One group live with their mothers, much as they would in the wild (except for the indoor pens and the daily rations). Another group, created to mimic the experience of a neglected or abused child, never see their mothers, spending two weeks in an incubator and then moving into a small group of peers.

Rhesus monkeys share with humans about 96 percent of their genes — including the long and short variations of 5-HTT. Using DNA samples, Suomi is able to track which of his monkeys have which allele. In an ongoing study, Suomi has found that motherless, peer-raised monkeys who have a copy of the short 5-HTT allele are more likely to experience fear, panic and aggression (accompanied by low levels of serotonin acid in spinal fluid) when a strange monkey in a cage is placed next to them. Motherless, peer-raised monkeys with two long alleles, on the other hand, are more likely to take the presence of the stranger in stride, as mother-raised monkeys do. (Only a tiny number of monkeys have two copies of the short allele, so they're not studied.) "How you grow up affects your hormonal output and the structure and function of the brain," Suomi says. "And these effects are tempered by the kind of gene the monkeys carry. So it's a true interaction."

In Suomi's lab, there's a room filled with large cages of 2- and 3-year-olds — adolescents approaching adulthood, in monkey years. "Go in quickly and quietly," Suomi tells me and then follows me through the door. Some of the monkeys stay in the middle of the cage, eyeing us without seeming preoccupied. Another group races to the back and huddles together in the farthest corner, their small fingers wrapping around one another's fur. They twitter and turn their faces away in distress.

The middle-of-the-cage monkeys were raised by their mothers. The freaked-out ones at the back raised one another. After a few minutes, some of the peer-raised monkeys begin to dart forward. After a few more minutes, they settle in with the mother-raised group. But others never move from the back of the cage. According to Suomi, you could approach the cage a hundred times and each time see the same result. And each time, the peer-raised monkeys would race to the back, and then a few would mirror human resilience by coming forward. And they would generally be the monkeys with two long 5-HTT alleles. The good version of the gene.

Suomi's peer-raised monkeys are deprived of their mothers and other adult monkeys. Abused children, by contrast, don't just live with other children. They may have in their lives grandparents, aunts, teachers, maybe an adult they know from church or a volunteer from a Big Brother or Big Sister program. And they are much more likely than other children to name one of these adults as the person on whom they most rely.

continued in next post below


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