Young + Mentally Competent by Nikko-Ryan Santillan

Nikko-Ryan Santillan Young and Mentally Competent

Overprotective Parenting May Make College Age Children Depressed

Twitter and Facebook ‘harming children’s development’

Lasting Legacy of Childhood Bullying: Psychiatric Problems in Adulthood

How Junior High Friendships Affect Adult Relationships

The Existential Pain of Being Young, White, and Affluent

Why Can Some Kids Handle Pressure While Others Fall Apart?

The Power of Choosing Resilience

Table of Contents

Screening Children For Mental Illness: Experts Call For Early Testing

Kate Kelland Huffington Post Screening Children For Mental Illness: Experts Call For Early Testing

Huffington Post 6

LONDON, Nov 28 (Reuters) — Leading mental health experts are calling for school children to be screened for risk of mental illnesses such as depression and have devised a test that reliably identifies those at high risk. The test can be done on a computer and could be used to alert doctors and psychologists to intervene early, said Barbara Sahakian a professor of clinical neuropsychology at Britain’s Cambridge University. Ian Goodyer, a child and adolescent psychiatrist who worked with Sahakian on a study published on Wednesday, said screening 11- to 12-year-old children could reveal those who have “low resilience”— putting them at higher risk of developing mental illnesses such as depression. Mental health problems are common in young people. Some 10 percent of children aged between five and 16 in Britain are assessed as having a mental disorder of some kind. Adolescence is also a critical period for the development of major depression — an illness that exacts a heavy toll on people and economies worldwide with patients unable to hold down jobs or needing repeated long stretches of time off work. The World Health Organisation says more than 350 million people worldwide have depression and predicts that by 2020, the disorder will rival heart disease as the illness with the highest global disease burden. Sahakian said testing children at school age could help health authorities get in early and offer therapy to prevent people descending into more serious, hard to treat conditions. “When you think that the burden of mental illness is more than cancer, more than heart disease — so why on earth don’t we try to do something more proactive,” Sahakian told Reuters after presenting her results at a briefing in London. “Why are we not doing anything to pick it up early? To me it’s a no-brainer”. Goodyer’s and Sahakian’s test, details of which were published in the PLOS ONE journal, involves a computer assessment designed to gauge how teenagers process emotional information. It includes asking whether certain words, such as “joyful”, “failure” or

Screening Children For Mental Illness: Experts Call For Early Testing

“range”, are positive, negative or neutral. For their initial study, 15- to 18-year-olds also underwent genetic testing — an exercise that would be too expensive for routine use but which validated a connection between genes and upbringing in determining mental health risks. The researchers found that adolescents who had a variation of a certain gene linked to the brain chemical serotonin and who had also experienced regular family arguments and parental rows for longer than six months before the age of six, had significant difficulty evaluating the emotion in the words. This, said Goodyer, suggested those children suffered from an inability to process emotional information — a factor which previous studies have established is linked to a significantly increased risk of depression and anxiety. “The evidence is that both our genes and our early childhood experiences contribute,” said Goodyer. “Before there are any clinical symptoms of depression or anxiety, this test reveals a deficient ability to…perceive emotion processes…which may lead to mental illnesses.” Experts are concerned about the early onset of mental disorders — a factor they say many policy makers and members of the public have not yet grasped. Hans Ulrich Wittchen, a psychologist at Germany’s University of Dresden, said in a major European study of mental illness last year that he too thought governments should consider screening adolescents to try to reduce the number who go on to suffer major and recurring bouts of depression. But other mental health experts advised caution. “Early screening in the service of early intervention to try to prevent later mental health problems undoubtedly has allure,” said Felicity Callard of London’s Institute of Psychiatry. “But to grow up with the knowledge that you are ‘at high risk’ of future mental health problems can affect the very way in which you grow up — and thereby… embed a sense that you are mentally vulnerable, with potentially untoward consequences.”

Huffington Post

Bonnie Rochman TIME Overprotective Parenting May Make College-Age Children Depressed

TIME 10

Helicopter parents, stop hovering: it’s officially not good for your kids — especially if they’re already grown. A new study in the Journal of Child and Family Studies found that being overly involved in your grownup kids’ lives can do more harm than good. The research was conducted by the same scientists who showed last year that intensive parenting — constantly stimulating your children — can make moms more depressed. You may think you’re helping out by phoning your kids’ college professors to haggle over the difference between a B+ and an A–, but that interference may be undermining young adults’ ability to problem-solve and fend for themselves. Constantly texting adult children and friending them on Facebook — letting them fly the coop but still demanding daily check-ins — is not exactly building a generation of confident and resilient grownups. And the problem only snowballs. “Parents are sending an unintentional message to their children that they are not competent,” says Holly Schiffrin, lead author of the study and an associate professor of psychology at the University of Mary Washington. “When adult children don’t get to practice problem-solving skills, they can’t solve these problems in the future.” To reach this conclusion, Schiffrin and colleagues surveyed 297 college-age children about their parents, asking a barrage of questions: Are your parents involved in selecting classes? Do they contact your professors about your grades? (Schiffrin herself has been on the receiving end of such calls more than once.) Do they intervene if you have a roommate issue? The students also reported on how satisfied they were with their lives, as well as their feelings of depression and anxiety. And they were questioned about the “self-determination theory,” which holds that every person has three basic needs in order to be happy: they must feel autonomous, competent and connected to other people. Their answers showed that helicopter parenting decreased adult children’s feelings of autonomy, competence and connection. In turn, feeling incom-

Overprotective Parenting May Make College-Age Children Depressed

petent led to increased reports of feeling depressed and dissatisfied. “These parents have the best intentions,” says Schiffrin. “They are being involved to help their child be successful. But as we know from the previous study, that high level of involvement is stressful for parents and it is not benefiting the kids. It’s actually harming them.” As exhausting as such hands-on parenting is, and despite the toll it may take on the moms’ mental health, they tend to consider the sacrifice worth it because they believe they’re helping their children. Schiffrin knows the feeling. “Personally, I feel a lot of guilt anytime I’m not doing something for my kids,” she admits. But her work should help moms to shift that perspective. Perhaps by choosing to watch Downton Abbey reruns instead of playing Candyland with a tot or editing college essays for a high-schooler, they are actually building their offspring’s independence and confidence. “For me, this at least says it’s OK to not do as much as other parents are doing because I’m helping my child become self-sufficient,” she says. “If we are doing something that is hurting us and is not helping our kids, then we need to stop.”

Twitter and Facebook ‘harming children’s development’

Graeme Paton The Telegraph

The Telegraph 14

Young people’s brains are failing to develop properly after being overexposed to the cyber world at an early age, it was claimed. Baroness Greenfield, professor of pharmacology at Oxford University, said a decline in physical human contact meant children struggled to formulate basic social skills and emotional reactions. She criticised the “unhealthy” addiction to Twitter among some users who resort to increasingly nasty outbursts under the “sanitised and often anonymous guise of the web”. In an interview with The Daily Telegraph, she also raised concerns over the “narcissistic” nature of sites such as Klout, which measures users’ popularity and influence on social networks. The comments come just 24 hours after teachers warned that over-exposure to technology was damaging children’s ability to concentrate in the classroom. A survey of secondary English teachers revealed that more than three-quarters thought pupils’ attention spans were shorter than ever before. Baroness Greenfield quoted figures showing that more than half of 13- to 17-year-olds now spend more than 30 hours a week using video games, computers, e-readers, mobile phones and other screen-based technology. She said the human brain evolved to its surroundings and needed a “stimulating environment” to grow and properly develop. But she warned that a reliance on social networking and increased use of computer games could effectively “rewire” the brain. The academic is due to present her findings in a speech to the Early Childhood Action group, which has been established to campaign for reforms to early years education. Speaking ahead of the organisation’s inaugural conference at Winchester University next Saturday, she said: “Most of us, by the time we reach adulthood, have an inner conceptual framework that enables us to interpret the world and have a robust sense of our own identity.

