W. T. Grant Consortium: Active Ingredients of Prevention Programs



Key ingredients of effective programs include:

EMOTIONAL SKILLS

• Identifying and labeling feelings

• Expressing feelings

• Assessing the intensity of feelings

• Managing feelings

• Delaying gratification

• Controlling impulses

• Reducing stress

• Knowing the difference between feelings and actions

COGNITIVE SKILLS

• Self-talk—conducting an "inner dialogue" as a way to cope with a topic or challenge or reinforce one's own behavior

• Reading and interpreting social cues—for example, recognizing social influences on behavior and seeing oneself in the perspective of the larger community

• Using steps for problem-solving and decision-making—for instance, controlling impulses, setting goals, identifying alternative actions, anticipating consequences

• Understanding the perspective of others

• Understanding behavioral norms (what is and is not acceptable behavior)

• A positive attitude toward life

• Self-awareness—for example, developing realistic expectations about oneself

BEHAVIORAL SKILLS

• Nonverbal—communicating through eye contact, facial expressiveness, tone of voice, gestures, and so on

• Verbal—making clear requests, responding effectively to criticism, resisting negative influences, listening to others, helping others, participating in positive peer groups

 

SOURCE: W. T. Grant Consortium on the School-Based Promotion of Social Competence, "Drug and Alcohol Prevention Curricula," in J. David Hawkins et al., Communities That Care (San Francisco: Jossey-Bass, 1992).

 

APPENDIX E

The Self Science Curriculum

Main components:

Self-awareness: observing yourself and recognizing your feelings; building a vocabulary for feelings; knowing the relationship between thoughts, feelings, and reactions

Personal decision-making: examining your actions and knowing their consequences; knowing if thought or feeling is ruling a decision; applying these insights to issues such as sex and drugs

Managing feelings: monitoring "self-talk" to catch negative messages such as internal put-downs; realizing what is behind a feeling (e.g., the hurt that underlies anger);finding ways to handle fears and anxieties, anger, and sadness

Handling stress: learning the value of exercise, guided imagery, relaxation methods

Empathy: understanding others' feelings and concerns and taking their perspective; appreciating the differences in how people feel about things

Communications: talking about feelings effectively: becoming a good listener and question-asker; distinguishing between what someone does or says and your own reactions or judgments about it; sending "I" messages instead of blame

Self-disclosure: valuing openness and building trust in a relationship; knowing when it's safe to risk talking about your private feelings

Insight: identifying patterns in your emotional life and reactions; recognizing similar patterns in others

Self-acceptance: feeling pride and seeing yourself in a positive light; recognizing your strengths and weaknesses; being able to laugh at yourself

Personal responsibility: taking responsibility; recognizing the consequences of your decisions and actions, accepting your feelings and moods, following through on commitments (e.g., to studying)

Assertiveness: stating your concerns and feelings without anger or passivity

Group dynamics: cooperation; knowing when and how to lead, when to follow

Conflict resolution: how to fight fair with other kids, with parents, with teachers; the win/win model for negotiating compromise

SOURCE: Karen F. Stone and Harold Q. Dillehunt, Self Science: The Subject Is Me (Santa Monica: Goodyear Publishing Co., 1978).

 

 

APPENDIX F

Social and Emotional Learning: Results

 

Child Development Project

Eric Schaps, Development Studies Center, Oakland, California.

Evaluation in schools in Northern California, grades K-6; rating by independent observers, comparing with control schools.

RESULTS:

• more responsible

• more assertive

• more popular and outgoing

• more pro-social and helpful

• better understanding of others

• more considerate, concerned

• more pro-social strategies for interpersonal problem-solving

• more harmonious

• more "democratic"

• better conflict-resolution skills

SOURCES: E. Schaps and V. Battistich, "Promoting Health Development Through School-Based Prevention: New Approaches," OSAP Prevention Monograph, no. 8: Preventing Adolescent Drug Use: From Theory to Practice. Eric Gopelrud (ed.), Rockville, MD: Office of Substance Abuse Prevention, U.S. Dept. of Health and Human Services, 1991.

D. Solomon, M. Watson, V. Battistich, E. Schaps, and K. Delucchi, "Creating a Caring Community: Educational Practices That Promote Children's Prosocial Development," in F. K. Oser, A. Dick, and J.-L. Patry, eds., Effective and Responsible Teaching: The New Synthesis (San Francisco: Jossey-Bass, 1992).

Paths

Mark Greenberg, Fast Track Project, University of Washington.

Evaluated in schools in Seattle, grades 1-5; ratings by teachers, comparing matched control students among 1) regular students, 2) deaf students, 3) special-education students.

RESULTS:

• Improvement in social cognitive skills

• Improvement in emotion, recognition, and understanding

• Better self-control

• Better planning for solving cognitive tasks

• More thinking before acting

• More effective conflict resolution

• More positive classroom atmosphere

SPECIAL-NEEDS STUDENTS:

Improved classroom behavior on:

• Frustration tolerance

• Assertive social skills

• Task orientation

• Peer skills

• Sharing

• Sociability

• Self-control

IMPROVED EMOTIONAL UNDERSTANDING:

• Recognition

• Labeling

• Decreases in self-reports of sadness and depression

• Decrease in anxiety and withdrawal

SOURCES: Conduct Problems Research Group, "A Developmental and Clinical Model for the Prevention of Conduct Disorder: The Fast Track Program," Development and Psychopathology 4 (1992).

M. T. Greenberg and C. A. Kusche, Promoting Social and Emotional Development in Deaf Children: The PATHS Project (Seattle: University of Washington Press, 1993).

M. T. Greenberg, C. A. Kusche, E. T. Cook, and J. P. Quamma, "Promoting Emotional Competence in School-Aged Children: The Effects of the PATHS Curriculum," Development and Psychopathology 7 (1995).

 

Seattle Social Development Project

J. David Hawkins, Social Development Research Group, University of Washington

Evaluated in Seattle elementary and middle schools by independent testing and objective standards, in comparison to nonprogram schools.

RESULTS:

• More positive attachment to family and school

• Boys less aggressive, girls less self-destructive

• Fewer suspensions and expulsions among low-achieving students

• Less drug-use initiation

• Less delinquency

• Better scores on standardized achievement tests

SOURCES: E. Schaps and V. Battistich, "Promoting Health Development Through School-Based Prevention: New Approaches," OSAP Prevention Monograph, no. 8: Preventing Adolescent Drug Use: From Theory to Practice. Eric Gopelrud (ed.), Rockville, MD: Office of Substance Abuse Prevention, U.S. Dept. of Health and Human Services, 1991.

J. D. Hawkins et al., "The Seattle Social Development Project," in J. McCord and R. Tremblay, eds., The Prevention of Antisocial Behavior in Children (New York: Guil-ford, 1992).

J. D. Hawkins, E. Von Cleve, and R. F. Catalano, "Reducing Early Childhood Aggression: Results of a Primary Prevention Program, "Journal of the American Academy of Child and Adolescent Psychiatry 30, 2 (1991), pp. 208-17.

J. A. O'Donnell, J. D. Hawkins, R. F. Catalano, R. D. Abbott, and L. E. Day, "Preventing School Failure, Drug Use, and Delinquency Among Low-Income Children: Effects of a Long-Term Prevention Project in Elementary Schools," American Journal of Ortho-psychiatry 65 (1994).

Yale-New Haven Social Competence Promotion Program

Roger Weissberg, University of Illinois at Chicago

Evaluated in New Haven Public Schools, grades 5-8, by independent observations and student and teacher reports, compared with control group.

