Richard G. Petty, MD

Wise Words About Leadership

William George.jpg

I was recently talking to someone about the difference between managers and leaders. Wherever you find yourself with a group of people who have to get something done, you can usually spot the leaders. They don’t necessarily have lots of stripes on their arms, distinctive epaulettes or shiny nameplates. For more than two centuries it has been known that around 5% of the population has a natural ability to lead. But more importantly others give them the permission to take charge. That 5% also has a number of other interesting characteristics that we shall talk about in other posts.

But there is more to leadership than natural ability.

Here are some wise words from someone who know more than most about successful leadership:

“Is leadership inherent or trainable? Both.

You are born with characteristics that reside deep inside you: drive, an ability to influence and motivate, perseverance. But you have to develop those qualities through actual leadership experiences.

A key quality is adaptability–facing unexpected obstacles, falling short of goals, reading the context, and changing your approach.

Absent that, leaders will continue to repeat mistakes and will not grow and develop. That leads me to the essence of the question “Why is it so hard to lead yourself?”

The answer, in my experience, lies in the differences between your idealized self–how you see yourself and how you want to be seen–and your real self. The key to growing as a leader is to narrow that gap by developing a deep self-awareness that comes from straight feedback and honest exploration of yourself, followed by a concerted effort to make changes.”

–William W. George (American Professor of Management Practice at Harvard Business School and Former CEO of Medtronic, Inc., 1942-) [Quoted in Fast Company, April 2007]

People Watching

For the eighth time in a week your humble reporter found himself at the Atlanta airport. Ahem, I should say, of course, the Hartsfield-Jackson Atlanta International Airport.

It’s a perfect place for people watching. New statistics out today have shown that in 2006 it held its position as the world’s busiest airport, followed by O’Hare in Chicago and London’s Heathrow.

I was chastened to realize that I have been in every one of the top ten airports in the last year or so. For people who like such things, here’s the list of the top ten busiest airports with the number of millions passengers who’ve been through each:

  1. Atlanta    84.8
  2. O’Hare    76.2
  3. Heathrow   67.5
  4. Tokyo’s Haneda    65.2
  5. Los Angeles International    61
  6. Dallas/Fort Worth    60
  7. Paris, Charles de Gaulle    56.8
  8. Frankfurt    52.8
  9. Beijing Capital International Airport    48.5
  10. Denver International    47.3

Spending a lot of time in airports can stress the physical, psychological and subtle systems of the body, as well as making it easy to lose touch with your spirituality.

I’m going to let you in on a secret: for over two decades I had learned and then taught methods for building resilience and bouncing back from adversity. But it wasn’t until I started flying a quarter of a million miles a year that I got the chance to test and refine the methods under the most extreme conditions. Engineers often talk about taking their constructions and “testing them to destruction.” I did the same thing with the methods I teach. If they couldn’t help people cope with flights, illness or job loss, then I discarded them and looked for something else. And if they didn’t also have another piece – a way to grow in response to adversity, they were out too.

The result has been a whole raft of techniques and methods that have been tried and tested again and again. Over the next year I shall be rolling out a great many of these techniques in a novel format.

Watch this space!

“Every adversity carries with it the seed of equal or greater benefit.”
–Napoleon Hill (American Founder of Personal Success Literature, 1883-1970)

“From the withered tree, a flower blooms.”
–Zen Buddhist Saying

“How you handle adversity in the workplace tends to have much more impact on your career than how you handle the good stuff. The people who know how to overcome adversity are the ones who rise to the top of the organization."
— Martin E. P. Seligman (American Psychologist, Professor at the University of Pennsylvania and Former President of the American Psychological Association, 1941-)

“Adversity is the diamond dust with which Heaven polishes its jewels.”
— Robert Leighton (Scottish Presbyterian Bishop and Classical Scholar, 1611-1684)

“Adversity has the effect of eliciting talents which in prosperous times would have lain dormant.”
–Horace (a.k.a. Quintus Horatius Flaccus, Roman Poet and Satirist, 65-8 B.C.E.)