Twitter and Facebook ‘harming children’s development’ 15

“My fear is that having an identity which is externally constructed and dependent on the moment-by-moment reactions of others will make people less robust and constantly at the mercy of the outside world.” She added: “What concerns me is when screenbased technology is used a lot, or by young people who don’t have the counterbalance of a highlydeveloped brain. “You are only good at what you’ve rehearsed, and if you haven’t rehearsed looking someone in the eye, interpreting body language and using appropriate physical contact, then you are not going to be good at those things.” Baroness Greenfield said that social networking websites such as Facebook and Twitter created a generation with a child-like desire for constant feedback on their lives. Repeated exposure leaves some users with an “identity crisis” as they crave constant attention from followers, she added. She highlighted the example of Klout, which provides users with a score based around their influence on social networking sites. “To have this ultimate beauty contest showing how much better you are than everyone else can only lead to sadness because there will always be someone who scores higher than you,” she said. “It means you are constantly lacking in self-esteem, over narcissistic and, at the same time, in constant anxiety.” Baroness Greenfield also warned that social networking websites were fuelling bullying, adding: “The anonymity of the web can make it easier to do and also removes the constraints that would normally apply for what one might regard as human nature.

Alexandra Sifferlin TIME Lasting Legacy of Childhood Bullying: Psychiatric Problems in Adulthood

TIME 18

It’s not just the victims of bullying that experience long-term consequences; bullies themselves are also at risk of mental health issues later in life. In a study published in JAMA Psychiatry, researchers report that bullying can have serious consequences on childhood development, and shouldn’t be dismissed as simply a playground rite-of-passage. Starting in 1993, the scientists followed over 1,400 children at three different ages — 9, 11 and 13, and interviewed them and their caregivers every year until the kids turned 16. Based on the interviews, they categorized the kids into four groups: victims only, bullies only, both bullies and victims, or neither. To determine the long-term effects of bullying, the researchers re-interviewed the participants when they were ages 19, 21, 24 and 26, and evaluted them for a wide range of different psychiatric disorders. “Bullying is not just a part of childhood, or some sort of a harmless activity between peers. This is actually something that has very detrimental, and very long lasting effects,” says study author William Copeland of Duke University Medical Center in Durham, North Carolina. All three groups who reported being involved in bullying experienced some long-term psychiatric effects in the form of anxiety, depressive, or antisocial personality disorders, or some type of alcohol or marijuana abuse. After controlling for family hardships that might also make these mental health issues more likely, the researchers found distinct patterns of psychiatric problems that distinguished the bullies from their victims. Victims of bullying were nearly three times as likely to have issues with generalized anxiety as those who were not bullied, and 4.6 times as likely to suffer from panic attacks, or agoraphobia, in which they felt trapped or had no escape, compared to those who were spared bullying. Bullies themselves showed a four times higher risk of antisocial personality disorder as adults compared to those who did not bully others, and children who reported being both bullies and victims seemed to fare the worst of all; these participants showed a nearly five times greater risk of de-

Lasting Legacy of Childhood Bullying: Psychiatric Problems in Adulthood

pression as young adults compared to those who had not both given and received bullying behavior, and a 14.5 times greater risk of having a panic disorder. These effects also showed some gender differences; women had a dramatically higher risk, at nearly 27 times, of having agoraphobia, while men showed an 18.5 times greater prevalence of suicidal tendencies. “For bullies, it’s a completely different kind of problem,” says Copeland. “With the victims, it is all related to their emotional functioning. For the bullies, they had higher rates of antisocial personality disorder, which is kind of related to criminal behavior, so they’re having completely different problems in adulthood than the victims.” The findings highlight the importance of considering school- and peer-based factors when kids are struggling, says Copeland. Many counselors, and research studies on the subject, focus on the home situation when children start acting out or becoming more withdrawn. Children’s relationships with their parents or maltreatment in the home are among the more obvious factors that affect behavior, but peer relationships may be just as critical in assessing young children’s development. “What this study really suggests is that what goes on at school, and what goes on between peers, may be just as important in understanding their long-term function as what goes on at home. In childhood, when kids are in school, they spend a lot more time with their peers than they do with their parents so we should not be so surprised about this,” says Copeland. “When we see kids having trouble, we tend to ask them about things going on at home and we don’t tend to ask them how they’re getting along with their peers and whether they’re the victim of bullying. I think we need to rethink that a bit.” Taking bullying more seriously, for example, as the potential seed for mental health and behavior problems in adulthood, could lead to better interventions and lower long-term health costs. Childhood experiences lay an important foundation for the type of people we become, and how youngsters interact with their peers is an important part of that dynamic.

TIME

How Junior High Friendships Affect Adult Relationships

Maia Szalavitz TIME

TIME 22

Middle school is typically a time of chaotic emotions, confusing relationships and challenging growing pains. But it may also have a surprisingly lasting influence on the future. In a study published in Child Development, researchers found that adolescents who were best able to negotiate the relationship minefield of finding friends and making sound behavior choices were most likely to be rated by their parents as successful both socially and professionally when they became young adults. “We tend to think that peer relationships in early adolescence don’t mean that much, but that tends to be dead wrong,” says Joseph Allen, a professor of psychology at the University of Virginia. “How well you do with peers as an early teen tells us a whole lot about how you manage in a lot of different ways as an adult.” Allen and his colleagues followed 184 youths from a public middle school in the Southeast, which included kids from both urban and suburban neighborhoods. They interviewed the teens’ parents as well as other adolescents that they identified as their closest friends annually for three years, starting when the participants were around 13. The authors followed up again when they were ages 20 to 23. “What we’re finding is that the path is not straightforward, it’s more like a tightrope walk between trying to connect well with peers on one side and avoiding getting swept up into peer influences toward deviant behavior like delinquency and drug use on the other,” says Allen. Indeed, the study showed that teens who best resisted peer pressure during junior high were less likely to engage in criminal behavior or to have alcohol or drug problems. Unfortunately, this ability to resist peer pressure can also be isolating; this same group also had fewer and weaker friendships as adults. Those who had the strongest interactions as adults, not surprisingly, were teens who walked a middle ground, remaining open to peer influence, but not allowing themselves to be overwhelmed by

How Junior High Friendships Affect Adult Relationships 23

the pressure to conform. “Teens who can manage that well have strong close friendships as adults,” says Allen. “They’re better at negotiating disagreements with romantic partners when we observed them doing that. They are less likely to have problems with alcohol and substance use and less likely to engage in criminal behavior.” That doesn’t mean, however, that when it came to the most common pressures during adolescence, such as smoking, drinking and trying drugs, these teens were abstinent. “The people who were best at connecting have a lower risk of problems with alcohol and drug abuse, but they actually drink slightly more,” Allen says. This confirms earlier research that suggested teens who were well adjusted didn’t always abstain entirely, but rather were able to avoid excess. “In terms of alcohol and drug use, the safest path would be to be more resistant of peer influences and slightly less connected, but that would then cost you in terms of your social relationships,” Allen notes. And being socially isolated could have negative health consequences. “The research shows that being socially isolated as an adult is as big a risk factor for dying early as cigarette smoking or obesity,” says Allen. “There’s no free lunch here.” As with many behaviors and their consequences, there are tradeoffs. Teen drinking is obviously not socially desirable, but it could lead to fewer friendships that translate into isolation later in life. The complexity of these actions and reactions may in part explain why abstinence programs of any kind, whether for sex, alcohol or other drugs, aren’t particularly effective, since they come with a cost in peer connections and acceptance that teens aren’t willing to pay. The findings also highlight how important being accepted by their peers is to teens, and suggests that adults should take these adolescent priorities more seriously. “Many people think, ‘Why are teens so preoccupied with these relationships? They’re really no big deal.’’’ Allen says. “They’re preoccupied because these [early relationships] are precursors

TIME

for how they will function in life socially for the rest of their lives. [Relationships] are critical to physical and mental health.â&#x20AC;? Rather than discounting them, it may be worth exploring how to improve them, while teaching teens to balance their desire for acceptance with an appreciation of associated risks.