RESULTS:

• Improved problem-solving skills

• More involvement with peers

• Better impulse control

• Improved behavior

• Improved interpersonal effectiveness and popularity

• Enhanced coping skills

• More skill in handling interpersonal problems

• Better coping with anxiety

• Less delinquent behaviors

• Better conflict-resolution skills

SOURCES: M. J. Elias and R. P. Weissberg, "School-Based Social Competence Promotion as a Primary Prevention Strategy: A Tale of Two Projects," Prevention in Human Services 7, 1 (1990), pp. 177-200.

M. Caplan, R. P. Weissberg, J. S. Grober, P. J. Sivo, K. Grady, and C. Jacoby, "Social Competence Promotion with Inner-City and Suburban Young Adolescents: Effects of Social Adjustment and Alcohol Use," Journal of Consulting and Clinical Psychology 60, 1 (1992), pp. 56-63.

Resolving Conflict Creatively Program

Linda Lantieri, National Center for Resolving Conflict Creatively Program (an initiative of Educators for Social Responsibility), New York City

Evaluated in New York City schools, grades K-12, by teachers' ratings, pre- and post-program.

RESULTS:

• Less violence in class

• Fewer verbal put-downs in class

• More-caring atmosphere

• More willingness to cooperate

• More empathy

• Improved communication skills

SOURCE: Metis Associates, Inc., The Resolving Conflict Creatively Program: 1988-1989. Summary of Significant Findings of RCCP New York Site (New York: Metis Associates, May 1990).

The Improving Social Awareness-Social Problem Solving Project

Maurice Elias, Rutgers University

Evaluated in New Jersey schools, grades K-6, by teacher ratings, peer assessments, and school records, compared to nonparticipants.

RESULTS:

• More sensitive to others' feelings

• Better understanding of the consequences of their behavior

• Increased ability to "size up" interpersonal situations and plan appropriate actions

• Higher self-esteem

• More prosocial behavior

• Sought out by peers for help

• Better handled the transition to middle school

• Less antisocial, self-destructive, and socially disordered behavior, even when followed up into high school

• Improved learning-to-learn skills

• Better self-control, social awareness, and social decision-making in and out of the classroom

SOURCES: M. J. Elias, M. A. Gara, T. R Schuyler, L. R. Branden-Muller, and M. A. Sayette, "The Promotion of Social Competence: Longitudinal Study of a Preventive School-Based Program," American Journal of Orthopsychiatry 61 (1991), pp. 409-17.

M. J. Elias and J. Clabby, Building Social Problem Solving Skills: Guidelines From a School-Based Program (San Francisco: Jossey-Bass, 1992).

 

 

Notes

PART ONE: THE EMOTIONAL BRAIN

Chapter 1. What Are Emotions For?

1. Associated Press, September 15, 1993.

2. The timelessness of this theme of selfless love is suggested by how pervasive it is in world myth: The Jataka tales, told throughout much of Asia for millennia, all narrate variations on such parables of self-sacrifice.

3. Altruistic love and human survival: The evolutionary theories that posit the adaptive advantages of altruism are well-summarized in Malcolm Slavin and Daniel Kriegman, The Adaptive Design of the Human Psyche (New York: Guilford Press, 1992).

4. Much of this discussion is based on Paul Ekman's key essay, "An Argument for Basic Emotions," Cognition and Emotion, 6, 1992, pp. 169-200. This point is from P. N. Johnson-Laird and K. Oatley's essay in the same issue of the journal.

5. The shooting of Matilda Crabtree: The New York Times, Nov. 11, 1994.

6. Only in adults: An observation by Paul Ekman, University of California at San Francisco.

7. Body changes in emotions and their evolutionary reasons: Some of the changes are documented in Robert W. Levenson, Paul Ekman, and Wallace V. Friesen, "Voluntary Facial Action Generates Emotion-Specific Autonomous Nervous System Activity," Psychophysiology, 27, 1990. This list is culled from there and other sources. At this point such a list remains speculative to a degree; there is scientific debate over the precise biological signature of each emotion, with some researchers taking the position that there is far more overlap than difference among emotions, or that our present ability to measure the biological correlates of emotion is too immature to distinguish among them reliably. For this debate see: Paul Ekman and Richard Davidson, eds., Fundamental Questions About Emotions (New York: Oxford University Press, 1994).

8. As Paul Ekman puts it, "Anger is the most dangerous emotion; some of the main problems destroying society these days involve anger run amok. It's the least adaptive emotion now because it mobilizes us to fight. Our emotions evolved when we didn't have the technology to act so powerfully on them. In prehistoric times, when you had an instantaneous rage and for a second wanted to kill someone, you couldn't do it very easily—but now you can."

9. Erasmus of Rotterdam, In Praise of Folly, trans. Eddie Radice (London: Penguin, 1971), p. 87.

10. Such basic responses defined what might pass for the "emotional life"—more aptly, an "instinct life"—of these species. More important in evolutionary terms, these are the decisions crucial to survival; those animals that could do them well, or well enough, survived to pass on their genes. In these early times, mental life was brutish: the senses and a simple repertoire of reactions to the stimuli they received got a lizard, frog, bird, or fish—and, perhaps, a brontosaurus—through the day. But this runt brain did not yet allow for what we think of as an emotion.

11. The limbic system and emotions: R. Joseph, "The Naked Neuron: Evolution and the Languages of the Brain and Body," New York: Plenum Publishing, 1993; Paul D. MacLean, The Triune Brain in Evolution (New York: Plenum, 1990).

12. Rhesus infants and adaptability: "Aspects of emotion conserved across species," Ned Kalin, M.D., Departments of Psychology and Psychiatry, University of Wisconsin, prepared for the MacArthur Affective Neuroscience Meeting, Nov., 1992.

Chapter 2. Anatomy of an Emotional Hijacking

1. The case of the man with no feelings was described by R. Joseph, op. cit. p. 83. On the other hand, there may be some vestiges of feeling in people who lack an amygdala (see Paul Ekman and Richard Davidson, eds., Questions About Emotion. New York: Oxford University Press, 1994). The different findings may hinge on exactly which parts of the amygdala and related circuits were missing; the last word on the detailed neurology of emotion is far from in.

2. Like many neuroscientists, LeDoux works at several levels, studying, for instance, how specific lesions in a rat's brain change its behavior; painstakingly tracing the path of single neurons; setting up elaborate experiments to condition fear in rats whose brains have been surgically altered. His findings, and others reviewed here, are at the frontier of exploration in neuroscience, and so remain somewhat speculative—particularly the implications that seem to flow from the raw data to an understanding of our emotional life. But LeDoux's work is supported by a growing body of converging evidence from a variety of neuroscientists who are steadily laying bare the neural underpinnings of emotions. See, for example, Joseph LeDoux, "Sensory Systems and Emotion," Integrative Psychiatry, 4, 1986; Joseph LeDoux, "Emotion and the Limbic System Concept," Concepts in Neuroscience, 2,1992.

3. The idea of the limbic system as the brain's emotional center was introduced by neurologist Paul MacLean more than forty years ago. In recent years discoveries like LeDoux's have refined the limbic system concept, showing that some of its central structures like the hippocampus are less directly involved in emotions, while circuits linking other parts of the brain—particularly the prefrontal lobes—to the amygdala are more central. Beyond that, there is a growing recognition that each emotion may call on distinct brain areas. The most current thinking is that there is not a neatly defined single "emotional brain," but rather several systems of circuits that disperse the regulation of a given emotion to farflung, but coordinated, parts of the brain. Neuroscientists speculate that when the full brain mapping of the emotions is accomplished, each major emotion will have its own topography, a distinct map of neuronal pathways determining its unique qualities, though many or most of these circuits are likely to be interlinked at key junctures in the limbic system, like the amygdala, and prefrontal cortex. See Joseph LeDoux, "Emotional Memory Systems in the Brain," Behavioral and Brain Research, 58,1993.