“Adversity is not undesirable. Because, it is only when you are down and out in life that you can realize its true value.”
–Swami Ramdas (a.k.a. Papa Ramdas, Indian Spiritual Teacher, 1884-1963)

Madness and Genius Revisited

I must have heard a thousand times that there’s a fine line between genius and insanity. I have talked before about the possible link between the two through schizotypal personality disorder. It is quite well known that there are two living Nobel Prize winners who have a diagnosis of schizophrenia and many more who have first-degree relatives with it.

There is some very interesting research in the current issue of the Journal of Clinical Investigation from a team of scientists at the National Institutes of Health’s (NIH) National Institute of Mental Health (NIMH).

In the latest installment of a story that has been unfolding over the last three decades, they report on their findings concerning a human gene for a master switch in the brain called DARPP-32. Most people inherit a version of a gene that optimizes their brain’s thinking circuitry, yet paradoxically also appears to increase risk for schizophrenia, an illness marked by impaired thinking. The main kinds of thinking involve reasoning, abstraction and creativity.

Over the last two decades, studies in animals, most notably by Nobel Laureate Paul Greengard at Rockefeller University, have established that DARPP-32 in the striatum switches streams of information coming from multiple brain chemical systems so that the cortex can process them. Both the neurotransmitter that DARPP-32 works through – dopamine – and the chromosomal site of the DARPP-32 gene have been implicated in schizophrenia.

The NIMH researchers in this new study have identified a common version of the gene and showed how it impacts the way in which two key brain regions exchange information, so affecting a range of functions from general intelligence to attention.

To understand DARPP-32’s role in the human brain, they used genetic, structural and functional magnetic resonance imaging and also post-mortem studies to identify the human gene’s variants and their functional consequences.

Seventy five percent of subjects had the most common version of the gene, which boosted the activity of circuits in the prefrontal cortex of the brain. This region is the major filter, controller and processor of cognitive information. When active, it increases structural and functional connections and our performance on tasks that involve thinking. It almost certainly does so by increasing gene expression. In 257 affected families, people with schizophrenia were also more likely to have this common version of the DARPP-32 gene.

DARPP-32 appears to shape and control a circuit running between the striatum and prefrontal cortex. The circuit affects key brain functions implicated in schizophrenia, such as motivation, working memory and reward-related learning.

The senior investigator is Daniel Weinberger, who had this to say,

"Our results raise the question of whether a gene variant favored by evolution, that would normally confer advantage, may translate into a disadvantage if the prefrontal cortex is impaired, as in schizophrenia. Normally, enhanced cortex connectivity with the striatum would provide increased flexibility, working memory capacity and executive control. But if other genes and environmental events conspire to render the cortex incapable of handling such information, it could backfire — resulting in the neural equivalent of a superhighway to a dead-end."

Although several groups of researchers have looked for the possible clinical relevance of DARPP-32, they have had much success. This study shows a strong connection between the molecule and human cognition and also, perhaps, with schizophrenia.

What is also interesting about this finding is that it helps provide us with a mechanism by which environmental stress could lead to cognitive problems.

Apart from the uninformed tirades of Tom Cruise, I see a lot of opinion pieces on websites and YouTube expressing the opinion that psychiatry is baseless, ostensibly because there is no science behind it. By anyone’s standards, this is high level science utilizing a series of state-of-the-art approaches. And another piece of evidence that psychiatry is becoming more science than art, linking the mind, the brain and the environment into one harmonious whole.

The Epigenetic Code

In Healing, Meaning and Purpose I reveal some of the extraordinary changes that are occurring in our understanding of genetics and inheritance. Even if you are currently learning genetics in college, it is quite likely that some of what your professors are teaching may already be out of date. I say that with the greatest possible respect: I find that in some of my fields of expertise, I am often having to update my teaching materials every week.