The Existential Pain of Being Young, White, and Affluent

Liz Kulze The Atlantic

The Atlantic

Abuse of prescription drugs is most common among those who enjoyed the most advantages in adolescence, causing some to rethink the consequences of privilege. By sophomore year Evan was sleeping on a blowup mattress in an empty house off campus. He had no bed. No furniture. No posters or mini-fridge or shelf fraught with textbooks. He had no friends. He had sold the former, severed ties with latter, and now spent his hours curled up on an Aerobed until his dealer came through. This is where the police found him. They wanted to know why he had purchased 43 calculus books when there wasn’t a single calculus class on his course load. He had been buying them on his parent’s credit card and selling them back for cash. When his parents called after having words with the police, his feebleness dislodged the truth: “I’ve been an Oxycontin addict for the past two years, and I need help.” \\\

Prescription drug abuse is now recognized as a page in our catalogue of national issues. The stories of its victims elicit both sympathy and rage. Fingers are pointed all over, but only recently has the government begun to act. The FDA is pushing for stricter regulations. Industry literature is being reevaluated. “Take-Back” initiatives designed to dispose of unused drugs are being implemented in many states, and prescription drug monitoring programs are already being used in most. Pills allow young adults to continue their lifestyles of overdependence and reliance even once they leave the crust-less sandwich comfort of their homes. These tactics, however, almost exclusively deal with the supply side of the problem. As we’ve seen with marijuana and psilocybin mushrooms, and several Schedule I drugs sprinkled like pixie dust over many an adolescent memory—regardless of how fortified the supply becomes with federal red tape, demand almost always comes out victorious.

The Existential Pain of Being Young, White, and Affluent

The question is, why is there a hot demand for prescription drugs to begin with? And who, exactly, is doing the demanding? This would have been fairly easy to answer some years ago when the opioid abuse so regnant in low-income, rural communities (pigeonholed as “hillbilly heroin”) was the role prescription drug addiction seemed to be playing on the national stage. Painkillers promise a quick metaphysical escape for those living in insufferable states of poverty. They also provide a lucrative business with a street price tag of a dollar per milligram. But what of the most recent demographic to come to the forefront of disheartening statistical surveys? What of white, affluent, youth — a social group which, historically, has it better than anyone else? Kids born between the years 1984 and 1990 abuse painkillers (the cause of three of every four overdoses) 40 percent more than any other age group or time before them. A study published in Health Affairs on Wednesday suggests that the increase in fatal drug overdoses among youth has grown so severe that it is a “major contributor” in the gap between life expectancy in the U.S. and other high-income countries. In 2011 alone, close to 1.7 million people between the ages of 12 and 25 (over 4,500 young people per day) abused a prescription drug for the first time; three-fourths of them were white. According to a 2009 survey, 88 percent of those admitted to treatment for the abuse of opioid-based medication, and 66 percent of those admitted for stimulants, were also white. Those who abuse prescription drugs in college are more likely to be white, as well as male, have a mother with a bachelor’s degree or more, and perform poorly academically. \\\

“I remember sitting by a fire in the eleventh grade and taking the medication and thinking to

Evan was all of the above.

The Atlantic

myself that if I had this every day in infinite amounts for the rest of my life I would use it all,” he said. “I would take it every day, and I wouldn’t have any problems. My life would be fine.” Evan had just gotten his wisdom teeth removed. He had been prescribed twenty 7.5 hydrocodone’s and had taken his first two. He was sitting beside the fireplace in his four-story house with a central staircase that spiraled up. He admired his parents, and they were thoroughly devoted to him. He attended a prestigious private school and had the camaraderie of a pack of plucky friends. To an outsider, he would appear to have no real “problems” apart from the bloody pits in his gums. But as he approached college, Evan had become increasingly distressed. “I didn’t understand what the meaning of life was,” he said. “I still don’t, but I thought that everyone else did, that there was this big secret that everyone was in on that I wasn’t. I thought everyone understood why we were here, and that they were all secretly happy somewhere without me.” These words may sound like the petty cry of a trite existential crisis, but for those who have been dosed with superficial happiness for the duration of their plush childhoods, such thoughts can become unbearable. For someone like Evan, who “never had to work for anything,” the inevitable adversities of life seemed insurmountable. So he turned to Roxycodone, 60 milligrams of rapid-release a day— euphoria that money can buy. \\\

It’s a narrative that has been written about often in the past five years, and few have done it better than the psychologist Dr. Madeline Levine. She was one of the first to theorize that an elite lifestyle could be detrimental to the character of a child, with her New York Times bestseller, The Price of Privilege. She wrote of the “enormous amounts of attention and resources that adults pour” into many of today’s children, and how “paradoxically,

The Existential Pain of Being Young, White, and Affluent 29

the more they pour, the less full many of [her] patients seem to be.” “Indulged, coddled, pressured and micromanaged on the outside,” she writes, “my young patients appeared to be inadvertently deprived of the opportunity to develop on the inside.” This deficit in individual autonomy is precisely what makes these drugs so attractive. They allow young adults to continue their lifestyles of overdependence and reliance even once they leave the crust-less sandwich comfort of their homes. Their lack of experience in failure, unpleasantness, or dealing with various forms of hardship also paints the “quick-fix” as the optimum solution. You just have to pop a pill, and the magic carpet slips right back beneath your feet. The unparalleled pressure to succeed, brought to bear by parents and educational institutions, is often another part of the prosperous lifestyle package. This too can become a catalyst for drug abuse. Privilege may appear to provide the foundation for a propitious future, but of course, the expectations are that much higher, the competition that much steeper, and satisfaction is far less easy to attain. When your adolescence has been bombarded with endless barometers of achievement— the BMW’s and the wrap-around porches and the clean blue pools and the boats bobbing up and down — the ladder appears to have less to do with internal gratification, and more with an expensive, material obligation. It’s no wonder that a recent study found that millennials are significantly more stressed than the rest of society. Failure haunts them like an ill-willed specter, and prescription drugs, with their various remedial powers, seem like a convenient charm to wish it away. The irony is that even while such substances are being “abused,” they are technically still being swallowed for medicinal purposes. Bereft of any authentic sense of self and the grit it takes to form one, and relentlessly pushed to socially defined ends, a privileged adolescence becomes the consummate breeding ground for selfharm, however unintended.

