Long sandy beaches, hibiscus flowers, clear waters of tropical fish and coral reefs. There are hundreds of islands in the Hawaiian archipelago, spread over 1,500 miles in the central Pacific Ocean. The eight main islands include Kauai, Maui and the island of Hawaii, nicknamed Big Island to differentiate it from the state. On Big Island the tiny, tear-shaped lava rocks that lie all around on its volcano’s sides, are named “Pele’s tears” after the Hawaiian fire goddess. The legend has it that if you take any away, you will be cursed until you return them to where they belong. In the midst of all the beauty, Hawaii has some dark and sinister stories.
Mirena (not her real name), was born on the island of Kauai. I meet her on Skype: me in my sitting room in the evening, the English weather dark outside; her in the office where she works at a local school, early in the morning, the light bright and palm trees visible from the window. Mirena is a charismatic woman who speaks with passion. She remembers a Hawaii from before the tourism boom, growing up playing in the red Anahola dirt, running through the cane fields. She recalls the excitement when the first stop light was erected for the cane-field trucks, with children walking across the island to look at it. But despite the setting, her childhood was far from a paradise. “I saw things...” she says. “I saw things children shouldn’t see.”
Mirena was born in 1955, the year that an experiment began. Mirena’s family, like all families on Kauai who had babies in that year, was approached by two researchers: Emmy Werner and Ruth Smith, psychologists who had become interested in which factors in a child’s early life set them on a positive trajectory, and which really get in the way of them reaching their full potential. It became one of the longest studies of child development and adversity ever conducted.
There were 698 families that agreed, and they were monitored from before the babies’ births, tracking them and checking in at ages one, two, 10, 18, 32 and 40. The researchers followed first the parents, then the children, finding out all sorts of things about their progress and their backgrounds through a mixture of semi-structured interviews, questionnaires and community records of mental health, marriage, divorce, criminal convictions, school achievement and employment.
“My first recollection of being a participant? I think age 18, I was already a young mother,” says Mirena. “I got a phone call from Dr Ruth Smith. She said, ‘Can I come and talk story?’ – which is interview. We’re talking story right now.”
Mirena spent her childhood in a three-bedroom house, with her parents and six siblings. The children walked the mile to and from school, arriving back home to a house they were responsible for keeping clean and tidy. Hawaii back then was a mix of plantations and a growing hotel industry. Mirena’s father worked for the coastguard. Her mother worked for Aloha Airlines as an entertainer, hula dancing and singing. Mirena’s family had very little money to feed the seven children, and her father drank heavily. The researchers in the Kauai study separated the nearly 700 children involved into two groups: about two-thirds were considered at low risk of developing any difficulties; but the others – such as Mirena – were classed as “high-risk”: born into poverty, perinatal stress, family discord (including domestic violence), parental alcoholism or illness.
The researchers expected to find the “high-risk” children would do less well as they grew up; and, in line with those expectations, they found two-thirds of them did go on to develop significant problems. But, unexpectedly, about one-third of the “high-risk” children developed into competent, confident and caring individuals, without significant problems in adult life. And the study of what made these children resilient – which is still ongoing – has become as least as important as any on the negative effects of a difficult childhood. Why did some of these children do so well despite their adverse circumstances?
It seems three clusters of protective factors tended to mark out the children who did well despite being “high-risk”: aspects of the child’s temperament, having someone who was consistently caring (typically a family member), and having a sense of belonging to a wider group. Also, overall, they tended to have grown up in families of four children or fewer, with two years or more between them and their siblings, few prolonged separations from their primary caregiver, and a close bond with at least one caregiver. They tended to be described positively as infants, with adjectives such as “active”, “cuddly” or “alert”. They had friends at school, emotional support outside their families more extracurricular activities and, if female, avoided pregnancy until after their teenage years.
The picture was complex, though, with different factors seeming important at different ages. Aged 10, doing well was linked to having been born without complications and having parents with fewer difficulties such as mental health problems, chronic poverty or trouble parenting. Aged 10 and 18, positive individual personality traits seemed to help, as well as the presence of positive relationships. Aged 32 and 40, a stable marriage was protective, as was participation in the armed forces. Strikingly, even some children who had “gone off the rails” in their teenage years managed to get their lives back on track by their thirties and forties, often without the help of mental-health professionals.
Many of the factors involved in such turnarounds, and several associated with resilience throughout life, involve relationships of some kind. But wider research suggests the more risk factors children face, the more protective factors they need to compensate. For Mirena, that meant having caring and supportive people and environments outside the immediate family home. “My parents, bless their hearts, they didn’t do what parents ought to do,” she says. “They were too busy trying to figure out themselves. What do you do with this house full of kids and not enough money, and an alcoholic husband? I saw my mom just raging with my dad. He’s in the kitchen, sitting, she’s busted all the bottles all over the kitchen. There’s blood everywhere and I’m thinking: ‘What can I do? I’m just a kid.’
