Posted by moonshiner on April 30, 2006 at 16:03:43
In Reply to: Research on why some abuse victims are more resilient in recovery posted by moonshiner on April 30, 2006 at 16:02:36:
Caspi and Moffitt's research was important in showing a link between genes and an abusive environment, but they didn't explore the effect of mitigating factors in the abused children's lives. Joan Kaufman, a Yale psychiatry professor, has taken the next step by doing so. In a paper this month in the journal Biological Psychiatry, Kaufman reported on 196 children between the ages of 5 and 15, 109 of them removed from their homes in Connecticut because of reports of physical or sexual abuse or neglect. This group was compared with a second nonabused group with the same racial composition — about 28 percent white, 24 percent Hispanic, 28 percent African-American and 20 percent biracial — and the same income of $25,000 or less. (Physical and sexual abuse are more prevalent among poor families, though abuse happens at all economic levels. Studies like Caspi and Moffitt's, which include families of varied income, show that the resilience findings apply to middle- and upper-class kids as well as poor ones.)
Kaufman gave all 196 children a questionnaire about their moods, which measure mental health. She also used DNA tests to check their 5-HTT alleles. Kaufman's abused children with two short 5-HTT alleles had a higher mean score for depression than the abused children with two long alleles and the nonabused children, no matter what their alleles. (In Kaufman's study, which was smaller than Caspi and Moffitt's, the moderate risk of depression posed by one short allele didn't show up, though that finding has been replicated by other researchers.)
In her recent paper and in earlier research, Kaufman also built on the work of psychologists who have measured the quality of abused children's relationships to adults, asking the children to name the person they most often "talk to about personal things, count on to buy the things they need, share good news with, get together with to have fun and go to if they need advice." The mean depression score for abused children with two short alleles who rarely saw the adults they named was off the charts. If the children with two short alleles saw the adults they counted on daily or almost daily, their depression scores were very close to the scores of the children with two long protective alleles — and within reach of the children who had not been abused. (The children with the protective version of the gene were far less affected by a lack of contact with their primary adult.) "Good support ameliorates the effect of abuse and of the high-risk genotype," Kaufman says. While he notes that Kaufman's research is preliminary, Dennis Charney, a psychiatry and neuroscience professor at Mount Sinai School of Medicine, says that the study used "solid methodology and yielded very interesting findings."
La'Tanya and Tichelle had relatively good support. When the state removed the girls and their sisters from their home, their grandmother took them in. "She did everything for us," La'Tanya remembers. Later, a half-sister who is 10 years older than La'Tanya began picking her up on weekends. "I spent a lot of time with her," La'Tanya says. "We'd rent movies, go places, do a lot of things together."
Having "good support" isn't just a question of good luck. Researchers have found that children who are resilient are skillful at creating beneficial relationships with adults, and those relationships in turn contribute to the children's resilience. La'Tanya and Tichelle were both good at forging these bonds. When I left New Haven in 1994, they wrote me. I moved back a few years later, and Tichelle called regularly, came to my office to meet me for lunch, asked me to stop by her house on the weekends. La'Tanya soon started calling, too. Sometimes the sisters were behind on their bills and, always with embarrassment, asked me for money. But more often they called, and still call, to check in, to ask after my kids or tell me about theirs. They let me know that I matter to them, and that has made them matter more to me.
In the last year or so, I've become more aware that La'Tanya and Tichelle are quite different and that the darkness of childhood seems to have left a more indelible mark on the older sister. La'Tanya and her sister were both molested. And they lived with their mother, who was remote — I don't think I ever saw Jean hug her daughters in the months surrounding the trial. But La'Tanya shouldered more of a burden than Tichelle did. As the oldest, La'Tanya often had to look after her sisters — make them dinner, put them to sleep. "La'Tanya raised us," Tichelle says. "She's more like a mom than a sister." La'Tanya wrote in her diary last year, "Ever since I can remember I've taken on more than any one person should have to."