The Atlantic

Such a notion catches most parents entirely off guard. After his initial confession and subsequent return home, Evan remained an addict for a halfdecade longer. He found a hook-up in his suburban neighborhood, began injecting the oxycodone directly into his bloodstream, and eventually turned to heroin when his dealer’s source went cold (an increasingly common trend). His parents were wholly oblivious to the fact that he was using again until they were faced with the physical evidence: used syringes casually discarded in his bedroom wastebasket. It seems contradictory that a life of ample provision could lead to such desperation, so the ignorance is somewhat understandable. Culturally entrenched and statistically unsound stereotypes are also to blame. A study released last month found that only 13 percent of white parents are very concerned about the abuse of narcotic painkillers in their families, over two times less than black or Hispanic parents. This is regardless of the fact that abuse rates are three times higher amongst white teens. The real delusion, however, is apparent in their attempts to seek rehabilitation — by sending their children “away for a bit” to a fancy treatment center, or military school, or into the wilderness to be healed. The hope is always that they will come back as clean as their empty bedrooms have been kept, but again, the answer is not so simple. “It was hard to find kids who wanted to stop,” Evan told me me. “Most of the time they were trying to quit just to maintain the support of their parents, and they were just using more money, and you would talk to them, and they’d say things like, ‘I plan on getting high the second I get out of here .’” That was at one the best facilities in the country, where Evan’s parents spent $70,000 trying to get him sober. It was his third attempt, and it failed exactly like the previous two. Five of the kids he met there are now dead.

\\\ The true solution is a far more abstract one. It

The Existential Pain of Being Young, White, and Affluent 31

consists of making an effort to cultivate steadfast meaning rather than fickle joy, and understanding that ceaseless superficial achievement means endless unfulfillment. It’s one of life’s greatest paradoxes: Those raised in a state of want are taught to be grateful for what they have, while those who have everything are brought up to continue wanting. As Evan describes it, “I wanted comfort in a way that doesn’t even exist.” Eventually, he attempted suicide, throwing himself sixty feet from the top landing of his parents’ home, his body denting the wooden floor in the fall. He woke up on his parent’s couch with nothing more than a broken rib and a cracked collarbone, and the revelation felt by those who survive the almost-end: “That something as simple as living is worth doing.” Evan has been sober since that day a year ago. He lives with his parents, drinks a lot of tea, works a crappy job, and for some reason, he regrets very little. “I know it sounds crazy, but I don’t know how I would have learned otherwise,” he said. “I wouldn’t change the past seven years. I’ve taken my focus off the fact that I have to achieve something for now. And it makes me feel real. Now I wake up in the morning and say, ‘Thank god I have this bed.’”

Why Can Some Kids Handle Pressure While Others Fall Apart?

Po Bronson and Ashley Merryman The New York Times

The New York Times 34

Noah Muthler took his first state standardized test in third grade at the Spring Cove Elementary School in Roaring Spring, Pa. It was a miserable experience, said his mother, Kathleen Muthler. He was a good student in a program for gifted children. But, Muthler said, “he was crying in my arms the night before the test, saying: ‘I’m not ready, Mom. They didn’t teach us everything that will be on the test.’” In fourth grade, he was upset the whole week before the exam. “He manifests it physically,” his mother said. “He got headaches and stomachaches. He would ask not to go to school.” Not a good sleeper anyway, Noah would slip downstairs after an hour tossing in bed and ask his mom to lie down with him until he fell asleep. In fifth grade, the anxiety lasted a solid month before the test. “Even after the test, he couldn’t let it go. He would wonder about questions he feared he misunderstood,” Muthler said. So this year, Muthler is opting Noah out of the Pennsylvania System of School Assessment, using a broad religious and ethical exemption. Just knowing he won’t be taking the tests in March has put Noah in a better frame of mind about school. “The pressure is off his shoulders now,” his mother said. When he doesn’t grasp a concept immediately, he can talk it through without any panic. “He looks forward to science class and math class again,” Muthler said. “He wants to be a chemical or nuclear engineer.” Muthler understands Noah’s distress; more mysterious is why her son Jacob, who is in eighth grade, isn’t the least bit unnerved by the same tests. He, too, is in the gifted program, but that seems to give him breezy confidence, not fear. “You would think he doesn’t even care,” Muthler marveled. “Noah has the panic and anxiety for both of them.” Nevertheless, she will opt out Jacob from the tests, too, to be consistent. Never before has the pressure to perform on high-stakes tests been so intense or meant so much for a child’s academic future. As more school districts strive for accountability, standardized

Why Can Some Kids Handle Pressure While Others Fall Apart? 35

tests have proliferated. The pressure to do well on achievement tests for college is filtering its way down to lower grades, so that even third graders feel as if they are on trial. Students get the message that class work isn’t what counts, and that the standardized exam is the truer measure. Sure, you did your homework and wrote a great history report — but this test is going to find out how smart you really are. Critics argue that all this test-taking is churning out sleep-deprived, overworked, miserable children. But some children actually do better under competitive, stressful circumstances. Why can Jacob thrive under pressure, while it undoes Noah? And how should that difference inform the way we think about high-stakes testing? An emerging field of research — and a pioneering study from Taiwan— has begun to offer some clues. Like any kind of human behavior, our response to competitive pressure is derived from a complex set of factors — how we were raised, our skills and experience, the hormones that we marinated in as fetuses. There is also a genetic component: One particular gene, referred to as the COMT gene, could to a large degree explain why one child is more prone to be a worrier, while another may be unflappable, or in the memorable phrasing of David Goldman, a geneticist at the National Institutes of Health, more of a warrior. Understanding their propensity to become stressed and how to deal with it can help children compete. Stress turns out to be far more complicated than we’ve assumed, and far more under our control than we imagine. Unlike long-term stress, short-term stress can actually help people perform, and viewing it that way changes its effect. Even for those genetically predisposed to anxiety, the antidote isn’t necessarily less competition — it’s more competition. It just needs to be the right kind. Every May in Taiwan, more than 200,000 ninthgrade children take the Basic Competency Test for Junior High School Students. This is not just any test. The scores will determine which high school the students are admitted to — or if they get into one at all. Only 39 percent of Taiwanese children make the

The New York Times 36

cut, with the rest diverted to vocational schools or backup private schools. The test, in essence, determines the future for Taiwanese children. The test is incredibly difficult; answering the multiple-choice questions requires knowledge of chemistry, physics, advanced algebra and geometry, and testing lasts for two days. “Many students go to cram school almost every night to study all the subjects on the test,” says Chun-Yen Chang, director of the Science Education Center at National Taiwan Normal University. “Just one or two percentage points difference will drag you from the No. 1 high school in the local region down to No. 3 or 4.” In other words, the exam was a perfect, real world experiment for studying the effects of genetics on high-stakes competition. Chang and his research team took blood samples from 779 students who had recently taken the Basic Competency Test in three regions of Taiwan. They matched each student’s genotype to his or her test score. The researchers were interested in a single gene, the COMT gene. This gene carries the assembly code for an enzyme that clears dopamine from the prefrontal cortex. That part of the brain is where we plan, make decisions, anticipate future consequences and resolve conflicts. “Dopamine changes the firing rate of neurons, speeding up the brain like a turbocharger,” says Silvia Bunge, associate professor of psychology and neuroscience at the University of California, Berkeley. Our brains work best when dopamine is maintained at an optimal level. You don’t want too much, or too little. By removing dopamine, the COMT enzyme helps regulate neural activity and maintain mental function. Here’s the thing: There are two variants of the gene. One variant builds enzymes that slowly remove dopamine. The other variant builds enzymes that rapidly clear dopamine. We all carry the genes for one or the other, or a combination of the two. In lab experiments, people have been given a variety of cognitive tasks — computerized puzzles and games, portions of IQ tests — and researchers have consistently found that, under normal