“Luckily for me, my mother’s parents lived nearby. They made a huge difference for me, just knowing that somebody loved me no matter what. And I was not always the easiest child. I was sometimes very aggressive and you become that when you have to defend your family. And we spent most of our days outside, so dirty. When things were really bad, I would end up at my grandma’s house: she would take me in the outside cement tub and wash the mud off me. And then she’d take me in the inside bathtub and scrub me clean, to get all the dirt out of my very long hair.
“Then, she’d sit me on her knee, and patiently take every tangle out of my hair – I’m crying because it hurts and she’s saying to me ‘almost pau’ – the Hawaiian word for finished – very gentle. But she would be eventually pau, and I remember I’d stand up, and she’d take that comb and go all the way down the back. And I remember just feeling clean. And pretty. And like maybe somebody could love me today, maybe I’m OK today.”
Mirena also thinks the boarding school she went to at 12 helped. “I realised when I came here and I lived in the dorm, with all these different people, that families didn’t have to be like this,” she says. The school’s sense of community was important for her, and she remains working there today. It’s also where she met her future husband, with whom she now has seven children and 15 grandchildren of her own. She says she recalls her grandmother often: “I do my best to be that kind of grandma to my own.”
It seems obvious that how we are cared for by our parents or primary caregivers is crucial, but the growing realisation of just how important love and affection are to children has only come about in the past century. Known as “attachment theory”, its father was John Bowlby, a psychiatrist, psychologist and psychoanalyst who defined it as a “deep and enduring emotional bond that connects one person to another across time and space”. Bowlby was interested in what happened to children who were separated from their caregivers early on. One of his earliest studies was of 88 adolescent patients from his clinic in London. Half had been referred for stealing, and half had emotional troubles but had not shown delinquent behaviour. Bowlby noticed that the “44 thieves”, as he called them, were much more likely than the control group to have lost a caregiver when they were young, which led him to think about how early experiences of loss can have profound effects. However, in the Kauai study, the children living in adverse circumstances largely remained in their homes, where some of them thrived regardless.
Across the other side of the world, anyone in Europe old enough to watch TV in 1990 is likely to have a memory of the Romanian orphanages after the fall of dictator Nicolae Ceausescu: bleak rooms, packed full of small children with big eyes, pulling themselves up on their cot bars to see the Western camera operators filming them. Under Ceausescu, abortion and contraception had been banned, leading to a massive rise in birth rates. Children without anyone to care for them had been left in institutions, to experience immense emotional deprivation and neglect. They had very little individualised care, no one to hug them or comfort them, no one to sing them to sleep. Their basic physical needs were met in terms of being given food and kept warm, but their basic emotional needs for affection and comfort were not. They learned not to even bother reaching out when adults were around.
The discovery of the conditions in the orphanages prompted a rush of compassion and charity initiatives to adopt the children; and the UK Department of Health contacted a researcher at King’s College London’s Institute of Psychiatry, Psychology and Neuroscience, Michael Rutter, to ask him to measure what was going on.
Sitting in his light and airy office at the Social Developmental and Genetic Psychiatry Centre in south London, Rutter remembers it as both a scientific and practical opportunity, “a natural experiment”. All such previous studies had involved children who had entered care institutions at a range of ages, meaning variations in their behaviour and wellbeing might be grounded in history. The Romanian orphans, though, had all been admitted within the first two weeks of life. “It’s a horrible thing,” says Rutter, “but given that it did happen, one may as well learn as much as possible.”
Rutter’s study assessed the children over time as they settled into new adoptive families: “The findings were surprises all along the line,” he says. The prevailing wisdom was that serious adversity in childhood led to a range of emotional and behavioural problems. Rutter’s research showed that – apart from a minority who had specific, extreme patterns, such as autistic spectrum disorders – “there was no increase in the ordinary emotional and behavioural problems”. Another surprise was that if the children were adopted early enough – within six months – they seemed to go on to develop well.
Rutter sees this resilience in the face of adversity as a dynamic process: “Resilience initially was talked about as a trait, but it’s become clear that it’s a process. You can be resilient to some things and not others.” (Still, he acknowledges that “children or, for that matter adults, who are resilient to some sorts of things are more likely to be resilient to others”.) He continues with a medical analogy: “The way to protect children against infections is either to allow natural immunity to develop or to immunise.” Either way, children benefit from limited early exposure to pathogens. To prevent this from happening is, in the long term, harmful. Likewise, children need some stress in their lives, so they can learn to cope with it. “Development involves both change and challenge and also continuity,” says Rutter. “So to see the norm as stability is wrong.”