One of the remarkable discoveries that is generating huge amounts of new information is what we call epigenetics. This is the study of a form of inheritance that can occur without fundamental changes in gene sequences. This has to do with the idea that there is a second layer of programming on top of our DNA. A code that can change over our lifetimes in response to environmental change. Diet, hormones, chemicals in the environment, stress and even thought, emotion and behavior, can all change the ways in which our genes are expressed. Some of these epigenetic changes can be passed on to other generations. In other words, there can be an inheritance of acquired characteristics. Something that has been denied for over a century.

Let me give you a simple example. Studies of a particular species of mouse have shown that maternal diet has an effect on the coat color of the offspring. This was the result of what is known as methylation that altered gene expression. These changes in coat color were carried on to the next generation: the grandchildren of the mouse given the special diet. This created quite a stir, because it had been thought that epigenetic changes in cells are erased each time that a cell divides. Obviously that was not happening. We now have many examples of epigenetic changes being passed on to the next generation and the next. There are literally hundreds of scientific papers on the subject.

As I have written before in my last book and CDs, in articles and in reviews at Amazon and elsewhere, the traditional view of genetics has been one of genetic determinism. That we are all little robots whose entire lives are dedicated to nothing more than passing our DNA from one generation to the next. And the genes even dictated how we did that. I still know many gene jockeys who are convinced that the whole of human behavior will ultimately be explained by our genes, and that free will is therefore a myth.

I’m just as sure that they are wrong.

Let me give you an example. Identical twins have identical DNA, yet we have known for fifty years that one twin may get a genetic illness that the other does not. And the brains of identical twins, though they start out identical, quickly become quite different from each other because of the impact of the environment. Twin studies of mental illness have been going on at the Institute of Psychiatry in London since 1960. Every patient coming to the hospital is asked by the clerical staff if he or she is a twin. And there has been groundbreaking research on mentally ill twins at the National Institute of Mental Health for decades. And what have we learned? Though there may be a genetic component in schizophrenia, when we look at people with schizophrenia who have identical twins, only half of the twins have the illness, despite having the same DNA. The key difference is at the epigenetic level.

Marcus Pembrey from the Clinical and Molecular Genetics Unit at the Institute of Child Health, part of University College, London, has been at the forefront of the work on epigenetics. Marcus has had the opportunity to study the unusually detailed historical medical records of the isolated northern Swedish city of Overkalix. He and his colleagues found something astonishing. The grandsons of men who experienced famine during mid-childhood went through puberty earlier and had longer life spans, while the grandsons of men who were well fed in early childhood had an increased likelihood of diabetes. For females, the effect was similar but it was tied to the grandmother, rather than the grandfather. Presumably these responses are designed to adjust our early growth and reproduction to be ready for unpredictable changes adverse events in the environment. I would call this epigenetic resilience.

In a separate study done in Bristol in England, Marcus studied two generations of families, and found that fathers who had started smoking before age 11 had sons who were significantly heavier than average. There was no similar effect on daughters.

There is already some evidence that epigenetic factors may play a role in the development of bipolar disorder and schizophrenia.  Many of us are becoming excited about the potential benefit that may flow from a better understanding of genetic and epigenetic mechanisms in major psychiatric disorders.

There is a new journal called, appropriately, Epigenetics that contains a treasure trove of important information. The editor is Moshe Szyf, form McGill University in Canada, and he recently pointed out that one single gene could have as many as 700 epigenetic programs associated with it.

His own research has linked epigenetic change to social interactions: the way in which we behave toward one another can lead to a change in how our genes operate.

Rats whose mothers groom and lick them when they are young grow up to be much calmer than rats whose mothers neglected them. There is, of course, nothing surprising about that. We all understand the importance of good child rearing. But what was surprising was the finding that epigenetic changes are the cause. By nurturing their young, the rat mothers activated a gene that suppressed the creation of cortisol, one of the stress hormones.

