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Fostering Resilience

Childhood trauma is toxic, but the damage is reversible. Credit: Credit: archangeleb/Flickr

Back in the mid-1980s, a physician working with obese patients in San Diego discovered something unexpected: The people making progress with his weight loss program were the ones most likely to reject it and walk away. Puzzled, Dr. Vincent Felitti studied 286 of these patients in greater depth and learned that many had been beaten or sexually abused as children — obesity, it turned out, was their shield against unwanted physical attention. They did not want to let it go.

Meanwhile, across the country in Atlanta, Dr. Robert Anda at the Centers for Disease Control was studying lifestyle-related diseases like cirrhosis of the liver and certain cancers. By the early 1990s, the two doctors had teamed up to design the largest U.S. study ever on the link between adult health disorders and traumatic childhood experience.

With 11 simple questions, many of them surprisingly pedestrian, they surveyed more than 17,000 patients who were visiting a California clinic for standard check-ups. The results were stunning.

Nearly two-thirds of participants — the majority of them white and college-educated — reported some form of childhood trauma, abuse or neglect. This ranged from fairly typical stuff, like watching parents divorce, to witnessing substance abuse and domestic violence. All of it significantly elevated the likelihood of adult depression, suicide and a host of costly medical conditions from heart disease to breathing disorders.

Take the Adverse Childhood Experiences test and see for yourself. Huge numbers of everyday people — regular, working folks who hardly appear to fit the label “at-risk” — may recognize themselves in questions like, “Did you often or very often feel that your family didn’t look out for each other, feel close to each other, or support each other?” Sixty-three percent of participants reported one category of childhood trauma and 20 percent logged three or more. By this definition, many of us could be described as “at-risk.”

What, then, does this term actually mean? At-risk for screwing up at work or drinking too much or making bad choices? At risk for becoming a ward of the state, a drain on the system? The renowned psychologist John Briere, Ph.D, has observed that if child abuse and neglect were to disappear, the Diagnostic and Statistical Manual — an 886-page tome cataloging some 300 mental disorders — would shrink to the size of a pamphlet, and the prisons would empty in two generations.

Considering this, it becomes easier to understand why foster youth, all of whom experienced home dysfunction severe enough to warrant removal, display astronomical rates of homelessness, poverty and incarceration as young adults. They are, says child psychiatrist Mick Storck, exhibiting a magnified version of traumas similar to those that many of us lug around.

“The same questions that we’re all grappling with — Do I have a place in this world? Will anyone love me? Do I really belong anywhere? — they’re sort of precociously in touch with,” he said. “Foster kids have this acceleration of the existential grid.”

We were discussing all this while sitting outside the gracious home in Ravenna where Storck has lived for 23 years, as idealized a setting as you could imagine. But I was thinking of the 23-year-old I’d met not long before, a young woman named Carrie who lives in an apartment so barren that looking at her bare walls and empty kitchen, I assumed she’d moved in just weeks ago. She’d been living there for three years. Carrie was a college student, working toward a degree in social work. But she could not settle in. She could not believe in her life.

During high school, Carrie often walked out of class to sit by herself in detention — that is, when she wasn’t on the run.

“I had a lot of things on my mind," she said. "I had to figure out, is the place where I think I’m going later today, really the place I’m going? Because anything can happen. You never know how the foster parent is going to feel about you. It’s like, I know you care, but I also know you don’t love me. I guess that’s the reason I always ran, because you don’t feel loved. You don’t.”

In foster youth, early trauma frequently shows up later as violence (rage at abandonment), an inability to connect and a cascade of resulting behaviors (high-risk sex, early pregnancies) that may look irredeemable to the rest of the world. But there is another way to view “at-risk” youth. Consider the homeless boy who lives under a bridge yet somehow shows up at school most days. Or the girl who gets herself from Yakima to Seattle on a Greyhound bus and finds a job at the mall, selling handbags. I’ve met these kids. They’re high school dropouts, yes. But they’re also paragons of resourcefulness, persistence and flexibility.