This suggests there is something about the way that some children adapt to and cope with adverse circumstances that enables them to be emotionally resilient. It’s not the stress that causes problems – although in the face of enormous adversity it would be much harder to remain resilient; rather, it’s the interaction between stress and ways of coping that’s really important. Maybe some ways of coping are more helpful than others, and maybe some protective factors mean the stress gets managed better.
But what if there are some children who need extra help, to boost them up to the same level of development as their more resilient peers? We still know very little about any resilience mechanisms and how we can help them to be more effective – so Eamon McCrory, professor of developmental neuroscience and psychopathology at University College London, is investigating just this.
McCrory and his team are collecting a combination of brain images, cognitive assessments, DNA and perceptual data from children who have been maltreated and allocated a social worker, and also from a control group who have not. The two groups have been painstakingly matched by age, pubertal development, IQ, socioeconomic status, ethnicity and sex; and the researchers aim to unpick what could predict how maltreated children will go on to develop difficulties and which will be resilient.
“If you have 100 children referred to social services who experienced maltreatment, we know that the majority of them actually won’t develop a mental health problem," he says. “But then, a minority are at significantly elevated risk. So it seems sensible to try and move the focus back from the disorder to a much earlier stage in the process and characterise the risk profile. Only longitudinal designs can give us this information.”
So far, he has identified three main areas where there are likely to be differences: threat processing, brain structure, and autobiographical memory. The first can be measured through the responsiveness of the amygdala and, says McCrory, the theory is that “a number of biological and neurocognitive systems adapt to a context characterised by early stress, threat and unpredictability”. (But, he warns, adaptations that may be helpful in one context can embed vulnerability in the longer term.)
For the second, the team are also scanning the children’s brains to try to see whether difference in brain structure in maltreated children are stable over time or changeable. For the third, the team is investigating whether the brain system involved in thinking about and processing memories of personal history might also be shaped by early traumatic experiences in a way that is adaptive in the short term but unhelpful in the longer term.
“Autobiographical memory is the process whereby you record and encode your own experiences and make sense of them,” explains McCrory. “We know that individuals who have depression and PTSD have an over-general autobiographical memory pattern, where they lack specificity in their recall of past experience. We also know that kids who have experienced maltreatment can show higher levels of this over-general memory pattern. And longitudinal studies have shown that a pattern of over-general memory can act as a risk factor for future disorder.” As a consequence, “one hypothesis is that the over-general memory limits an individual’s ability to effectively assimilate and negotiate future experiences, because we draw on our past experiences to be able to predict the contingencies and likelihood of events in the future, and use that knowledge to negotiate those experiences well”.
It makes sense that, if horrible things have happened to you in the past, you will want to avoid thinking about and remembering them – which might lead to a tendency to have a memory that’s light on detail. McCrory’s team are certainly finding reliable associations. But ask Mirena, back in Hawaii, and she finds it hard to know whether her memory really has been affected. “We don’t know what we don’t remember,” she says. But the memories she does have of her family growing up are mixed. She often describes them fondly: her father as “a brilliant man” who “read all the time” and was “just kind of ordinary except when he was drunk”. Her mother was “a beautiful Hawaiian woman who had a beautiful voice, who did her best”. But alongside these descriptions are darker memories, of coming home to arguments in the kitchen, or worse: “I saw my mother try to kill my father on several occasions, cos’ daddy was drunk and mom was mad. And I was usually the one that would try to stop them.” Sometimes she becomes tearful, remembering difficult times; other times, she speaks with passion about the importance of protecting children.
In an ideal world, we wouldn’t have to work out how to best to help children who have been abused or neglected; we would instead be able to remove those risks. Trying to understand what we can do to prevent the negative effects of childhood adversity and to boost individual resilience, is perhaps the next best thing. As McCrory says, “I think it’s hopeful to see that recovery is possible and that [brain systems] are characterised by plasticity. The questions are then about how to promote that: Are there developmental periods where that is more possible, and how much can we enhance plasticity over those periods?”
The idea of resilience as an adaptive process rather than an individual trait opens up the potential for other people to be involved in that process. Lali McCubbin, now principal investigator in Hawaii and daughter of one of the original research team, sees the importance of relationships as being wider than just people, and she and her team have created a new measure of “relational well-being” to try to capture this. “You think of relationship as with a person,” she says. “What we found was that it was relationship with the land, relationship with nature, relationship with God, relationship with ancestors, relationship with culture.”
But for Mirena, the vital thing is still “that there’s somebody they know cares about them. Just one person, it can make all the difference.”
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A longer version of this article first appeared on mosaicscience.com. It is republished here under a Creative Commons licence
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