A Prescription for Resilience: World Expert Helps Explain What Can Make Us Stronger in the Face of Adversity

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Dennis S. Charney, M.D., Expert on Anxiety and Resiliency
Dennis S. Charney, M.D.

From The Quarterly, Winter 2013

“I’m a big believer in mothers.”

This is Dr. Dennis Charney speaking, and it is a remark that both charms and disarms the listener—so down to earth, yet coming from one of the most sophisticated and accomplished researchers in the field of brain research. Dr. Charney, a member of the Brain & Behavior Research Foundation Scientific Council, recipient of a NARSAD Distinguished Investigator Grant, former Chief of the Mood and Anxiety Disorder Research Program at the National Institute of Mental Health, and now Dean of the Mount Sinai School of Medicine in New York, has over 700 publications to his name—hundreds of scientific articles, dozens of scholarly books, chapters, and reviews —a list that continues to lengthen as his career moves forward.
 
Adapting to early stress
In this particular remark, not to be confused with a simple defense of motherhood, Dr. Charney is trying to place into proper context a remarkable recent research finding: “children, in particular, display remarkable resilience” when faced with sources of stress in their environment. A leading expert on resilience, Dr. Charney acknowledges the observation is true in the narrow sense that the brain of the young child is comparatively malleable. It is an organ still in the process of assuming its mature form —a process that will take the better part of two decades. It’s an extraordinarily complicated process, involving the progressive unfolding of neural networks, shaped partly by individual experience, but also by the expression of hundreds of genes in each person’s unique DNA.
 
Research shows that children are surprisingly good at adapting to stress. But only up to a point: for children most certainly need and depend upon parental protection. Some recent studies have shown that rodent pups subjected to early maternal separations later prove more resilient than pups that were not separated from their mothers. “But those are data from animal models of stress,” Dr. Charney cautions. The applicability to humans remains ambiguous. A minimal experience of separation from ‘mama’ might be helpful in some cases when young people are involved, he allows, “as long as it is not that much.” He adds that not only is he a big believer in mothers, but “in mothers who are very predictable and helpful.”
 
But where is the tipping point in this, and other kinds of stress? While many people exhibit remarkable resilience, there are many others, in response to stress, who go on to develop brain and behavior disorders, ranging from mood disorders such as depression, to anxiety disorders such as post-traumatic stress disorder (PTSD), to substance-abuse disorders like alcoholism and drug addiction. 
 
Identifying the links between stress and illness
It is now widely known that there are biologically predisposing factors that make the onset of depression and other brain and behavior disorders more likely for some people than others. The development of the disorder in these cases may be triggered by adverse environmental circumstances or not.
 
The biology of depression and similar disorders has been linked to dysfunctions of the stress hormone system, and what physicians refer to as the HPA (hypothalamic-pituitary-adrenal) axis. The HPA axis is engaged with many key bodily systems, such as those regulating digestion and the immune response. There is also evidence of abnormal gene expression impacting the brain circuits and networks involved in the regulation of mood and the natural ability to respond to stress. 
 
The Brain & Behavior Research Foundation funds much research to better understand what malfunctions and why, and importantly, how the dysfunctions can potentially be corrected. Of this support, Dr. Charney says, “The great thing is that the great majority of the grant money has gone to young people, early in their careers. They need a jump-start—to take the right ideas and test them. The Foundation has made a seminal contribution to the field.”
 
What makes some people more resilient?
Dr. Charney, in trying to come to grips with possible and probable factors pertinent to the stress response, had an epiphany during his years at Yale. “In those years, along with fellow Foundation Scientific Council Members Drs. Eric Nestler and John Krystal and others, including Dr. Steven Southwick, I was studying PTSD and depression. We were doing a lot with military veterans, and ultimately we said, ‘May- be we can learn from people who have been traumatized but who did not develop PTSD, depression or substance abuse problems.’
 
“In the ensuing years, we have studied diverse populations of people who have demonstrated resilience. We studied POWs from Vietnam; men held in prison for 6 to 8 years; we studied the U.S. Special Forces; victims of hurricanes; victims of earthquakes in Pakistan; people who were raised in conditions of crime and poverty in inner-city Washington, D.C. We began by saying, ‘We want to learn from you. You tell us what enables you to show incredible courage and resilience to get through tough times.’”
 