4. Brain circuitry of different levels of fear: This analysis is based on the excellent synthesis in Jerome Kagan, Galen's Prophecy (New York: Basic Books, 1994).

5. I wrote about Joseph LeDoux's research in The New York Times on August 15,1989. The discussion in this chapter is based on interviews with him, and several of his articles, including Joseph LeDoux, "Emotional Memory Systems in the Brain," Behavioural Brain Research, 58,1993; Joseph LeDoux, "Emotion, Memory and the Brain," Scientific American, June, 1994; Joseph LeDoux, "Emotion and the Limbic System Concept," Concepts in Neuroscience, 2, 1992.

6. Unconscious preferences: William Raft Kunst-Wilson and R. B. Zajonc, "Affective Discrimination of Stimuli That Cannot Be Recognized," Science (Feb. 1, 1980).

7. Unconscious opinion: John A. Bargh, "First Second: The Preconscious in Social Interactions," presented at the meeting of the American Psychological Society, Washington, DC (June 1994).

8. Emotional memory: Larry Cahill et al., "Beta-adrenergic activation and memory for emotional events," Nature (Oct. 20, 1994).

9. Psychoanalytic theory and brain maturation: the most detailed discussion of the early years and the emotional consequences of brain development is Allan Schore, Affect Regulation and the Origin of Self (Hillsdale, NJ: Lawrence Erlbaum Associates, 1994).

10. Dangerous, even if you don't know what it is: LeDoux, quoted in "How Scary Things Get That Way," Science (Nov. 6, 1992), p. 887.

11. Much of this speculation about the fine-tuning of emotional response by the neocortex comes from Ned Kalin, op. cit.

12. A closer look at the neuroanatomy shows how the prefrontal lobes act as emotional managers. Much evidence points to part of the prefrontal cortex as a site where most or all cortical circuits involved in an emotional reaction come together. In humans, the strongest connections between neocortex and amygdala run to the left prefrontal lobe and the temporal lobe below and to the side of the frontal lobe (the temporal lobe is critical in identifying what an object is). Both these connections are made in a single projection, suggesting a rapid and powerful pathway, a virtual neural highway. The single-neuron projection between the amygdala and prefrontal cortex runs to an area called the orbitofrontal cortex. This is the area that seems most critical for assessing emotional responses as we are in the midst of them and making mid-course corrections.

The orbitofrontal cortex both receives signals from the amygdala and has its own intricate, extensive web of projections throughout the limbic brain. Through this web it plays a role in regulating emotional responses—including inhibiting signals from the limbic brain as they reach other areas of the cortex, thus toning down the neural urgency of those signals. The orbitofrontal cortex's connections to the limbic brain are so extensive that some neuroanatomists have called it a kind of "limbic cortex"—the thinking part of the emotional brain. See Ned Kalin, Departments of Psychology and Psychiatry, University of Wisconsin, "Aspects of Emotion Conserved Across Species," an unpublished manuscript prepared for the MacArthur Affective Neuroscience Meeting, November, 1992; and Allan Schore, Affect Regulation and the Origin of Self (Hillsdale, NJ: Lawrence Erlbaum Associates, 1994).

There is not only a structural bridge between amygdala and prefrontal cortex, but, as always, a biochemical one: both the ventromedial section of the prefrontal cortex and the amygdala are especially high in concentrations of chemical receptors for the neurotransmitter serotonin. This brain chemical seems, among other things, to prime cooperation: monkeys with extremely high density of receptors for serotonin in the prefrontal-amygdala circuit are "socially well-tuned," while those with low concentrations are hostile and antagonistic. See Antonio Damosio, Descartes' Error (New York: Grosset/Putnam, 1994).

13. Animal studies show that when areas of the prefrontal lobes are lesioned, so that they no longer modulate emotional signals from the limbic area, the animals become erratic, impulsively and unpredictably exploding in rage or cringing in fear. A. R. Luria, the brilliant Russian neuropsychologist, proposed as long ago as the 1930s that the prefrontal cortex was key for self-control and constraining emotional outbursts; patients who had damage to this area, he noted, were impulsive and prone to flareups of fear and anger. And a study of two dozen men and women who had been convicted of impulsive, heat-of-passion murders found, using PET scans for brain imaging, that they had a much lower than usual level of activity in these same sections of the prefrontal cortex.

14. Some of the main work on lesioned lobes in rats was done by Victor Dermenberg, a psychologist at the University of Connecticut.

15. Left hemisphere lesions and joviality: G. Gianotti, "Emotional behavior and hemispheric side of lesion," Cortex, 8,1972.

16. The case of the happier stroke patient was reported by Mary K. Morris, of the Department of Neurology at the University of Florida, at the International Neuro-physiological Society Meeting, February 13-16,1991, in San Antonio.

17. Prefrontal cortex and working memory: Lynn D. Selemon et al., "Prefrontal Cortex," American Journal of Psychiatry, 152,1995.

18. Faulty frontal lobes: Philip Harden and Robert Pihl, "Cognitive Function, Cardiovascular Reactivity, and Behavior in Boys at High Risk for Alcoholism," Journal of Abnormal Psychology, 104,1995.

19. Prefrontal cortex: Antonio Damasio, Descartes' Error: Emotion, Reason and the Human Brain (New York: Grosset/Putnam, 1994).

PART TWO: THE NATURE OF EMOTIONAL INTELLIGENCE

Chapter 3. When Smart Is Dumb

1. Jason H.'s story was reported in "Warning by a Valedictorian Who Faced Prison," in The New York Times (June 23,1992).

2. One observer notes: Howard Gardner, "Cracking Open the IQ Box," The American Prospect, Winter 1995.

3. Richard Herrnstein and Charles Murray, The Bell Curve: Intelligence and Class Structure in American Life (New York: Free Press, 1994), p. 66.

4. George Vaillant, Adaptation to Life (Boston: Little, Brown, 1977). The average SAT score of the Harvard group was 584, on a scale where 800 is tops. Dr. Vaillant, now at Harvard University Medical School, told me about the relatively poor predictive value of test scores for life success in this group of advantaged men.

5. J. K. Felsman and G. E. Vaillant, "Resilient Children as Adults: A 40-Year Study," in E. J. Anderson and B. J. Cohler, eds., The Invulnerable Child (New York: Guilford Press, 1987).

6. Karen Arnold, who did the study of valedictorians with Terry Denny at the University of Illinois, was quoted in The Chicago Tribune (May 29,1992).

7. Project Spectrum: Principal colleagues of Gardner in developing Project Spectrum were Mara Krechevsky and David Feldman.

8. I interviewed Howard Gardner about his theory of multiple intelligences in "Rethinking the Value of Intelligence Tests," in The New York Times Education Supplement (Nov. 3,1986) and several times since.

9. The comparison of IQ tests and Spectrum abilities is reported in a chapter, coauthored with Mara Krechevsky, in Howard Gardner, Multiple Intelligences: The Theory in Practice (New York: Basic Books, 1993).

10. The nutshell summary is from Howard Gardner, Multiple Intelligences, p. 9.

11. Howard Gardner and Thomas Hatch, "Multiple Intelligences Go to School," Educational Researcher IS, 8 (1989).

12. The model of emotional intelligence was first proposed in Peter Salovey and John D. Mayer, "Emotional Intelligence," Imagination, Cognition, and Personality 9 (1990), pp. 185-211.

13. Practical intelligence and people skills: Robert J. Sternberg, Beyond I.Q. (New York: Cambridge University Press, 1985).