In March 1994, when they were 14 and 12, the girls sent me letters. Tichelle wrote: "My grades are excellent. I got all A's and two B+'s. In school I am a cheerleader we cheer every Tuesday and Thursday. I am still in double dutch it's very fun." La'Tanya also reported her good grades. But mostly she described the heaviness of her world. "A lot of people have been getting killed," she wrote. "A house almost got burned down and nobody ever goes outside."A year later, La'Tanya ran away from home. She moved in with her 17-year-old boyfriend and decided to have a baby. The thread that runs through these decisions is her anger and disappointment with Jean. "I had a baby to be loved by someone," La'Tanya says. "When all the mess fell out, my mother didn't do anything about it. That's what made me think she didn't love us."
Tichelle, by contrast, forgave her mother and relies on her. "That's my mom, and I'm not going to let anyone take her away." On the day Tichelle went into labor last spring, the father of her baby was arrested for selling drugs. She called her mother, and after the birth Jean slept at the hospital with her daughter and grandson. Jean takes care of the baby every day while Tichelle is at work, as she has done for her other grandchildren.
Before her baby was born, Tichelle landed a permanent position in her office after impressing her boss as a temp. "I'm 23, and I know what I want for myself," she told me last year. La'Tanya, meanwhile, was struggling with crying spells and panic attacks. After a recurrent nightmare about Osborn, she would wake up and compulsively check and recheck the locks in her apartment. She couldn't stop thinking about Osborn's gun — "a black shotgun with a light brown barrel."
There are a lot of reasons that La'Tanya has had a harder time than her sister, not least of them that she was abused for a longer period of time. But reading all the GxE research made me wonder whether she was also more genetically vulnerable. I asked the girls if they'd be willing to be tested, and they agreed — they said they were curious. Last month, La'Tanya, Tichelle and Charnelle (who had been abused by Osborn for a shorter period when she was 3) sent cheek swabs with their DNA to a lab run by a Colorado-based company called NeuroMark, which tests for the 5-HTT alleles.
The study of resilience is nearly 50 years old. Yet its contribution to our understanding of the effects of child abuse has gained little traction beyond a small subset of academics. Historically, the study of resilience inadvertently collided with the movement to treat child abuse as a national cause for alarm. In the 1950's, experts like Alfred Kinsey minimized the damage of sexual abuse. The fright described by children who'd had sexual contact with adults was "nearer the level that children will show when they see insects [or] spiders," Kinsey wrote, as Joseph E. Davis, a sociologist, recounts in his recent book, "Accounts of Innocence." Until the mid 1970's, standard psychology textbooks also played down the effects of abuse and put the incidence of incest at one in a million.
By the beginning of the next decade, the textbooks were being rewritten. Led by Judith Lewis Herman, a professor of clinical psychiatry at Harvard, feminists shredded the myth that sexual abuse is rare and does little significant harm. They argued that even a brief, single incident of abuse could and often did scar victims for life. In 1980, Herman helped win an official psychiatric diagnosis for post-traumatic stress disorder, as a response to trauma that causes people to "dissociate," or fragment, by alternately feeling numb and reliving the event. According to its clinical definition, PTSD can strike a victim of rape or child abuse as easily as a combat veteran. The orthodoxy that abuse necessarily causes trauma grew and still remains entrenched. It has extensive institutional support — $29 million a year in government financing goes to a national "traumatic stress" center and 44 hospitals and community-based programs around the nation. "The problem in our country isn't that we overidentify trauma," said Ellen Gerrity, associate director for the national center. "It's that we underidentify it."
All along, a few experts have raised doubts about equating childhood sexual experience with trauma and about the assumption that abuse destroys victims' lives. But they got little attention — until an academic brush fire over terminology exploded into a public war. In 1998, Bruce Rind, Robert Bauserman and Philip Tromovitch published an article in Psychological Bulletin, a journal of the American Psychological Association, analyzing 59 studies of the long-term effects of sexual abuse and adult-child sexual contact on college students. "At the time, the starting hypothesis in the field was that child sexual abuse, broadly defined, was extremely harmful in all cases," Rind says. "Our idea was to take this very strong statement and to be statistically and methodologically rigorous about testing it."
The Rind paper found only a marginal difference between the psychological well-being of college students who'd been "sexually abused" and those who hadn't. But there was a catch: Some of the studies being analyzed defined sexual abuse broadly to include exhibitionism and consensual contact between teenagers and adults. When abuse was limited to lack of consent, force or incest, its deleterious effects were more pronounced. So Rind and his co-authors recommended narrowing the definition of abuse.