Researchers are catching on. In the last decade they have devoted increasing resources to identifying the factors that allow some at-risk youth to build successful adult lives, when other kids from more “normal” backgrounds fall to drug addiction or early death. A few key points rise to the surface in study after study, and they could provide an instructive angle on our foster care system:

1. Resilience is not inborn. It is built and strengthened, or weakened, by life experience.

2. Consistency, in the form of a caring, competent adult, makes more difference than money. If not a parent, then a teacher. If not a teacher, then a coach, mentor or therapist.

In other words, despite the dire and lasting effects of a painful childhood, the human brain is infinitely plastic, constantly changing in response to its environment. So exposure to severe trauma, while toxic, is reversible, and through some surprisingly simple, low-cost methods.

“Resilience does not appear to require extraordinary talents or resources, but instead depends on fundamental human adaptive systems,” writes Ann Masten, a child-development expert from Minnesota, who specializes in linking research to public-policy. “What might be called ‘ordinary magic.’”

These concepts provide the basic foundation for Pongo Publishing, a treatment program in use at King County Juvenile Detention and the state psychiatric hospital for children. Since 1996, Pongo has been connecting kids deemed incorrigible with a volunteer corps of writers who help them turn their stories into poetry. The act of writing itself seems to strengthen resilience in youth, therapists say, a sense of purpose and agency that spurs the will to reach for more. You could call it emotional weight-lifting.

“God, this is trans-personal, it’s transformative,” said Storck after reading Pongo’s early poetry collections. (He has since joined the Board of Directors.) “The resilience comes, in part, from feeling that your suffering was not in vain, that you have some value on this planet, something to give. All of us need to feel that. And for these kids, having the poems by their bedsides is like having a literary floatation device when the world is crashing in.”

Pongo was founded in the mid-1990s by Richard Gold, a former executive at Microsoft, who has now worked with more than 6,000 young people in the court and mental health systems, and looks at them through a similar glass-half-full prism.

“They’re carrying around these unbelievable experiences. But there’s a kind of genius in people who have suffered terribly,” he says. “They pay a price, but they understand some things about life that the rest of us don’t.”

There Had to Have Been

There’s no important person in my life. 

There just isn’t. 

Hasn’t always been this way. â€¨â€¨

At some point there had to have been a person 

That made me feel 

Happy, 

As happy as my splat pink hair. â€¨â€¨

At some point there had to have been a person 

That made me feel 

Loved,
As loved as a small baby bluebird


In Mama Bluebird’s nest. â€¨â€¨

At some point there had to have been a person 

That made me feel 

Important, 

As important as The President 

At her inauguration. â€¨â€¨

Right now 

There’s no important person in my life, 

But at some point 

There had to have been.

Storck, who’s been treating child patients at Western State Psychiatric Hospital for more than two decades, pointed me toward this poem as an example of resilience, a document speaking to the reservoir of belief hidden deep within the 14-year-old girl who wrote it. After gathering stories and poems like hers for nearly two decades, Gold is bothered less by what life has dealt these young people than by what he sees as adults’ refusal to listen.

“The resilience of these kids is underappreciated because many people, including teachers, therapists, social workers, are unwilling to hear, unwilling to recognize that the path to resilience is the path through pain,” he said. “It’s not easy, and I do feel like a changed person because I’ve heard these stories. But it builds a certain kind of emotional strength.”

Shannon Dorsey, a clinical psychologist who has devoted much of her career to studying foster care in Washington, believes that better training and support for foster parents would go a long way toward boosting resilience in youth. Because the more instability there is in a child’s life, the more likely she is to act out, and then get kicked out, again. It is truly a vicious cycle. Carrie, for one, estimates that she had 15 placements during three years in state care.

In her below-ground-level apartment, there is just one decoration: a deflated Mylar balloon taped to the wall above her bed. “I love you,” it says in red script.

The poem There Had To Have Been is reprinted courtesy of PongoTeenWriting. Kids at Risk coverage is made possible by a grant from Ballmer Family Giving. Go here for more of Crosscut's Kids at Risk coverage.

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