14. The basic definition of "emotional intelligence" is in Salovey and Mayer, "Emotional Intelligence," p. 189.

15. IQ vs. emotional intelligence: Jack Block, University of California at Berkeley, unpublished manuscript, February, 1995. Block uses the concept "ego resilience" rather than emotional intelligence, but notes that its main components include emotional self-regulation, an adaptive impulse control, a sense of self-efficacy, and social intelligence. Since these are main elements of emotional intelligence, ego resilience can be seen as a surrogate measure for emotional intelligence, much like SAT scores are for IQ. Block analyzed data from a longitudinal study of about a hundred men and women in their teen years and early twenties, and used statistical methods to assess the personality and behavioral correlates of high IQ independent of emotional intelligence, and emotional intelligence apart from IQ. There is, he finds, a modest correlation between IQ and ego resilience, but the two are independent constructs.

Chapter 4. Know Thyself

1. My usage of self-awareness refers to a self-reflexive, introspective attention to one's own experience, sometimes called mindfulness.

2. See also: Jon Kabat-Zinn, Wherever You Go, There You Are (New York: Hyperion, 1994).

3. The observing ego: An insightful comparison of the psychoanalyst's attentional stance and self-awareness appears in Mark Epstein's Thoughts Without a Thinker (New York: Basic Books, 1995). Epstein notes that if this ability is cultivated deeply, it can drop the self-consciousness of the observer and become a "more flexible and braver 'developed ego,' capable of embracing all of life."

4. William Styron, Darkness Visible: A Memoir of Madness (New York: Random House, 1990), p. 64.

5. John D. Mayer and Alexander Stevens, "An Emerging Understanding of the Reflective (Meta) Experience of Mood," unpublished manuscript (1993).

6. Mayer and Stevens, "An Emerging Understanding." Some of the terms for these emotional self-awareness styles are my own adaptations of their categories.

7. The intensity of emotions: Much of this work was done by or with Randy Larsen, a former graduate student of Diener's now at the University of Michigan.

8. Gary, the emotionally bland surgeon, is described in Hillel I. Swiller, "Alexithymia: Treatment Utilizing Combined Individual and Group Psychotherapy," International Journal for Group Psychotherapy 38, 1 (1988), pp. 47-61.

9. Emotional illiterate was the term used by M. B. Freedman and B. S. Sweet, "Some Specific Features of Group Psychotherapy," International Journal for Group Psychotherapy 4 (1954), pp. 335-68.

10. The clinical features of alexithymia are described in Graeme J. Taylor, "Alexithymia: History of the Concept," paper presented at the annual meeting of the American Psychiatric Association in Washington, DC (May 1986).

11. The description of alexithymia is from Peter Sifneos, "Affect, Emotional Conflict, and Deficit: An Overview," Psychotherapy-and-Psychosomatics 56 (1991), pp. 116-22.

12. The woman who did not know why she was crying is reported in H. Warnes, "Alexithymia, Clinical and Therapeutic Aspects," Psychotherapy-and-Psychosomatics 46 (1986), pp. 96-104.

13. Role of emotions in reasoning: Damasio, Descartes' Error.

14. Unconscious fear: The snake studies are described in Kagan, Galen's Prophecy.

Chapter 5. Passion's Slaves

1. For details on the ratio of positive to negative feelings and well-being, see Ed Diener and Randy J. Larsen, "The Experience of Emotional Well-Being," in Michael Lewis and Jeannette Haviland, eds., Handbook of Emotions (New York: Guilford Press, 1993).

2. I interviewed Diane Tice about her research on how well people shake off bad moods in December 1992. She published her findings on anger in a chapter she wrote with her husband, Roy Baumeister, in Daniel Wegner and James Pennebaker, eds., Handbook of Mental Control v. 5 (Englewood Cliffs, NJ: Prentice-Hall, 1993).

3. Bill collectors: also described in Arlie Hochschild, The Managed Heart (New York: Free Press, 1980).

4. The case against anger, and for self-control, is based largely on Diane Tice and Roy F. Baumeister, "Controlling Anger: Self-Induced Emotion Change," in Wegner and Pennebaker, Handbook of Mental Control. But see also Carol Tavris, Anger: The Misunderstood Emotion (New York: Touchstone, 1989).

5. The research on rage is described in Dolf Zillmann, "Mental Control of Angry Aggression," in Wegner and Pennebaker, Handbook of Mental Control.

6. The soothing walk: quoted in Tavris, Anger: The Misunderstood Emotion, p. 135.

7. Redford Williams's strategies for controlling hostility are detailed in Redford Williams and Virginia Williams, Anger Kills (New York: Times Books, 1993).

8. Venting anger does not dispel it: see, for example, S. K. Mallick and B. R. McCandless, "A Study of Catharsis Aggression," Journal of Personality and Social Psychology 4 (1966). For a summary of this research, see Tavris, Anger: The Misunderstood Emotion.

9. When lashing out in anger is effective: Tavris, Anger: The Misunderstood Emotion.

10. The work of worrying: Lizabeth Roemer and Thomas Borkovec, "Worry: Unwanted Cognitive Activity That Controls Unwanted Somatic Experience," in Wegner and Pennebaker, Handbook of Mental Control.

11. Fear of germs: David Riggs and Edna Foa, "Obsessive-Compulsive Disorder," in David Barlow, ed., Clinical Handbook of Psychological Disorders (New York: Guilford Press, 1993).

12. The worried patient was quoted in Roemer and Borkovec, "Worry," p. 221.

13. Therapies for anxiety disorder: see, for example, David H. Barlow, ed., Clinical Handbook of Psychological Disorders (New York: Guilford Press, 1993).

14. Styron's depression: William Styron, Darkness Visible: A Memoir of Madness (New York: Random House, 1990).

15. The worries of the depressed are reported in Susan Nolen-Hoeksma, "Sex Differences in Control of Depression," in Wegner and Pennebaker, Handbook of Mental Control, p. 307.

16. Therapy for depression: K. S. Dobson, "A Meta-analysis of the Efficacy of Cognitive Therapy for Depression," Journal of Consulting and Clinical Psychology 57 (1989).

17. The study of depressed people's thought patterns is reported in Richard Wenzlaff, "The Mental Control of Depression," in Wegner and Pennebaker, Handbook of Mental Control.

18. Shelley Taylor et al., "Maintaining Positive Illusions in the Face of Negative Information," Journal of Clinical and Social Psychology 8 (1989).

19. The repressing college student is from Daniel A. Weinberger, "The Construct Validity of the Repressive Coping Style," in J. L. Singer, ed., Repression and Dissociation (Chicago: University of Chicago Press, 1990). Weinberger, who developed the concept of repressors in early studies with Gary F. Schwartz and Richard Davidson, has become the leading researcher on the topic.

Chapter 6. The Master Aptitude

1. The terror of the exam: Daniel Goleman, Vital Lies, Simple Truths: The Psychology of Self-Deception (New York: Simon and Schuster, 1985).

2. Working memory: Alan Baddeley, Working Memory (Oxford: Clarendon Press, 1986).

3. Prefrontal cortex and working memory: Patricia Goldman-Rakic, "Cellular and Circuit Basis of Working Memory in Prefrontal Cortex of Nonhuman Primates," Progress in Brain Research, 85, 1990; Daniel Weinberger, "A Connectionist Approach to the Prefrontal Cortex," Journal of Neuropsychiatry 5 (1993).

4. Motivation and elite performance: Anders Ericsson, "Expert Performance: Its Structure and Acquisition," American Psychologist (Aug. 1994).