Pups who were neglected did not have that gene activated, so they produced more cortisol and were therefore more stressed out.

Knowing this, the researchers were able to increase the well-nurtured rats’ stress by injecting them with methionine, an amino acid commonly found in food supplements.

Here we have proof that the link between food and mood is not just due to transient chemical changes in the neurotransmitters of the brain, but that a chemical in our diet could cause fundamental changes in the way in which our genes work. In this case a rat’s emotions and state of mind. The implications for all of us are extraordinary.

Since 2003, a consortium of public and private firms in Europe has been working on the first Human Epigenome Project (HEP), and it hopes to have completed 10% of the map by the end of this year. As you can see, it is a lot more complicated than mapping the human genome, and epigenetic codes are constantly moving targets. The first reports from HEP have indicated that at least 20% of the genes studied so far can have their behavior modified by the environment. The food that we eat, the chemicals that we ingest and the attitude of our parents and peers can all change the way in which our genes function.

As Marcus Pembrey has said, “Child care has a whole new meaning.”

This is all crucially important, because one of our most important discoveries has been that human beings have been undergoing extremely rapid physical as well as psychological and social change, and that is one of the reasons why the Laws of Healing have been changing over the last century.

Beating Burnout

I have been getting a number of requests to re-post some of my materials about burnout.

This is a summary of some of the information that we cover in our corporate wellness seminars. For people who are interested, we have also created a Powerpoint slide set, together with reference materials which are available for purchase from our website.

So let us begin at the beginning and ask:

What is Burnout?
This may seem such an obvious question, since the term “burnout” has become part of everyday language, but it is still the topic of a great deal of research.

The best definition of burnout is “a prolonged response to chronic physical, emotional and interpersonal stressors at work.” It is defined by three dimensions:

  1. Exhaustion
  2. Cynicism
  3. Inefficacy

It is more than just an individual experience of stress: it has to be seen in the larger organizational context of people’s relationship with their work.

It is often the case that individuals miss all the signs in themselves.

So what are the main symptoms of burnout?

  1. Worrying, particularly at night
  2. Trouble sleeping
  3. Feeling unappreciated or “used” at work
  4. Feeling less effective or competent than you used to
  5. Easily angry or irritated
  6. Dread of going to work
  7. A feeling of being overwhelmed
  8. Recurrent stress-related physical symptoms like headaches, or back pain
  9. Watching the clock and counting down toward the end of the work day
  10. Rigidly applying riles without considering more creative solutions
  11. Automatically expressing negative attitudes
  12. Finding excuses to be absent from work
  13. Alcohol or substance abuse

We need to ask questions about conditions at work. For instance whether individuals are asked to work extra long shifts, go without breaks and lack clear guidelines.

Who is at greatest risk?
Helping professionals and people who have great responsibility for others, such as  airline pilots and air traffic controllers.

Although there are some psychological predictors for who are more likely to suffer from burnout, with enough stressors just about anyone can become a victim of it. Some people have claimed that burnout is a physical illness resulting from exhaustion of the adrenal glands, but the research doesn’t show that. Burnout is primarily a problem of the system in which you work, interacting with your body and your mind. So now let’s look at how to transform yourself from victim to victor.

The major risk factors are:

  1. Feeling powerless
  2. Being caught in conflict
  3. Having inadequate information
  4. Lack of central visions
  5. Incoordination of the team
  6. Overload
  7. Boredom
  8. Alienation
  9. Ambiguity
  10. Conflict of values

What are the Solutions?

Dealing with burnout needs the help of all workers and the organization as a whole. Sometimes it also needs the help of an outsider. I was once working in a very unhappy place, in the days long before I realized that I had the power to change things myself. A psychologist friend working in the then new field of systems theory, told me that the problem was not with individuals, but that the whole system was “sick” and disorganized and what was needed was a system overhaul.