Why Can Some Kids Handle Pressure While Others Fall Apart? 37

conditions, those with slow-acting enzymes have a cognitive advantage. They have superior executive function and all it entails: they can reason, solve problems, orchestrate complex thought and better foresee consequences. They can concentrate better. This advantage appears to increase with the number of years of education. The brains of the people with the other variant, meanwhile, are comparatively lackadaisical. The fast-acting enzymes remove too much dopamine, so the overall level is too low. The prefrontal cortex simply doesn’t work as well. On that score alone, having slow-acting enzymes sounds better. There seems to be a trade-off, however, to these slow enzymes, one triggered by stress. In the absence of stress, there is a cognitive advantage. But when under stress, the advantage goes away and in fact reverses itself. “Stress floods the prefrontal cortex with dopamine,” says Adele Diamond, professor of developmental cognitive neuroscience at the University of British Columbia. A little booster hit of dopamine is normally a good thing, but the big surge brought on by stress is too much for people with the slowacting enzyme, which can’t remove the dopamine fast enough. “Much like flooding a car engine with too much gasoline, prefrontal-cortex function melts down,” Diamond says. Other research has found that those with the slow-acting enzymes have higher IQ’s, on average. One study of Beijing schoolchildren calculated the advantage to be 10 IQ points. But it was unclear if the cognitive advantages they had would stay with them when they were under stress outside the security of the lab environment. The Taiwan study was the first to look at the COMT gene in a high-stakes, real-life setting. Would the IQ advantage hold up, or would the stress undermine performance? It was the latter. The Taiwanese students with the slow-acting enzymes sank on the national exam. On average, they scored 8 percent lower than those with the fast-acting enzymes. It was as if some of the

The New York Times 38

A students and B students traded places at test time. “I am not against pressure. Actually, pressure is good [for] someone,” Chang commented. “But those who are more vulnerable to stress will be more disadvantaged.” As of 2014, Taiwan will no longer require all students to take the Basic Competency Test, as the country moves to 12-year compulsory education. The system will no longer be built to weed out children, but to keep them all in school. But academically advanced students will still take some kind of entrance exam. And those elite students will still feel the pressure, which, it bears repeating, will hurt some but help others. “The people who perform best in normal conditions may not be the same people who perform best under stress,” Diamond says. People born with the fast-acting enzymes “actually need the stress to perform their best.” To them, the everyday is underwhelming; it doesn’t excite them enough to stimulate the sharpness of mind of which they are capable. They benefit from that surge in dopamine— it raises the level up to optimal. They are like Superman emerging from the phone booth in times of crisis; their abilities to concentrate and solve problems go up. Some scholars have suggested that we are all Warriors or Worriers. Those with fast-acting dopamine clearers are the Warriors, ready for threatening environments where maximum performance is required. Those with slow-acting dopamine clearers are the Worriers, capable of more complex planning. Over the course of evolution, both Warriors and Worriers were necessary for human tribes to survive. In truth, because we all get one COMT gene from our father and one from our mother, about half of all people inherit one of each gene variation, so they have a mix of the enzymes and are somewhere in between the Warriors and the Worriers. About a quarter of people carry Warrior-only genes, and a quarter of people Worrier-only. A number of research studies are looking at COMT, including several involving the American

Why Can Some Kids Handle Pressure While Others Fall Apart? 39

military. Researchers at Brown University have been studying COMT’s connection to post-traumatic stress disorder in veterans of the wars in Iraq and Afghanistan. Quinn Kennedy, a research psychologist at the Naval Postgraduate School, is studying how the gene correlates with pilot performance. Douglas C. Johnson, a professor of psychiatry at the University of California, San Diego, is part of a consortium of researchers called the OptiBrain Center, where he is interested in COMT’s role in combat performance and well-being. While the studies are ongoing, the early results show those with Worrier-genes can still handle incredible stress — as long as they are well trained. Even some Navy SEALs have the Worrier genes, so you can literally be a Worrier-gene Warrior. In Kennedy’s sample, almost a third of the expert pilots were Worriers — a larger proportion than in the general population. Kennedy’s work is particularly revealing. She puts pilots through a series of six flight-simulator tests, where pilots endure turbulence, oil-pressure problems, iced carburetors and crosswinds while landing. They are kept furiously busy, dialing to new frequencies, flying to new altitudes and headings and punching in transponder codes. Among recreational pilots with the lowest rating level — trained to fly only in daylight— those with Warrior genes performed best. But that changed with more experience. Among recreational pilots who had the next level of qualification — trained to fly at night using cockpit instruments — the Worriers far outperformed the Warriors. Their genetically blessed working memory and attention advantage kicked in. And their experience meant they didn’t melt under the pressure of their genetic curse. What this suggests, Kennedy says, is that, for Worriers, “through training, they can learn to manage the particular stress in the specific pilot training, even if it is not necessarily transferred over to other parts of their lives.” So while the single-shot stakes of a standardized exam is particularly ill suited for Worrier

The New York Times 40

genotypes, this doesn’t mean that they should be shielded from all challenge. In fact, shielding them could be the worst response, depriving them of the chance to acclimate to recurring stressors. Johnson explains this as a form of stress inoculation: You tax them without overwhelming them. “And then allow for sufficient recovery,” he continued. Training, preparation and repetition defuse the Worrier’s curse. There are many psychological and physiological reasons that long-term stress is harmful, but the science of elite performance has drawn a different conclusion about short-term stress. Studies that compare professionals with amateur competitors— whether concert pianists, male rugby or female volleyball players — show that professionals feel just as much anxiety as amateurs. The difference is in how they interpret their anxiety. The amateurs view it as detrimental, while the professionals tend to view stress as energizing. It gets them to focus. A similar mental shift can also help students in test-taking situations. Jeremy Jamieson, assistant professor of social psychology at the University of Rochester, has done a series of experiments that reveal how the labeling of stress affects performance on academic testing. The first experiment was at Harvard University with undergraduates who were studying for the Graduate Record Examination. Before taking a practice test, the students read a short note explaining that the study’s purpose was to examine the effects of stress on cognition. Half of the students, however, were also given a statement declaring that recent research suggests “people who feel anxious during a test might actually do better.” Therefore, if the students felt anxious during the practice test, it said, “you shouldn’t feel concerned…simply remind yourself that your arousal could be helping you do well.” Just reading this statement significantly improved students’ performance. They scored 50 points higher in the quantitative section (out of a possible 800) than the control group on the practice test. Remarkable as that seemed, it is relatively easy to get a result in a lab. Would it affect their

Why Can Some Kids Handle Pressure While Others Fall Apart? 41

actual GRE results? A couple of months later, the students turned in their real GRE scores. Jamieson calculated that the group taught to see anxiety as beneficial in the lab experiment scored 65 points higher than the controls. In ongoing work, Jamieson is replicating the experiment with remedial math students at a Midwestern community college: after they were told to think of stress as beneficial, their grades improved. At first blush, you might assume that the statement about anxiety being beneficial simply calmed the students, reducing their stress and allowing them to focus. But that was not the case. Jamieson’s team took saliva samples of the students, both the day before the practice test to set a base line, and right after reading the lines about the new science — just moments before they started the first question. Jamieson had the saliva tested for biomarkers that show the level of activation of the body’s sympathetic nervous system — our “fight or flight” response. The experimental group’s stress levels were decidedly higher. The biological stress was real, but it had different physiological manifestations and had somehow been transformed into a positive force that drove performance. If you went to an SAT testing site and could run physiological and neurological scans on the teenagers milling outside the door right before the exam, you would observe very different biomarkers from student to student. Those standing with shoulders hunched, or perhaps rubbing their hands, stamping their feet to get warm, might be approaching what Wendy Berry Mendes and colleagues call a “threat state.” According to Mendes, an associate professor of psychology at the University of California, San Francisco, the hallmark of a threat state is vasoconstriction — a tightening of the smooth muscles that line every blood vessel in the body. Blood pressure rises; breathing gets shallow. Oxygenated blood levels drop, and energy supplies are reduced. Meanwhile, a rush of hormones amplifies activity in the brain’s amygdala, making you more aware of risks and fearful of mistakes.