5. Asian IQ advantage: Herrnstein and Murray, The Bell Curve.

6. IQ and occupation of Asian-Americans: James Flynn, Asian-American Achievement Beyond IQ (New Jersey: Lawrence Erlbaum, 1991).

7. The study of delay of gratification in four-year-olds was reported in Yuichi Shoda, Walter Mischel, and Philip K. Peake, "Predicting Adolescent Cognitive and Self-regulatory Competencies From Preschool Delay of Gratification," Developmental Psychology, 26, 6 (1990), pp. 978-86.

8. SAT scores of impulsive and self-controlled children: The analysis of SAT data was done by Phil Peake, a psychologist at Smith College.

9. IQ vs. delay as predictors of SAT scores: personal communication from Phil Peake, psychologist at Smith College, who analyzed the SAT data in Walter Mischel's study of delay of gratification.

10. Impulsivity and delinquency: See the discussion in: Jack Block, "On the Relation Between IQ, Impulsivity, and Delinquency," Journal of Abnormal Psychology 104 (1995).

11. The worried mother: Timothy A. Brown et al., "Generalized Anxiety Disorder," in David H. Barlow, ed., Clinical Handbook of Psychological Disorders (New York: Guilford Press, 1993).

12. Air traffic controllers and anxiety: W. E. Collins et al., "Relationships of Anxiety Scores to Academy and Field Training Performance of Air Traffic Control Specialists," FAA Office of Aviation Medicine Reports (May 1989).

13. Anxiety and academic performance: Bettina Seipp, "Anxiety and Academic Performance: A Meta-analysis," Anxiety Research 4, 1 (1991).

14. Worriers: Richard Metzger et al., "Worry Changes Decision-making: The Effects of Negative Thoughts on Cognitive Processing," Journal of Clinical Psychology (Jan. 1990).

15. Ralph Haber and Richard Alpert, "Test Anxiety," Journal of Abnormal and Social Psychology 13 (1958).

16. Anxious students: Theodore Chapin, "The Relationship of Trait Anxiety and Academic Performance to Achievement Anxiety," Journal of College Student Development (May 1989).

17. Negative thoughts and test scores: John Hunsley, "Internal Dialogue During Academic Examinations," Cognitive Therapy and Research (Dec. 1987).

18. The internists given a gift of candy: Alice Isen et al., "The Influence of Positive Affect on Clinical Problem Solving," Medical Decision Making (July-Sept. 1991).

19. Hope and a bad grade: C. R. Snyder et al., "The Will and the Ways: Development and Validation of an Individual-Differences Measure of Hope," Journal of Personality and Social Psychology 60, 4 (1991), p. 579.

20. I interviewed C. R. Snyder in The New York Times (Dec. 24, 1991).

21. Optimistic swimmers: Martin Seligman, Learned Optimism (New York: Knopf, 1991).

22. A realistic vs. naive optimism: see, for example, Carol Whalen et al., "Optimism in Children's Judgments of Health and Environmental Risks," Health Psychology 13 (1994).

23. I interviewed Martin Seligman about optimism in The New York Times (Feb. 3,1987).

24. I interviewed Albert Bandura about self-efficacy in The New York Times(Mzy 8,1988).

25. Mihaly Csikszentmihalyi, "Play and Intrinsic Rewards," Journal of Humanistic Psychology 15, 3 (1975).

26. Mihaly Csikszentmihalyi, Flow: The Psychology of Optimal Experience, 1st ed. (New York: Harper and Row, 1990).

27. "Like a waterfall": Newsweek (Feb. 28, 1994).

28. I interviewed Dr. Csikszentmihalyi in The New York Times (Mar. 4, 1986).

29. The brain in flow: Jean Hamilton et al., "Intrinsic Enjoyment and Boredom Coping Scales: Validation With Personality, Evoked Potential and Attention Measures," Personality and Individual Differences 5, 2 (1984).

30. Cortical activation and fatigue: Ernest Hartmann, The Functions of Sleep (New Haven: Yale University Press, 1973).

31. I interviewed Dr. Csikszentmihalyi in The New York Times (MM. 22, 1992).

32. The study of flow and math students: Jeanne Nakamura, "Optimal Experience and the Uses of Talent," in Mihaly Csikszentmihalyi and Isabella Csikszentmihalyi, Optimal Experience: Psychological Studies of Flow in Consciousness (Cambridge: Cambridge University Press, 1988).

Chapter 7. The Roots of Empathy

1. Self-awareness and empathy: see, for example, John Mayer and Melissa Kirkpatrick, "Hot Information-Processing Becomes More Accurate With Open Emotional Experience," University of New Hampshire, unpublished manuscript (Oct. 1994); Randy Larsen et al., "Cognitive Operations Associated With Individual Differences in Affect Intensity," Journal of Personality and Social Psychology 53 (1987).

2. Robert Rosenthal et al., "The PONS Test: Measuring Sensitivity to Nonverbal Cues," in P. McReynolds, ed., Advances in Psychological Assessment (San Francisco: Jossey-Bass, 1977).

3. Stephen Nowicki and Marshall Duke, "A Measure of Nonverbal Social Processing Ability in Children Between the Ages of 6 and 10," paper presented at the American Psychological Society meeting (1989).

4. The mothers who acted as researchers were trained by Marian Radke-Yarrow and Carolyn Zahn-Waxler at the Laboratory of Developmental Psychology, National Institute of Mental Health.

5. I wrote about empathy, its developmental roots, and its neurology in The New York Times (Mar. 28, 1989).

6. Instilling empathy in children: Marian Radke-Yarrow and Carolyn Zahn-Waxler, "Roots, Motives and Patterns in Children's Prosocial Behavior," in Ervin Staub et al., eds., Development and Maintenance of Prosocial Behavior (New York: Plenum, 1984).

7. Daniel Stern, The Interpersonal World of the Infant (New York: Basic Books, 1987), p. 30.

8. Stern, op. cit.

9. The depressed infants are described in Jeffrey Pickens and Tiffany Field, "Facial Expressivity in Infants of Depressed Mothers," Developmental Psychology 29, 6 (1993).

10. The study of violent rapists' childhoods was done by Robert Prentky, a psychologist in Philadelphia.

11. Empathy in borderline patients: "Giftedness and Psychological Abuse in Borderline Personality Disorder: Their Relevance to Genesis and Treatment," Journal of Personality Disorders 6 (1992).

12. Leslie Brothers, "A Biological Perspective on Empathy," American Journal of Psychiatry 146, 1 (1989).

13. Brothers, "A Biological Perspective," p. 16.

14. Physiology of empathy: Robert Levenson and Anna Ruef, "Empathy: A Physiological Substrate," Journal of Personality and Social Psychology 63, 2 (1992).

15. Martin L. Hoffman, "Empathy, Social Cognition, and Moral Action," in W. Kurtines and J. Gerwitz, eds., Moral Behavior and Development: Advances in Theory, Research, and Applications (New York: John Wiley and Sons, 1984).

16. Studies of the link between empathy and ethics are in Hoffman, "Empathy, Social Cognition, and Moral Action."

17. I wrote about the emotional cycle that culminates in sex crimes in The New York Times (Apr. 14, 1992). The source is William Pithers, a psychologist with the Vermont Department of Corrections.

18. The nature of psychopathy is described in more detail in an article I wrote in The New York Times on July 7,1987. Much of what I write here comes from the work of Robert Hare, a psychologist at the University of British Columbia, an expert on psychopaths.

19. Leon Bing, Do or Die (New York: HarperCollins, 1991).

20. Wife batterers: Neil S. Jacobson et al., "Affect, Verbal Content, and Psychophysiology in the Arguments of Couples With a Violent Husband," Journal of Clinical and Consulting Psychology (July 1994).