The opposite of job burnout is job engagement. If you feel that you are engaged in doing something valuable, for which you are appreciated, you are far more likely to have a satisfying life and enjoy doing your job well. There is good evidence that participation, engagement and autonomy are powerful predictors of health outcomes.

First, at the personal level:

The keys to preventing burnout are represented by the acronym REAP:


  1. Evaluate your personal goals and priorities: what do you really want to get out of life, and even more importantly, what do you want to put in to life
  2. Ensure that you have established your own core values, your purpose and your meaning. (My book and CD series Healing, Meaning and Purpose spends a lot of time on helping you do exactly that.)
  3. Attend to your own health, through exercise, nutrition and sleep. (I have worked with countless individuals with burnout, whose problems largely evaporated once they were diverted from the coffee, soda and snack machines. Remember the close relationships between food and mood.)
  4. Make sure that you have some outside interests. Not just things that further drain your energy, but something that you enjoy.
  5. Learn some specific stress reduction techniques. (I also have some suggestions for doing so in my book.)
  6. Are you a micromanager who has to do everything yourself? If so, then it is a really good idea to learn to delegate. And don’t take on responsibilities that are not yours. (It took me years to learn that one: I was such a slave to perfectionism, that I always thought that I had to everything myself. Bad mistake)
  7. If your find yourself expressing negativity, work on substituting a positive word for every negative one.
  8. Learn to forgive yourself if things are not going well, and use reversals as the fuel to power you to achievement: it’s what I call “silver-lining:” How to find the positive in any negative situation.
  9. Try to form a support group or see if you can arrange for an outsider to some in and help you.
  10. Are there some specific skills that you need to build and develop?
  11. Can you tailor or change your job?
  12. Develop detachment

Second, at the organizational level:

  1. Evaluate overall work performance: if it declining, it may be an early sign that staff members are being afflicted by burnout.
  2. Consider changes in managerial practices, to move away from the dominator to a partnership model.
  3. Research has indicated that there are six key areas in which mismatches may lead to burnout: workload; personal control; appropriateness of rewards; sense of connection; sense of fairness and a conflict of values. So it is a good idea to break down any analyses and interventions along these lines.
  4. All the evidence suggests that a combination of managerial change and education are the best way to head off and to deal with burnout.
  5. There is also some research showing that a values-based spiritual program to prevent and deal with burnout. The recommendations include a short time for silence, visualization, reflection, active listening, appreciation creativity and playfulness.

What is very clear is that burnout is not just a personal problem; it is something that can affect an entire organization, and has to be tackled as an organization. If it is not, then in these difficult times in health care, we are going to have ever more tired and disillusioned people trying to care for sicker and sicker patients, and just not having the resources to do so.

Transcending Overload and Burnout
There is an important notion that is rarely even talked about. Why does stress and burnout exist? Is it simply bad overloaded wiring in the brain and bad overloaded wiring in our relationships and in our places of work? Well, yes, that is of course correct. But there is also something else: burnout occurs because multiple sets of systems are failing. Nature abhors a vacuum, so from the ashes of these failed systems a new and improved you can emerge. Remember the ancient story of the Phoenix that emerges from the flames. And you might know the statement by Richard Bach: “What the caterpillar calls the end of the world, the master calls a butterfly.”

We need to discard broken systems so that our true self can emerge.

I would like you to think about burnout as a state of consciousness that you are ready to outgrow. You can practice the psychological band-aids, or you can accept the invitation to grow.

There will inevitably be some transition pains, but that is to be expected as the new you is being born. This is also a good time to do an exercise that I recommend in Healing, Meaning and Purpose, and it is to establish where each part of you – Physical, Psychological, Social, Subtle and Spiritual – lies in terms of the Memes of Spiral Dynamics. If you do this exercise every few months, and at times of transition, it can provide powerful proof that the burnout is actually presenting you with a unique opportunity to grow.

Artificial Light and the Biological Clock

Many of the things that we do to babies and young children have been called into question in recent years.