Conservatives condemned the Rind paper, and Congress denounced it. The uproar virtually derailed the hope of opening child sex studies to rigorous inquiry. "There had been an underestimation of the extent to which children can recover from sexual abuse," says David Finkelhor, a sociologist who directs the Crimes Against Children Research Center at the University of New Hampshire and who has found that pre-existing depression may make children vulnerable to sexual abuse and may help account for the problems some suffer afterward. "But that article started a trend in the opposite direction," he says — by discouraging investigations of the differences between harmful sexual abuse and other sexual contact.
Still, in trying to understand why some children are not scarred for life, resilience research brightens a picture that is often painted in black. And the promise of GxE brings with it new excitement — and grant money. Caspi and Moffitt, whose article about 5-HTT received widespread praise, didn't bother to try to get government money when they began collecting DNA data in 1998. Now they receive $500,000 a year in N.I.M.H. and U.K. government grants. Other researchers have similar support for GxE work.
If GxE pans out as the enthusiasts hope, it could change not just our understanding of the effects of abuse but also our treatment of it. Neurobiological research on mice and rats has begun to look at the effect that the 5-HTT gene has on the brain at the molecular level. Eventually, a designer drug might succeed in mimicking precisely what the long-allele variation of 5-HTT does to foster resilience. "A magic drug down the line — yes, that's the whole point of understanding the neurological mechanisms," Joan Kaufman says.
Other experts, however, are skeptical. Whatever an abused child's genes, they argue, she still needs the ingredients that promote resilience — adults she can trust, the reinforcements that make her believe in herself. "It's nice to know what's going on in the body," says Suniya Luthar, a psychology professor at Columbia University's Teachers College. "But what's the real promise here? We already know what people need to be resilient. From the standpoint of intervention, I'd rather see money go toward things that are more likely to make real change," like developing effective interventions. Luthar also worries about genetic profiling. "Are we going to think about genetic engineering" to weed out the high-risk variation of a gene? she asks.
Kaufman, too, warns that finding out which variation of 5-HTT you carry is not like getting a diagnosis. The short allele increases vulnerability across a large group rather than exposing any one person who has it. Other genes, as well as relationships, contribute. "Think about it as one factor on a scale," Kaufman says. "It can tip the scale toward depression or away from it. But other factors can tip the scale, more powerfully, in the opposite direction."
Still, the test results for La'Tanya, Tichelle and their younger sister Charnelle are intriguing. As it turns out, Tichelle carries only the protective version of the gene (two long alleles). So does Charnelle, who at 20 is thriving, with a steady job at a nursing home and an apartment she shares with a boyfriend whom her family likes.
La'Tanya, though, carries one copy of the short 5-HTT allele, putting her in the group of abused children who are at moderate risk of depression. Perhaps her genes help account for the times she has gone to the hospital because she's so anxious she can't breathe and the days she can't stop crying or get out of bed.
Yet, as Kaufman says, La'Tanya's genes don't doom her to unhappiness. She has good days too. Last year she signed up with a home-health-aide agency and was frustrated — and broke — because she was getting only scattered hours of work. She wanted a hospital job. But that required a state recertification. I gave her $700 for the four-week course she needed.
At the graduation ceremony last spring, two dozen students ate pizza next to the hospital beds and dummy patient they'd practiced on. "I got a 93 on the final," La'Tanya told me twice. She was wearing a pink turtleneck sweater, pressed jeans and high-heeled black boots. She'd taken out her lip piercing because the teacher said it might put off potential employers. "Now I just need to take the licensing test," she said to a friend. "When we leave from here I'm going over to sign up." She did. She passed. She got the hospital job she wanted. Keeping it hasn't been easy, especially because her younger son has been acting up in school. But she is doing it.
Next month, NeuroMark will begin selling the 5-HTT test to people whose doctors request it. The results won't solve the riddle of which survivors of abuse fare better than others. But they may provide a clue. "I think for me it helps explain things," La'Tanya said. "I feel a little better that there is a reason, another reason, for my life being hard. And I understand that what I'm able to do for myself and my kids, even with this, is good. It's good."
Emily Bazelon is a senior editor at Slate and a recent Soros Media Justice Fellow.