21. Psychopaths have no fear—the effect is seen as criminal psychopaths are about to receive a shock: One of the more recent replications of the effect is Christopher Patrick et al., "Emotion in the Criminal Psychopath: Fear Image Processing," Journal of Abnormal Psychology 103 (1994).

Chapter 8. The Social Arts

1. The exchange between Jay and Len was reported by Judy Dunn and Jane Brown in "Relationships, Talk About Feelings, and the Development of Affect Regulation in Early Childhood," Judy Garber and Kenneth A. Dodge, eds., The Development of Emotion Regulation and Dysregulation (Cambridge: Cambridge University Press, 1991). The dramatic flourishes are my own.

2. The display rules are in Paul Ekman and Wallace Friesen, Unmasking the Face (Englewood Cliffs, NJ: Prentice Hall, 1975).

3. Monks in the heat of battle: the story is told by David Busch in "Culture Cul-de-Sac," Arizona State University Research (Spring/Summer 1994).

4. The study of mood transfer was reported by Ellen Sullins in the April 1991 issue of the Personality and Social Psychology Bulletin.

5. The studies of mood transmission and synchrony are by Frank Bernieri, a psychologist at Oregon State University; I wrote about his work in The New York Times. Much of his research is reported in Bernieri and Robert Rosenthal, "Interpersonal Coordination, Behavior Matching, and Interpersonal Synchrony," in Robert Feldman and Bernard Rime, eds., Fundamentals of Nonverbal Behavior (Cambridge: Cambridge University Press, 1991).

6. The entrainment theory is proposed by Bernieri and Rosenthal, Fundamentals of Nonverbal Behavior.

7. Thomas Hatch, "Social Intelligence in Young Children," paper delivered at the annual meeting of the American Psychological Association (1990).

8. Social chameleons: Mark Snyder, "Impression Management: The Self in Social Interaction," in L. S. Wrightsman and K. Deaux, Social Psychology in the '80s (Monterey, CA: Brooks/Cole, 1981).

9. E. Lakin Phillips, The Social Skills Basis of Psychopathology (New York: Grune and Stratton, 1978), p. 140.

10. Nonverbal learning disorders: Stephen Nowicki and Marshall Duke, Helping the Child Who Doesn't Fit In (Atlanta: Peachtree Publishers, 1992). See also Byron Rourke, Nonverbal Learning Disabilities (New York: Guilford Press, 1989).

11. Nowicki and Duke, Helping the Child Who Doesn't Fit In.

12. This vignette, and the review of research on entering a group, is from Martha Putallaz and Aviva Wasserman, "Children's Entry Behavior," in Steven Asher and John Coie, eds., Peer Rejection in Childhood (New York: Cambridge University Press, 1990).

13. Putallaz and Wasserman, "Children's Entry Behavior."

14. Hatch, "Social Intelligence in Young Children."

15. Terry Dobson's tale of the Japanese drunk and the old man is used by permission of Dobson's estate. It is also retold by Ram Dass and Paul Gorman, How Can I Help? (New York: Alfred A. Knopf, 1985), pp. 167-71.

PART THREE: EMOTIONAL INTELLIGENCE APPLIED

Chapter 9. Intimate Enemies

1. There are many ways to calculate the divorce rate, and the statistical means used will determine the outcome. Some methods show the divorce rate peaking at around 50 percent and then dipping a bit. When divorces are calculated by the total number in a given year, the rate appears to have peaked in the 1980s. But the statistics I cite here calculate not the number of divorces that occur in a given year, but rather the odds that a couple marrying in a given year will eventually have their marriage end in divorce. That statistic shows a climbing rate of divorce over the last century. For more detail: John Gottman, What Predicts Divorce: The Relationship Between Marital Processes and Marital Outcomes (Hillsdale, NJ: Lawrence Erlbaum Associates, Inc., 1993).

2. The separate worlds of boys and girls: Eleanor Maccoby and C. N. Jacklin, "Gender Segregation in Childhood," in H. Reese, ed., Advances in Child Development and Behavior (New York: Academic Press, 1987).

3. Same-sex playmates: John Gottman, "Same and Cross Sex Friendship in Young Children," in J. Gottman and J. Parker, eds., Conversation of Friends (New York: Cambridge University Press, 1986).

4. This and the following summary of sex differences in socialization of emotions are based on the excellent review in Leslie R. Brody and Judith A. Hall, "Gender and Emotion," in Michael Lewis and Jeannette Haviland, eds., Handbook of Emotions (New York: Guilford Press, 1993).

5. Brody and Hall, "Gender and Emotion," p. 456.

6. Girls and the arts of aggression: Robert B. Cairns and Beverley D. Cairns, Lifelines and Risks (New York: Cambridge University Press, 1994).

7. Brody and Hall, "Gender and Emotion," p. 454.

8. The findings about gender differences in emotion are reviewed in Brody and Hall, "Gender and Emotion."

9. The importance of good communication for women was reported in Mark H. Davis and H. Alan Oathout, "Maintenance of Satisfaction in Romantic Relationships: Empathy and Relational Competence," Journal of Personality and Social Psychology 53, 2 (1987), pp. 397-410.

10. The study of husbands' and wives' complaints: Robert J. Sternberg, "Triangulating Love," in Robert Sternberg and Michael Barnes, eds., The Psychology of Love (New Haven: Yale University Press, 1988).

11. Reading sad faces: The research is by Dr. Ruben C. Gur at the University of Pennsylvania School of Medicine.

12. The exchange between Fred and Ingrid is from Gottman, What Predicts Divorce, p. 84.

13. The marital research by John Gottman and colleagues at the University of Washington is described in more detail in two books: John Gottman, Why Marriages Succeed or Fail (New York: Simon and Schuster, 1994), and What Predicts Divorce.

14. Stonewalling: Gottman, What Predicts Divorce.

15. Poisonous thoughts: Aaron Beck, Love Is Never Enough (New York: Harper and Row, 1988), pp. 145-46.

16. Thoughts in troubled marriages: Gottman, What Predicts Divorce.

17. The distorted thinking of violent husbands is described in Amy Holtzworth-Munroe and Glenn Hutchinson, "Attributing Negative Intent to Wife Behavior: The Attributions of Maritally Violent Versus Nonviolent Men," Journal of Abnormal Psychology 102, 2 (1993), pp. 206-11. The suspiciousness of sexually aggressive men: Neil Malamuth and Lisa Brown, "Sexually Aggressive Men's Perceptions of Women's Communications," Journal of Personality and Social Psychology 67 (1994).

18. Battering husbands: There are three kinds of husbands who become violent: those who rarely do, those who do so impulsively when they get angered, and those who do so in a cool, calculated manner. Therapy seems helpful only with the first two kinds. See Neil Jacobson et al., Clinical Handbook of Marital Therapy (New York: Guilford Press, 1994).

19. Flooding: Gottman, What Predicts Divorce.

20. Husbands dislike squabbles: Robert Levenson et al., "The Influence of Age and Gender on Affect, Physiology, and Their Interrelations: A Study of Long-term Marriages," Journal of Personality and Social Psychology 67 (1994).

21. Flooding in husbands: Gottman, What Predicts Divorce.

22. Men stonewall, women criticize: Gottman, What Predicts Divorce.

23. "Wife Charged with Shooting Husband Over Football on TV," The New York Times (Nov. 3, 1993).