The debate about doing an excessive number of fetal ultrasounds and high tone deafness seems to have gone away for now. Though not disappeared: there is a paper in the week’s Proceedings of the National Academy of Sciences that revisits this important issue. Then there was the realization that doctors were not good at recognizing and dealing with pain in very young children.

And now there is another one that has worried me for years: what happens to babies who are exposed to constant high levels of light? Doesn’t it damage the development of normal circadian rhythms?

I have just seen a study that seems to confirm some of those fears.

Investigators from Vanderbilt University in Nashville examined the impact of exposing babt mice to constant light. The main biological clock is in the brain, and is located in a region called  the suprachiasmatic nuclei (SCN). It is responsible for orchestrating an orderly internal physiological and behavioral cycle. It influences the activity of virtually all our organs, including the brain, heart, liver and lungs. It egulates the daily activity cycles that we call circadian rhythms.

When the mice are exposed to normal variations in light the cells of the SCN quickly become synchronized, and a normal circadian rhythm is established. Constant exposure to light disrupted the development of the SCN and prevented the animals from developing normal circadian rhythms.

This is far from being an academic exercise: each year around 14 million premature babies are born worldwide, and many are exposed to artificial lighting in hospitals. If their biological clocks are not allowed to develop normally, we would anticipate that they would, in later life, have less psychological resilience, and to be prediposed to sleep and mood disorders.

I could conceive of a way to test that experimentally by looking at records of people wth those problems. Secondly, we need to see if reducing unnecessary light exposure would have a real benefit for babies, and for the children and audlts that they will become. I would be astonished if exposing babies to a natural spectrum of light and a natural light cycle did  not have enormous benefits for them as they grow up.

Resilience, Misfortune, and Mortality

Much of the development of the ideas of Integrated Medicine has been driven by the idea that a truly effective holistic medicine does not simply integrate different modalities to achieve health and wellness, but is also aimed at integrating all the different aspects of a person into a coherent whole. That was the real reason for choosing the term “Integrated” medicine in the United Kingdom, though “Integrative” and “Integral” medicine are ultimately all aiming for the same thing.

This is quite different from simply adding some acupuncture, an herb or some relaxation therapy to a conventional medical program. Its aim is not so much getting someone better, as to give the whole person – physical, psychological, social, subtle and spiritual – what he or she needs to be able to get themselves back on an even keel, so as to be able to deal with future challenges as they arise. And not just deal with them, but to use challenges as springboards to growth and development.

The whole idea of this system of medicine included an extra dimension that had often been left out: the interaction between the person in trouble and the practitioner. We are social animals, but even more than that it looks as if we are highly interconnected from cell to soul. We have to take into account the impact of a therapeutic interaction on the clinician, as well as the influence of the clinician’s psychological, subtle and spiritual makeup on the individual.

The development of this system of medicine had many parents. One was the American-born Israeli sociologist Professor Aaron Antonovsky who first generated the idea of salutogenesis: the study of the factors that support human health and wellness. He was one of the first to show that people who were relatively unstressed were far more likely to be able to resist illness, compared with stressed people. His interest was not just in what causes disease, but what are the roots of health.

He returned to and discussed, developed and applied an idea that had been around since the work of Sigmund Freud and Roberto Assagioli: that was that our experience of well-being constitutes a Sense of Coherence (SOC). He defined the sense of coherence like this:

A global orientation that expresses the extent to which one has a pervasive, enduring though dynamic feeling of confidence that one’s internal and external environments are predictable and that there is a high probability that things will work out as well as can reasonably be expected.

Two recent studies seem to indicate that this concept of coherence is fundamentally correct.

