Here is one of the most powerful graphs I’ve been exposed to in some time:
The diagram tells part of the developmental story of Sara (not her real name) a 2 ½-year-old girl in foster care who suffered significant early trauma. Her story powerfully illuminates some important aspects of trauma resilience, particularly early in life.
Little was known of Sara’s mother, except that she was an occasionally homeless sex worker who reported suffering from bouts of schizophrenia. (Nothing was known of her father.) On her first day of life, against her doctor’s advice, Sara’s mother removed her from the hospital, only to abandon her a day later. Sara was then entered into protective custody and placed with her first foster family, with whom she stayed for her first 15 months of life.
By all accounts, she was a healthy baby and toddler, developing normally. Then, sadly, the husband/father in her foster family became ill and suddenly died. Sara was removed, without any preparation, from the only family she had known, and placed with a second foster family.
Almost immediately, everything about Sara’s developmental narrative changed. Upon arrival in her new home, she cried for a month without consolation. Her language skills declined precipitously, and she rarely spoke spontaneously. Distressingly, she would assume ‘statue-like poses’ for up to 20 minutes at a time, leading her new foster mother to speculate that she might have developmental disabilities. Even her physical growth slowed, as noted in the chart above – a phenomenon called ‘psychosocial dwarfism’. A consulting psychologist initially concluded she was functionally retarded, and may have been severely deprived. After much debate, she was admitted to an inpatient child psychiatric unit for evaluation.
In the hospital, Sara continued to express this fear of strangers, ‘freezing’ or walking with difficulty and stiffness, and showing an intense attachment, first to her foster mother, and then to her primary care nurse.
But after a month at the hospital, Sara’s interdisciplinary case team concluded that she was neither developmentally disabled nor schizophrenic. Rather, Sara’s challenges had come from environmental stressors, particularly the interruption of her early attachment relationships. They recommended she be adopted right away, and literally wrote a prescription for a new family designed around her needs: one that would have older children in it, but no infants or toddlers; a mother who would be at home most of the time; and a commitment to stay in the same place for some time.
Encouragingly, just such a family was found, and after several weeks of counseling, this new adoptive family took Sara home for good. Over her three months in the hospital, Sara had gained a year, developmentally; after discharge, she continued to grow, and after a year with her new (and permanent) family, had fully caught up. An assessment conducted several years later found she was a normal and well-adjusted little girl.
Sara’s precipitous decline after the trauma of being removed from her first foster home shows how severe stressors can affect not just our brains, but also our bodies – particularly when they are still developing. Her equally dramatic reversal shows just how resilient we can be, when placed in the right psychosocial context. (And, to me, it also captures something about the essential experience of love.)
Researchers, like Masten and others who study personal resilience, find many adaptive systems at work in our ability to recover from trauma. The strength of our social networks; the quality of our attachment relationships; the health of our brain and body; the interaction of our genes and lived experiences; our level of personal mastery and self-control; our spirituality and systems of belief; our access to resources of all kinds; the quality of the community we inhabit; and (especially) our ‘habits of mind’ – all play a part.
The good news is that these processes are neither mysterious nor rare – indeed they are so common (though by no means universal) that Masten famously labeled them ‘Ordinary Magic’.
The even better news is that we are discovering new ways to help bolster that innate resilience where it might have been diminished by circumstance. Thaddeus Pace, of the Emory University Mind Body Program (and a PopTech Science Fellow) and his colleagues have long-studied the effects of contemplative, compassion-based practices on our psychological and physical health. These practices, which researchers call Cognitively-Based Compassion Training (CBCT) originated in Tibetan Buddhism, and are designed to help practitioners better manage the emotional content of lived experience, and cultivate a sense of compassion toward themselves and others.
Pace and his colleagues recently researched the effectiveness of CBCT with a group of adolescents in the foster care system in Atlanta. Almost by definition, all of these children had experienced severe stressors – ranging from neglect and abuse to drug addiction and violence. CBCT training not only decreased their anxiety and improved other measures of psychological resilience, it also diminished their physiological levels of a biomarker called the C-reactive protein, which signifies a person’s level of cellular inflammation. This inflammation, in turn, is implicated in a wide array of chronic illnesses later in life, from cardiovascular disease and type 2 diabetes to cancer and depression. In other words, CBCT might (and I must stress, might) not only boost the near-term psychosocial resilience of young people who experience trauma, but also long-term, adverse health effects that might not manifest for decades.
These kinds of results are moving, inexorably, from the lab to the field. The coming years will bring exciting new ways of packaging, delivering and reinforcing such training – in person, via mobile devices, and in ways as yet unimagined.