24. Productive marital fights: Gottman, What Predicts Divorce.

25. Lack of repair abilities in couples: Gottman, What Predicts Divorce.

26. The four steps that lead to "goodfights" are from Gottman, Why Marriages Succeed or Fail.

27. Monitoring pulse rate: Gottman, Ibid.

28. Catching automatic thoughts: Beck, Love Is Never Enough.

29. Mirroring: Harville Hendrix, Getting the Love You Want (New York: Henry Holt, 1988).

Chapter 10. Managing With Heart

1. The crash of the intimidating pilot: Carl Lavin, "When Moods Affect Safety: Communications in a Cockpit Mean a Lot a Few Miles Up," The New York Times (June 26, 1994).

2. The survey of 250 executives: Michael Maccoby, "The Corporate Climber Has to Find His Heart," Fortune (Dec. 1976).

3. Zuboff: in conversation, June 1994. For the impact of information technologies, see her book In the Age of the Smart Machine (New York: Basic Books, 1991).

4. The story of the sarcastic vice president was told to me by Hendrie Weisinger, a psychologist at the UCLA Graduate School of Business. His book is The Critical Edge: How to Criticize Up and Down the Organization and Make It Pay Off "(Boston: Little, Brown, 1989).

5. The survey of times managers blew up was done by Robert Baron, a psychologist at Rensselaer Polytechnic Institute, whom I interviewed for The New York Times (Sept. 11, 1990).

6. Criticism as a cause of conflict: Robert Baron, "Countering the Effects of Destructive Criticism: The Relative Efficacy of Four Interventions," Journal of Applied Psychology 75, 3 (1990).

7. Specific and vague criticism: Harry Levinson, "Feedback to Subordinates" Addendum to the Levinson Letter, Levinson Institute, Waltham, MA (1992).

8. Changing face of workforce: A survey of 645 national companies by Towers Perrin management consultants in Manhattan, reported in The New York Times (Aug. 26, 1990).

9. The roots of hatred: Vamik Volkan, The Need to Have Enemies and Allies (Northvale, NJ: Jason Aronson, 1988).

10. Thomas Pettigrew: I interviewed Pettigrew in The New York Times (May 12, 1987).

11. Stereotypes and subtle bias: Samuel Gaertner and John Davidio, Prejudice, Discrimination, and Racism (New York: Academic Press, 1987).

12. Subtle bias: Gaertner and Davidio, Prejudice, Discrimination, and Racism.

13. Relman: quoted in Howard Kohn, "Service With a Sneer," The New York Times Sunday Magazine (Now. 11, 1994).

14. IBM: "Responding to a Diverse Work Force," The New York Times (Aug. 26, 1990).

15. Power of speaking out: Fletcher Blanchard, "Reducing the Expression of Racial Prejudice," Psychological Science (vol. 2,1991).

16. Stereotypes break down: Gaertner and Davidio, Prejudice, Discrimination, and Racism.

17. Teams: Peter Drucker, "The Age of Social Transformation," The Atlantic Monthly (Nov. 1994).

18. The concept of group intelligence is set forth in Wendy Williams and Robert Sternberg, "Group Intelligence: Why Some Groups Are Better Than Others," Intelligence (1988).

19. The study of the stars at Bell Labs was reported in Robert Kelley and Janet Caplan, "How Bell Labs Creates Star Performers," Harvard Business Review (July-Aug. 1993).

20. The usefulness of informal networks is noted by David Krackhardt and Jeffrey R. Hanson, "Informal Networks: The Company Behind the Chart," Harvard Business Review (July-Aug. 1993), p. 104.

Chapter 11. Mind and Medicine

1. Immune system as the body's brain: Francisco Varela at the Third Mind and Life meeting, Dharamsala, India (Dec. 1990).

2. Chemical messengers between brain and immune system: see Robert Ader et al., Psychoneuroimmunology, 2nd edition (San Diego: Academic Press, 1990).

3. Contact between nerves and immune cells: David Felten et al., "Noradrenergic Sympathetic Innervation of Lymphoid Tissue," Journal of Immunology 135 (1985).

4. Hormones and immune function: B. S. Rabin et al., "Bidirectional Interaction Between the Central Nervous System and the Immune System," Critical Reviews in Immunology 9 (4), (1989), pp. 279-312.

5. Connections between brain and immune system: see, for example, Steven B. Maier et al., "Psychoneuroimmunology," American Psychologist (Dec. 1994).

6. Toxic emotions: Howard Friedman and S. Boothby-Kewley, "The Disease-Prone Personality: A Meta-Analytic View," American Psychologist 42 (1987). This broad analysis of studies used "meta-analysis," in which results from many smaller studies can be combined statistically into one immense study. This allows effects that might not show up in any given study to be detected more easily because of the much larger total number of people being studied.

7. Skeptics argue that the emotional picture linked to higher rates of disease is the profile of the quintessential neurotic—an anxious, depressed, and angry emotional wreck—and that the higher rates of disease they report are due not so much to a medical fact as to a propensity to whine and complain about health problems, exaggerating their seriousness. But Friedman and others argue that the weight of evidence for the emotion-disease link is borne by research in which it is physicians' evaluations of observable signs of illness and medical tests, not patients' complaints, that determine the level of sickness—a more objective basis. Of course, there is the possibility that increased distress is the result of a medical condition, as well as precipitating it; for that reason the most convincing data come from prospective studies in which emotional states are evaluated prior to the onset of disease.

8. Gail Ironson et al., "Effects of Anger on Left Ventricular Ejection Fraction in Coronary Artery Disease," The American Journal of Cardiology 10 1992. Pumping efficiency, sometimes referred to as the "ejection fraction," quantifies the heart's ability to pump blood out of the left ventricle into the arteries; it measures the percentage of blood pumped out of the ventricles with each beat of the heart. In heart disease the drop in pumping efficiency means a weakening of the heart muscle.

9. Of the dozen or so studies of hostility and death from heart disease, some have failed to find a link. But that failure may be due to differences in method, such as using a poor measure of hostility, and to the relative subdety of the effect. For instance, the greatest number of deaths from the hostility effect seem to occur in midlife. If a study fails to track down the causes of death for people during this period, it misses the effect.

10. Hostility and heart disease: Redford Williams, The Trusting Heart (New York: Times Books/Random House, 1989).

11. Peter Kaufman: I interviewed Dr. Kaufman in The New York Times (Sept. 1, 1992).

12. Stanford study of anger and second heart attacks: Carl Thoreson, presented at the International Congress of Behavioral Medicine, Uppsala, Sweden (July 1990).

13. Lynda H. Powell, Emotional Arousal as a Predictor of Long-Term Mortality and Morbidity in Post M.I. Men," Circulation, vol. 82, no. 4, Supplement III, Oct. 1990.

14. Murray A. Mittleman, "Triggering of Myocardial Infarction Onset by Episodes of Anger," Circulation, vol. 89, no. 2 (1994).

15. Suppressing anger raises blood pressure: Robert Levenson, "Can We Control Our Emotions, and How Does Such Control Change an Emotional Episode?" in Richard Davidson and Paul Ekman, eds., Fundamental Questions About Emotions (New York: Oxford University Press, 1995).

16. The angry personal style: I wrote about Redford Williams's research on anger and the heart in The New York Times Good Health Magazine (Kpx. 16, 1989).

17. A 44 percent reduction in second heart attacks: Thoreson, op. cit.

18. Dr. Williams's program for anger control: Williams, The Trusting Heart.

19. The worried woman: Timothy Brown et al., "Generalized Anxiety Disorder," in David H. Barlow, ed., Clinical Handbook of Psychological Disorders (New York: Guilford Press, 1993).

20. Stress and metastasis: Bruce McEwen and Eliot Stellar, "Stress and the Individual: Mechanisms Leading to Disease," Archives of Internal Medicine 153 (Sept. 27,1993). The study they are describing is M. Robertson and J. Ritz, "Biology and Clinical Relevance of Human Natural Killer Cells," Blood 76 (1990).