Researchers in Cambridge in the United Kingdom have reported a population-based cohort of 20,921 men and women completed a postal assessment of their lifetime experience of specific adverse events and a measure of their sense of coherence. Those with a weak SOC reported significantly slower adaptation to the adverse effects of life experiences, compared with those with a string SOC, and were more likely to die prematurely. Although the size of the effect was not large, the results suggest that SOC is a potential marker of an individual’s adaptive capacity to deal with social stress, which is predictive of mortality

The second study was a systematic review from Finland. I like the way in which the study was done, and it came to this conclusion:

“SOC seems to be a health promoting resource, which strengthens resilience and develops a positive subjective state of health. Salutogenesis is a valuable approach for health promotion.”

So what does this mean for you?

Developing a sense of coherence is a most critical factor in creating and maintaining robust health and ability to adapt to change, be it in health, stress, your relationship or at work.

How do you do that? Healing, Meaning and Purpose spends over a hundred pages or several CDs explaining the most up to date ways of doing exactly that using a process known as Creative Self-Integration.

I do hope that you take the opportunity to sample some of the techniques for yourself.

Psychological Reslience and Adult Support

Most of us would agree that it is very difficult to try to reduce human behavior to genes alone: one of the most important breakthroughs in our understanding of many genes is the way in which they interact constantly with the environment. This has been known for years with the genes involved in metabolism, but we now also know that the main function of genes in the brain is not to determine behavior, but to predispose us to the way in which we handle the environment.

There is a good discussion of this distinction in a paper posted by someone whom I am sorry to say that I do not know, called R.J. O’Hara, that endorses our point: even if you have genes that could predispose you to a bad long-term outcome, if you had strong, positive support from an adult, it could significantly reduce the impact of "bad" genes.

It leaves us with an important question: how late in life can strong social supports and a positive mental attitude cancel out some of our genetic predispositions?

My answer? "Biology is not destiny, and we can help people make a new start at any age or at any time in life."

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Posttraumatic Stress Disorder, Resilience and the Brain

There has always been a puzzle about posttraumatic stress disorder (PTSD): why do some people get it and others don’t? It has always seemed that if the stress was bad enough, and particularly if it was unexpected, then pretty much anyone could get PTSD. But in between the mild stressor that makes one person fall apart and suffer terribly, while others scarcely notice, and the severe trauma that catches almost everyone, is a great unexplained mass of suffering people.

Six years ago research by Tamara Gurvits and her colleagues from the VA in Manchester, New Hampshire first suggested that people with PTSD may have some subtle neurological problems that couldn’t be explained away by alcohol abuse or injury. Now the same group has published a new study that adds significantly to our knowledge about this issue. A study of twins lead the investigators to conclude that the neurological abnormalities predated the PTSD and most likely predisposes patients to it.

The researchers studied 49 pairs of identical male twins in whom one twin had been exposed to combat during the Vietnam War and the other had not.

In 25 pairs the combat-exposed twin had a current diagnosis of PTSD, while the remaining 24 twins did not have the problem.

All the subjects were tested for what we call neurological “soft signs.” This is not a good term, and refers to subtle neurological disturbances, usually involving some complex systems of the brain. They include things like an impaired sense of direction, being able to do rapid, complex motor actions, copying pictures and movements. The combat veterans with PTSD scored higher on the soft signs tests than did the veterans without PTSD. But now it gets interesting: the identical twins of people with PTSD also had high soft sign scores. In other words there appears to a familial vulnerability to developing PTSD. This is consistent with a fascinating new paper on the neurological circuitry involved in fear. We can now map out some of the neurological vulnerabilities involved in PTSD as well as some of the neurological consequences of severe PTSD. Nobody knows if we can reverse them with psychological or other approaches, but we now think it is very possible.

There is a lot more work to be done. But as a first suggestion: someone who has this kind of evidence of vulnerability to PTSD should be the first to get advanced training in developing resilience. We already know that even the most limited efforts to bolster and develop resilience can have marked effects.

The key is to start building your resilience starting today.