This work has culminated in what Dr. Charney calls ‘a prescription for resilience.’ Again and again, he and his associates were told by people who were dealing successfully with trauma or stress that they called upon prior experiences in their lives that helped them get through the current challenge. Behavioral scientists call this form of coping ‘stress inoculation:’ exposure to the dangerous thing enables some people to learn how to cope with it.
 
“It has implications for how you might want to raise your children,” Dr. Charney says. “If you grow up in a stress-free environment, you’re not prepared for the inevitable stresses and strains that life presents. Everybody suffers the loss of loved ones. Everyone faces medical illness and meets with disappointment. The point is that you need to be prepared. I’ve done this with my own children. You need to take them out of their confidence zone. You give them challenges they can manage, and therefore learn from. And they develop a psychological toolbox they can call upon when faced with something difficult.”
 
What he and his colleagues learned from veterans and victims of both natural calamites and physical and psychological abuse is that those who were resilient tended to be the ones who sought support from others. “If your house is burnt, you figure out ways to rebuild it; you don’t wait for people to come to you. You engage the help of others to help you rebuild what has become broken.”
 
Dr. Charney points out that it is perfectly normal to experience fear. It’s an emotion and associated set of behaviors that evolution has preserved because it tends to promote our collective survival. “People who are courageous are not fearless,” he notes. “Courage is all about overcoming fear—acting despite being afraid. Facing fears can increase your self-esteem,” and thus enhance resilience.
 
When he talks to non-scientists about stress and resilience, Dr. Charney finds that his audiences are “most interested in our finding that you can train yourself to be more resilient.” He does not mean with the guidance of a psychoanalyst, and he is not talking here about those who are suffering from clinical depression (although the lessons do apply, he says, in-so-far as patients are able to apply them).  
 
Optimism is strongly correlated with resilience. This is exemplified in what has been called ‘the Stockdale paradox,’ after one of the most famous of the Vietnam POWs, James Stockdale: “You know you are in deep trouble; so you face the brutal facts of the challenge you’re facing. But at the same time you feel deeply that you will prevail.”  
 
Also, those who speak of having a strong set of core moral principles have been shown to be more apt to be resilient. So have those who seek models of successful coping behavior in others—whether a friend or relative or someone famous. Role models can help people hold up under stress, Dr. Charney reports.
 
Having spent so much time studying clinically depressed people, Dr. Charney makes very clear that 
“depression is not the opposite condition of resilience. It’s not as if people who suffer from depression are not resilient. You might be depressed because you are biologically predisposed. In such individuals, the illness must be treated in a ‘precise and focused way,’ with the help of professionals. Resilience, however, can separately help the depressed. So if you unfortunately suffer from depression because you are pre-disposed, working on some of the factors we’ve identified that promote resilience can help you deal with depression.”
 
Scientific Council Member
2007 NARSAD Distinguished Investigator Grantee
Anne and Joel Ehrenkranz Dean of Mount Sinai School of Medicine
Executive Vice President for Academic Affairs of the
Mount Sinai Medical Center

Article comments

The key point is Resilient people go to other people for support. I just came home from New Directions Support Group for people with mood disorders and their loved ones here in suburban Philadelphia. More than a dozen individuals shared their often-traumatic stories with others who listened intently and gave the gift of understanding. All of us in our group are resilient b/c we believe in the healing power of storytelling to the right people. See www.newdirectionssupport.org

This discussion rings true, and I have written similar notes on how optimism and perseverance can often be found by drawing on past positive experience (including resilience) and having confidence that the future will hold similar events. While the present may be difficult to endure, stamina can be built if we have optimism and look forward to future moments. Whether future joy is achievement of a complex goal, or as simple as a glass to quench a thirst, a conversation with friend/family or a vision to behold - enduring the present can be considered well-worthwhile with optimistic goals and visions of the future. Training in this type of mindfulness - to consider past and future joys, is likely to increase resilience. I see this idea in Dr. Charney's discussion. My blog discusses these topics: www.macromichael.com. Thanks!

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