The New York Times 42

At that same test center, you might see students shoulders back, chest open, putting weight on their toes. They may be in a “challenge state.” Hormones activate the brain’s reward centers and suppress the fear networks, so the person is excited to start in on the test. In this state, decision making becomes automatic. The blood vessels and lungs dilate. In a different study of stress, Jamieson found that the people told to feel positive about being anxious had their blood flow increase by an average of more than half a liter per minute, with more oxygen and energy coursing throughout the body and brain. Some had up to two liters per minute extra. Jamieson is frustrated that our culture has such a negative view of stress: “When people say, ‘I’m stressed out,’ it means, ‘I’m not doing well.’ It doesn’t mean, ‘I’m excited — I have increased oxygenated blood going to my brain. ” As the doors to the test center open, the line between challenge and threat is thin. Probably nothing induces a threat state more than feeling you can’t make any mistakes. Threat physiology can be activated with the sense of being judged, or anything that triggers the fear of disappointing others. As a student opens his test booklet, threat can flare when he sees a subject he has recently learned but hasn’t mastered. Or when he sees a problem he has no idea how to solve. Armando Rodriguez graduated last spring from Bright Star Secondary Charter Academy in Los Angeles, but he is waiting until next fall to start college. He is not taking a gap year to figure out what he wants to do with his life. He’s recuperating from knee surgery for a bone condition, spending his days in physical therapy. And what does he miss about being out of school? Competing. “It’s an adrenaline rush — like no other thing.” He misses being happy when he wins. He even misses losing. “At least it was a feeling you got,” he said. “It made you want to be better, the next time.” Without a competitive goal, he feels a little adrift. He finds himself mentally competing with other physicaltherapy patients.

Why Can Some Kids Handle Pressure While Others Fall Apart? 43

Rodriguez recorded a 3.86 GPA his senior year of high school and was a defender for the school soccer team. The knee injury happened during a stint on the school’s football team: his doctor had warned that it was too risky to play, but “I just had to try,” he said. He used to constantly challenge his friends on quiz grades; it’s how they made schoolwork fun. But when he took the SAT last year, he experienced a different sensation. “My heart was racing,” he said. “I had butterflies.” Occasionally, he’d look up from his exam to see everyone else working on their own tests: they seemed to be concentrating so hard and answering questions faster than he was. “What if they’re doing way better than me?” immediately led to the thought, “These people are smarter than me. All the good schools are going to want them, and not me.” Within seconds, he arrived at the worst possible outcome: his hopes of a good college would be gone. It might seem surprising that the same student can experience competition in such different ways. But this points to what researchers think is the difference between competition that challenges and competition that threatens. Taking a standardized test is a competition in which the only thing anyone cares about is the final score. No one says, “I didn’t do that well, but it was still worth doing, because I learned so much math from all the months of studying.” Nobody has ever come out of an SAT test saying, “Well, I won’t get into the college I wanted, but that’s OK because I made a lot of new friends at the Kaplan center.” Standardized tests lack the side benefits of competing that normally buffer children’s anxiety. When you sign your child up for the swim team, he may really want to finish first, but there are many other reasons to be in the pool, even if he finishes last. High-stakes academic testing isn’t going away. Nor should competition among students. In fact several scholars have concluded that what students need is more academic competition, but modeled on the kinds children enjoy.

The New York Times 44

David and Christi Bergin, professors of educational and developmental psychology at the University of Missouri, have begun a pilot study of junior high school students participating in math competitions. They have observed that, within a few weeks, students were tackling more complex problems than they would even at the end of a yearlong class. Some were even doing college-level math. That was true even for students who didn’t like math before joining the team and were forced into it by their parents. Knowing they were going up against other teams in front of an audience, the children took ownership over the material. They became excited about discovering ever more advanced concepts, having realized each new fact was another weapon in their intellectual arsenal. In-class spelling bees. Science fairs. Chess teams. “The performance is highly motivating,” David Bergin says. Even if a child knows her science project won’t win the science fair, she still gets that moment to perform. That moment can be stressful and invigorating and scary, but if the child handles it well, it feels like a victory. “Children benefit from competition they have prepared for intensely, especially when viewed as an opportunity to gain recognition for their efforts and improve for the next time,” says Rena Subotnik, a psychologist at the American Psychological Association. Subotnik notes that scholastic competitions can raise the social status of academic work as well as that of the contestants. Competitions like these are certainly not without stress, but the pressure comes in predictable ebbs and flows, broken up by moments of fun and excitement. Maybe the best thing about academic competitions is that they benefit both Warriors and Worriers equally. The Warriors get the thrilling intensity their minds are suited for, where they can shine. The Worriers get the gradual stress inoculation they need, so that one day they can do more than just tolerate stress — they can embrace it. And through the cycle of preparation, performance and recovery, what they learn becomes ingrained.

Why Can Some Kids Handle Pressure While Others Fall Apart? 45

It may be difficult to believe, as Jamieson advises, that stress can benefit your performance. We can read it, and we can talk about it, but it’s the sort of thing that needs to be practiced, perhaps for years, before it can become a deeply held conviction. It turns out that Armando Rodriguez was accepted at five colleges. He rallied that day on the SAT. It wasn’t his best score — he did better the second time around — but it was not as bad as he feared. Rodriguez had never heard of Jeremy Jamieson. He had never read, or ever been told, that intense stress could be harnessed to perform his best. But he understood it and drew strength from it. In the middle of his downward spiral of panic, he realized something: “I’m in a competition. This is a competition. I’ve got to beat them.”

John-Manuel Andriote The Atlantic The Power of Choosing Resilience

The Atlantic

“He would walk into a room and say a couple quick words and everybody would just forget their problems and smile. He had a gift.” Bud Hill was describing 15-year-old Jadin Bell, a popular kid with green-dyed hair and a supportive family in La Grand, Oregon. Jadin died February 3, after being on life support since January 19. That was the day he hung himself from an elementary school play structure after being bullied by schoolmates because he was gay. “He was different,” said Hill, a family friend, “and they tend to pick on the different ones.” Two days after Jadin hung himself, President Obama proclaimed in his second inaugural address that gay Americans should finally be treated as fully human and equal citizens. As he spoke, Jadin Bell lay dying in an Oregon hospital, one of the inestimable number of young men whose “difference” marks them for ridicule and ostracism and, too often, early death by their own or another’s hand. If “it gets better” with age, according to the campaign started in 2010 after a rash of gay youth suicides, it isn’t only because high school bullies are left behind to wallow in the filth of their own hatred. It’s because, despite the tremendous odds stacked against us, most gay men are able to find the resilience we need to survive and thrive. \\\

The day Jadin Bell died, a new study published in Pediatrics reported that although bullying drops as young people move beyond high school, young gay men are almost four times more likely than their straight peers to be bullied. The project has actually found that increasing family support reduces the young people’s substance abuse, HIV risk behaviors, and suicidality. Other grim statistics show that driving young sexual minority people to the brink of despair has terrible consequences, as it did for Jadin: • Nearly eight out of ten LGBT middle and high-

The Power of Choosing Resilience

At The Fenway Institute in Boston, Kenneth H. Mayer, the medical research director as well as a professor of medicine at Harvard, said that greatly improved HIV medical care has allowed researchers breathing room to focus on issues such as resilience and the reasons LGBT people face so many challenges. “From 1981 to 1996,” said Mayer, “I don’t think we caught our breaths by having to think about our own health, having our friends dying.” He said the research literature has made it clear that bullying, exclusion from the military and being forbidden to marry have consequences. “These send messages that they are not normal and right, and that has downstream consequences,” said Mayer. University of Pittsburgh medical anthropologist Ron Stall and his colleagues have identified four interconnected “epidemics” of psychosocial health conditions among urban gay and bisexual men, each magnifying the others: childhood sexual abuse, partner violence, depression, and drug use. Together, their insidious effects are called “syndemics.” “Something horrible is happening during adolescence to young gay men,” Stall told me in a 2010 interview for my book Victory Deferred. “These young men don’t understand what’s happening to themselves. There’s no community. Sometimes if the ‘sissy boy’ goes to dad to tell about getting beat up on the playground, he risks being beaten up by his dad. That kind of experience has got to be searing, and leaves scars on gay men.” The scarring manifests itself in still more

school students reported physical or verbal harassment in the Gay, Lesbian, and Straight Education Network’s 2011 National School Climate Survey. This was actually an improvement over previous years. • Gay and lesbian teens are two to three times more likely than other youths to commit suicide. • They are five times more likely to miss school because they feel unsafe after being bullied because of sexual orientation.