“Always plan. It wasn’t raining when Noah built the ark.”
–Richard C. Cushing (American Roman Catholic Cardinal, 1895-1970)

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Temperament, Depression, Class and Resilience

Within the first few weeks of life, infants show marked individual differences in their level of activity, their responsiveness to change in the environment and their irritability. Some clearly enjoy being touched and mold their bodies to the person holding them, while other stiffen and squirm and do less to adjust their bodies to another person. These mood-related personality characteristics are called temperaments. There is some evidence that temperament is one of the basic building blocks of the personality. Temperament appears to consist of inborn traits, but they can be modified by parental contact: there is actually a reciprocal relationship between child and parent. The child modifies the behavior and attitude of the parent.

It is commonly said that a child’s temperament is as fixed as handedness or eye color, but this is inaccurate: we have overwhelming evidence that temperament can be changed by environmental influences. This makes sense. In Healing, Meaning and Purpose, we discuss the implications of the new findings about genes in the brain: they do not so much determine behavior as predispose you to the way that you will handle the environment. An important questions is just how plastic is human temperament? To what extent can you overcome your genetic programming and early rearing? Some recent research has indicated that the environment of the first three years of life is not as critical to later development as we used to believe. But I think that it’s dangerous to read too much into this research. Early emotional deprivation may leave the deepest scars and also be associated with physical deprivation. If a developing brain is deprived of key nutrients, it is difficult to catch up later.

More and more research is finding key genes that contribute to temperament. There is important evidence from animal research that the temperament of infant female rats can predict life span in those who develop spontaneous tumors. It is difficult to extrapolate from that to humans, but it is a further demonstration of the incredibly subtle interactions between genes, the environment, behavior and physical illness.

Some important recent research has examined the impact of temperament on the clinical features of bipolar disorder and of ADHD and autistic spectrum disorders. As expected, people with ADHD reported high levels of novelty seeking and high levels of harm avoidance. Patients with autism spectrum disorders were low on measures of novelty seeking, they had little dependence on rewards and high harm avoidance. Cluster B personality disorders, the dramatic, emotional, or erratic disorders ones (antisocial, borderline, narcissistic and histrionic), were more common in people with ADHD and the other clusters A and C were more common in autistic spectrum disorders. This tells us that these tow clinical conditions can have some specific effects on the structure of temperament, and on the risk of developing specific personality disorders.

In a new study in next month’s issue of the Journal of Personality, Kati Heinonen and colleagues from the Department of Psychology at University of Helsinki, have found a correlation between adult pessimism and childhood temperament in low socioeconomic status (SES) families. It is no surprise to learn that children raised in higher socioeconomic groups have a more optimistic outlook on life. But this is what is interesting, and the thing that will launch a great many more studies. It was discovered that the effect of childhood socioeconomic status on pessimism tended to remain the same despite opportunities for socioeconomic fluidity. A person from a low SES childhood who moved upwards in status was less likely to be optimistic as an adult than someone from a high SES childhood who remained in a high SES environment. The inverse also held true, as people from a high SES childhood who moved downwards in socioeconomic status were more optimistic than those who remained in low SES. This indicates that children who had the chance to develop coping strategies during childhood and subsequently developed a sense of mastery and control that protected them in adulthood from the adverse effects of lower SES. By contrast children from lower SES backgrounds who are subsequently upwardly mobile may not have had the opportunities to develop those psychological resources. They are thus unable to benefit as much as possible from later experiences of success.

We already know that pessimism is related to physical and mental health, so this new study provides a critical link between socioeconomic status and long-term outcome. This is essential information for policy makers and for parents interested in helping children develop more effective coping strategies.

This research really proves that some of the excessive optimism of the self-help movement can sometimes be misplaced: just wanting something to be different does not make it so. If you had a lousy up-bringing in impoverished surroundings, it will make it more difficult to bounce back and learn essential coping skills.

More difficult, but not impossible.

Research on resilience has provided us with a great deal of information about developing mastery and coping skills in the face of being in a low SES, and we shall return to some of that work in the near future.

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