The Atlantic 50

startling statistics for gay men compared to non-gay people — including higher rates of anxiety, depression, alcohol and other substance abuse, and greater risk for HIV infection. The Centers for Disease Control and Prevention (CDC) reports that in 2009, gay and bisexual men accounted for 61 percent of all HIV infections in the United States, and 78 percent of all new infections among men . Although new HIV infections were “relatively stable” among men who have sex with men between 2006 and 2009, the CDC says they increased 34 percent among young gay and bisexual men — mainly due to a 48 percent increase among 13- to 29-year-old African-American gay and bisexual males. It’s a popular assumption that gay men have such high rates of HIV and other sexually transmitted infections because of irresponsible hedonism. It’s rare that even those of us at high risk consider that something deeper than pleasure-seeking may be what’s really driving the urge to merge-at-allcosts, that maybe we are confusing “horny” with, say, depressed or lonely. Or that we have taken to heart the many messages we receive telling us that our “difference” means we are broken, unlovable and unworthy of an intimate relationship. Gregory M. Herek, a professor of psychology at the University of California at Davis, and an internationally recognized authority on prejudice against lesbians and gay men, hate crimes and anti-gay violence, and AIDS-related stigma, said in an interview, “Certainly in the past, everybody was brought up with the attitude that homosexuality was wrong, a sickness, sin, that everybody who was gay or lesbian was a bad person. So being raised in that it’s almost inevitable that almost all people have accepted or believed it.” But not everyone accepts or believes it. In fact fewer than ever do, and they have much to teach. “What I think is amazing,” said Herek, “is how many people are doing fine and are mentally healthy, and leading whole and productive lives. How do they do that? Given all they’re up against, how do they come

As proof, Ron Stall in a recent interview pointed to his study of gay men’s psychosocial health problems. Eleven percent of the 812 men reporting one problem had recently engaged in high-risk sex, as had 23 percent of the 129 men reporting three or four problems. The evidence of resilience among these men was in the fact that the overwhelming majority of them had not engaged in high-risk sex, even the men burdened with multiple psychosocial health problems. Stall said, “We were able to show that guys who do the best job of resolving internalized homophobia [or self-stigma] are the least likely to have current victimization, substance abuse and compulsive [high-risk] sex.” He said such findings demonstrate that, to be truly effective, HIV prevention and substance abuse interventions need to build on gay men’s resilience, to be “strength-based,” rather than deficit-based. “We’re so focused on risk factors to the point that we forget about resilience,” he said. “It seems to me a smarter way to go would be to look at the guys who are thriving in spite of the adversities, how they pulled that off, see what the lessons learned are, and apply that to the interventions we already use and have developed.” In fact, the National Institutes of Health’s LGBT Research Coordinating Committee in a January 2013 report recommended the institutes ramp up their research on resilience among LGBT populations, as they were advised to do in a 2011 Institute of Medicine (IOM) report commissioned by the NIH. The NIH committee said resilience should be studied to find out “how it develops, may protect health, and may buffer against the internalization of stigma and/or other negative experiences associated with sexual or gender minority status.”

The Power of Choosing Resilience

\\\

out of it? The answer is resilience. If they’ve overcome this internalized self-stigma, they have more resources for overcoming this psychological distress.”

The Atlantic

\\\

Before the first mention of ‘the gay adolescent’ in a 1987 Pediatrics article, Penn State University human development professor Anthony R. D’Augelli said, “the literature I read about ‘homosexuals’ described people who seemed to spring from nowhere, that is, they were never children or adolescents, and did not seem to have siblings, parents, or grandparents.” Writing in Human Development in 2012, D’Augelli said “this fractured portrait” has begun to be repaired, even shaded with greater depth and nuance, as more LGBT youth have ‘come out’ and more research has focused on them. He said this has supported a model of our development over the life span — and the understanding that “to talk about the development of their lives without focus on family, social, institutional and historical factors is fundamentally distorted.” Caitlin Ryan, who was a member of the IOM committee that developed the LGBT health report, is a clinical social worker with nearly 40 years of research and practice experience focused on LGBT health and mental health. In 2002 Ryan launched the Family Acceptance Project, based at San Francisco State University, after her groundbreaking work demonstrated that a family’s acceptance is vitally important for LGBT children to become healthy and resilient adults—and that, contrarily, their rejection undermines health and dramatically increases their risk of attempted suicide. The Family Acceptance Project has worked with hundreds of families from all kinds of ethnic, racial, religious and socioeconomic backgrounds, and developed educational materials to support them in learning to be supportive of their “different” kids. Ryan said the project has found their respectful approach to be met in kind. “Meeting families where they are,” she told me, “we build on family strengths to show them what we’ve learned from our research, and help them understand that some of the ways they have treated their children have been putting

The Power of Choosing Resilience 53

them at risk.” The project has actually found that increasing family support reduces the young people’s substance abuse, HIV risk behaviors, and suicidality. “This is exciting because these have been seen as intractable problems,” said Ryan. Aimed at young gay men, the MPowerment project is, technically, an HIV prevention intervention. The CDC-funded program isn’t formally billed as “resilience-building”. But co-principal investigator Greg Rebchook, an assistant professor at the University of California-San Francisco’s Center for AIDS Prevention Studies, told me, “We don’t start from a place where gay men are wounded, their wings are broken.” Instead, MPowerment uses outreach, drop-in centers and community-building efforts to strengthen young gay men’s self-esteem, positive relationships, and social support. Using a “whole-man” approach, Rebchook said, “It’s not just about condoms, but about all the factors that come together to affect their lives.” Although MPowerment is a subtly powerful way to buttress young gay men’s resilience and health, its focus on “upstream” issues that drive behavior is new territory for government prevention funders. Rebchook said, “There is a lot of interest in my colleagues around resilience, but when you look at RFPs [requests for proposals], they are all about the health disparities in the community.” Stephen F. Morin, medical professor, chief of the prevention science division and director of UCSF’s Center for AIDS Prevention Studies, told me that prevention program planners are focused on treating those living with HIV to reduce their infectiousness. But he said they will have to address the social drivers of behavior to ensure that HIV-positive clients adhere to their medication. “At some point they’ll start to focus on substance abuse and mental health to get their goals met,” said Morin. Because San Francisco’s gay demographics skew older — perhaps because of the city’s high cost of living — gay and bisexual men in their thirties and forties represent the leading edge of new HIV infec-

The Atlantic 54

tions in the city. A new approach to prevention aimed at these men but that doesn’t “look like” prevention is the Bridgemen project. Launched by the Stop AIDS Project in July 2011 and funded by the CDC, Bridgemen reaches out to men in what program director Frank Stenglein calls our “third life.” He explained that after a first stage of making friends and having fun in our twenties, then building careers and settling down, men in this third stage ask themselves such questions as “What comes next? What am I going to leave behind me?” Stenglein, forty-five, said gay men at this point in our lives — particularly those who don’t have a partner— are at risk for depression, isolation and drug use. Through weekly and monthly meetings, events and community service projects, Bridgemen offers the chance to make new friends and talk about things in a safe space. “By men being involved in their community,” said Stenglein, “they are more likely to take care of themselves, their brothers and their community.” The HIV prevention aspect, he explained, lies in building “a happy, healthier community that embraces each other and men who are taking care of each other, being responsible for each other.” Continuing to draw from, and build, resilience is also important for the health and well-being of gay men in the later years of midlife and into the older years. Brian DeVries, professor of gerontology at San Francisco State University, says in a forthcoming book chapter that older gay men are more likely than heterosexuals or lesbians to live alone and have higher rates of mental distress. “The psychological weight of lives at the margins exact a toll on mental health, in turn jeopardizing physical well-being in an oscillating fashion,” he writes. Resilience is no longer such an abstract proposition. But not all older gay men live under this weight. DeVries in an interview used the term “positive marginality” for the ways gay men and other marginalized people are able to find meaning and purpose simply in resisting our marginalization. “We have been excluded,” he said, “and there are huge costs of that

Robert M. Kertzner, a psychiatrist who shuttles between a research science position at Columbia University and a clinical professorship at UCSF, told me that interest in the resilience of gay men — and LGBT people generally — has increased in the last five to ten years because “resilience is no longer such an abstract proposition.” He said the push for same-sex marriage, the overturning of the military ‘Don’t Ask, Don’t Tell’ policy, and the revelation to the world of the variety of gay lives are examples of the “good things in our lives” that inspire hope. “These things challenged the general population,” said Kertzner, “but also challenged LGBT people to think differently about themselves.” Reminding one another of the progress already made toward full equality can “help people with the strengths and resources they need to develop resilience within themselves,” said Kertzner. Well before the recent uptick of interest in LGBT health, gay men were already drawing from our experiences of standing up to the people and circumstances that oppress us — discovering our own courage and strength, defining life on our terms. Some

The Power of Choosing Resilience

\\\

exclusion. But as a result we’ve had to find our own way, to find ways of interacting and being that are unlike ways that were modeled by our [heterosexual] peers and elders. We’ve created ways that fit us. Besides redefining what “old” might look like or mean, DeVries said gay men of all ages have the choice to frame our personal stories in a way that truly accentuates the positive, eliminates the negative — and most assuredly does not mess around with “Mr. In-Between.” “In the stories we tell of our lives,” said DeVries, “as gay men, as survivors, the victims story is one of discontinuity, how we’re not what we ‘should’ be because of all these things. The victory story is one that sees the ways we can grow from them. It provides hope, direction, and allows you to learn from the experiences.”

The Atlantic 56

of us have drawn from our family and community histories, while others have had to find the courage to live boldly and with purpose by repurposing old skills to meet even severe new challenges. H. Alexander Satorie-Robinson was president of the National Task Force on AIDS Prevention, when the nation’s first prevention program targeting gay men of color was created in 1988. Lacking a full embrace in the mostly white gay community, and not very welcome in the black, Latino and Asian communities that reared the men it served, the Task Force “was a place of comfort,” said Satorie-Robinson. Tapping into the cultural values of community, faith, family and a shared history of survival, he said, “we were recreating those places in our gay/bisexual image.” Even without empirical data, Satorie-Robinson said, cultural survival instincts were used and adapted to make a difference. “We came together, drew on our history, looked at what the people who had come before us were able to survive.” In John Killacky’s case, the instincts he developed as a young dancer and marathoner pulled him through a long, grueling rehabilitation and enabled him to survive. That and a good man. In his early forties and together with his partner Larry Connolly only a year at that point, Killacky one night had a kind of seizure as he and Larry were just going to sleep. An MRI at the hospital found a tumor involving sixty percent of his spinal cord. After surgery at Abbott Northwestern, in Minneapolis where the two men lived then, and ten days in the ICU, Killacky was moved to the ward for people with spinal injuries. Killacky recounts how he was able to learn to walk again by using a mirror — as he’d once learned new dance steps. As a former marathoner, he had to learn not to focus on his pain or fatigue, but “always look at the horizon.” Today, Killacky, now director of the Flynn Performing Arts Center in Burlington, Vt. walks with a cane. The left side of what he calls “this bifurcated body” is still different from the right side. He

The Power of Choosing Resilience 57

still has extreme pain in one leg and on the right side of his pelvis. And after seventeen years, he still has Larry. “I am very lucky,” he said. “I had a partner who stayed with me through this. Often eighteen months after a traumatic incident, couples break up because it’s not what you signed up for.” Although the many benefits of marriage are welldocumented, most same-sex couples lack the legal and social recognition of their relationships that heterosexuals take for granted. This makes committed long-term relationships that endure in spite of the barriers all the more striking. It makes a relationship like John Killacky and Larry Connolly’s astonishing. For his part, Connolly told me, “I don’t know how he would have done it [without a partner].” He said that both of them find great comfort in each other. “We find resilience in the marriage itself,” he said. Another Larry, Lawrence D. Mass, a physician in Manhattan and co-founder of Gay Men’s Health Crisis, the world’s first HIV/AIDS service organization, described how, besides his own long-term relationship, recovery programs have provided such strong support for his own health and well-being. As both a longtime clean-and-sober participant in 12-step programs and medical director of addiction services at Beth Israel Medical Center, Mass said, “Recovery is this huge and infinitely valuable resource for resilience. Unfortunately it’s not something that many people avail themselves of. You have to want it and seek it out. It’s not something that can be force-fed as medicine.” Greg Herek, the University of California at Davis psychology professor and noted expert on LGBT prejudice, said, “The active voice is a really important part of it. [Resilience] is not something that happens; it’s something people do.” While there are more role models and more accepting non-gay people, Herek said, “It’s something the individual has to do.” Ultimately we gay men choose — like everyone, really — whether we will recover from our addictions, tame the syndemic forces that can undermine us

The Atlantic

and live with resilience, or not. But the choice is easier than putting it into practice. Which is why we have to understand itâ&#x20AC;&#x2122;s not a one-time decision, but a lifelong series. Each time we choose, we decide whom we want to be: victor or victim. Each choice to be victorious marks one more step toward that place; not over the rainbow, but here and now. Gay men become resilient when we choose not to listen to bullies, because we believe ourselves to be lovable.

http://healthland.time.com/2013/02/22/hover-nomore-helicopter-parents-may-breed-depression-andincompetence-in-their-children/

Bibliography

http://www.huffingtonpost.com/2012/11/28/ screening-children-for-mental-illness_n_2207095. html?utm_hp_ref=parents-kids

http://www.telegraph.co.uk/education/ educationnews/9620117/Twitter-and-Facebookharming-childrens-development.html http://healthland.time.com/2013/02/21/lastinglegacy-of-childhood-bullying-psychiatric-problems-inadulthood/ http://healthland.time.com/2013/04/02/howjunior-high-friendships-affect-adult-relationships/ http://www.theatlantic.com/health/archive/2013/ 03/the-existential-pain-of-being-young-white-andaffluent/273471/ ` http://www.nytimes.com/2013/02/10/magazine/ why-can-some-kids-handle-pressure-while-othersfall-apart.html?pagewanted=2&_r=1&ref=mentalhe althanddisorders&pagewanted=all&

http://www.theatlantic.com/health/archive/2013/ 02/the-power-of-choosing-resilience/2732