21. There may be multiple reasons why people under stress are more vulnerable to sickness, apart from biological pathways. One might be that the ways people try to soothe their anxiety—for example, smoking, drinking, or bingeing on fatty foods—are in themselves unhealthy. Still another is that constant worry and anxiety can make people lose sleep or forget to comply with medical regimens—such as taking medications—and so prolong illnesses they already have. Most likely, all of these work in tandem to link stress and disease.

22. Stress weakens the immune system: For instance, in the study of medical students facing exam stress, the students had not only a lowered immune control of the herpes virus, but also a decline in the ability of their white blood cells to kill infected cells, as well as an increase in levels of a chemical associated with suppression of immune abilities in lymphocytes, the white blood cells central to the immune response. See Ronald Glaser and Janice Kiecolt-Glaser, "Stress-Associated Depression in Cellular Immunity," Brain, Behavior, and Immunity 1 (1987). But in most such studies showing a weakening of immune defenses with stress, it has not been clear that these levels were low enough to lead to medical risk.

23. Stress and colds: Sheldon Cohen et al, "Psychological Stress and Susceptibility to the Common Cold," New England Journal of Medicine 325 (1991).

24. Daily upsets and infection: Arthur Stone et al., "Secretory IgA as a Measure of Immunocompetence," Journal of Human Stress 13 (1987). In another study, 246 husbands, wives, and children kept daily logs of stresses in their family's life over the course of the flu season. Those who had the most family crises also had the highest rate of flu, as measured both by days with fever and flu antibody levels. See R. D. Clover et al., "Family Functioning and Stress as Predictors of Influenza B Infection," Journal of Family Practice 28 (May 1989).

25. Herpes virus flare-up and stress: a series of studies by Ronald Glaser and Janice Kiecolt-Glaser—e.g., "Psychological Influences on Immunity," American Psychologist A3 (1988). The relationship between stress and herpes activity is so strong that it has been demonstrated in a study of only ten patients, using the actual breaking-out of herpes sores as a measure; the more anxiety, hassles, and stress reported by the patients, the more likely they were to have herpes outbreaks in the following weeks; placid periods in their lives led to dormancy of the herpes. See H. E. Schmidt et al., "Stress as a Precipitating Factor in Subjects With Recurrent Herpes Labialis,"Journal " of Family Practice, 20 (1985).

26. Anxiety in women and heart disease: Carl Thoreson, presented at the International Congress of Behavioral Medicine, Uppsala, Sweden (July 1990). Anxiety may also play a role in making some men more vulnerable to heart disease. In a study at the University of Alabama medical school, 1,123 men and women between the ages of forty-five and seventy-seven were assessed on their emotional profiles. Those men most prone to anxiety and worry in middle age were far more likely than others to have hypertension when tracked down twenty years later. See Abraham Markowitz et al., Journal of the American Medical Association (Nov. 14, 1993).

27. Stress and colorectal cancer: Joseph C. Courtney et al., "Stressful Life Events and the Risk of Colorectal Cancer," Epidemiology (Sept. 1993), 4(5).

28. Relaxation to counter stress-based symptoms: See, for example, Daniel Goleman and Joel Gurin, Mind Body Medicine (New York: Consumer Reports Books/St. Martin's Press, 1993).

29. Depression and disease: see, e.g., Seymour Reichlin, "Neuroendocrine-Immune Interactions," New England Journal of Medicine (Oct. 21, 1993).

30. Bone marrow transplant: cited in James Strain, "Cost Offset From a Psychiatric Consultation-Liaison Intervention With Elderly Hip Fracture Patients," American Journal of Psychiatry 148 (1991).

31. Howard Burton et al., "The Relationship of Depression to Survival in Chronic Renal Failure," Psychosomatic Medicine (March 1986).

32. Hopelessness and death from heart disease: Robert Anda et al., "Depressed Affect, Hopelessness, and the Risk of Ischemic Heart Disease in a Cohort of U.S. Adults," Epidemiology (July 1993).

33. Depression and heart attack: Nancy Frasure-Smith et al., "Depression Following Myocardial Infarction," Journal of the American Medical Association (Oct. 20,1993).

34. Depression in multiple illness: Dr. Michael von Korff, the University of Washington psychiatrist who did the study, pointed out to me that with such patients, who face tremendous challenges just in living from day to day, "If you treat a patient's depression, you see improvements over and above any changes in their medical condition. If you're depressed, your symptoms seem worse to you. Having a chronic physical disease is a major adaptive challenge. If you're depressed, you're less able to learn to take care of your illness. Even with physical impairment, if you're motivated and have energy and feelings of self-worth—all of which are at risk in depression—then people can adapt remarkably even to severe impairments."

35. Optimism and bypass surgery: Chris Peterson et al., Learned Helplessness: A Theory for the Age of Personal Control (New York: Oxford University Press, 1993).

36. Spinal injury and hope: Timothy Elliott et al., "Negotiating Reality After Physical Loss: Hope, Depression, and Disability," Journal of Personality and Social Psychology 61, 4 (1991).

37. Medical risk of social isolation: James House et al., "Social Relationships and Health," ScienceQuly 29,1988). But also see a mixed finding: Carol Smith et al., "Meta-Analysis of the Associations Between Social Support and Health Outcomes," Journal of Behavioral Medicine (1994).

38. Isolation and mortality risk: Other studies suggest a biological mechanism at work. These findings, cited in House, "Social Relationships and Health," have found that the simple presence of another person can reduce anxiety and lessen physiological distress in people in intensive-care units. The comforting effect of another person's presence has been found to lower not just heart rate and blood pressure, but also the secretion of fatty acids that can block arteries. One theory put forward to explain the healing effects of social contact suggests a brain mechanism at work. This theory points to animal data showing a calming effect on the posterior hypothalamic zone, an area of the limbic system with rich connections to the amygdala. The comforting presence of another person, this view holds, inhibits limbic activity, lowering the rate of secretion of acetylcholine, cortisol, and catecholamines, all neurochemicals that trigger more rapid breathing, a quickened heartbeat, and other physiological signs of stress.

39. Strain, "Cost Offset."

40. Heart attack survival and emotional support: Lisa Berkman et al., "Emotional Support and Survival After Myocardial Infarction, A Prospective Population Based Study of the Elderly," Annals of Internal Medicine (Dec. 15, 1992).

41. The Swedish study: Annika Rosengren et al., "Stressful Life Events, Social Support, and Mortality in Men Born in 1933," British Medical Journal (Oct. 19, 1993).

42. Marital arguments and immune system: Janice Kiecolt-Glaser et al., "Marital Quality, Marital Disruption, and Immune Function," Psychosomatic Medicine 49 (1987).

43. I interviewed John Cacioppo for The New York Times (Dec. 15, 1992).

44. Talking about troubling thoughts: James Pennebaker, "Putting Stress Into Words: Health, Linguistic and Therapeutic Implications," paper presented at the American Psychological Association meeting, Washington, DC (1992).

45. Psychotherapy and medical improvements: Lester Luborsky et al., "Is Psychotherapy Good for Your Health?" paper presented at the American Psychological Association meeting, Washington, DC (1993).

46. Cancer support groups: David Spiegel et al., "Effect of Psychosocial Treatment on Survival of Patients with Metastatic Breast Cancer," Lancet No. 8668, ii (1989).

47. Patients' questions: The finding was cited by Dr. Steven Cohen-Cole, a psychiatrist at Emory University, when I interviewed him in The New York Times (Nov. 13, 1991).

48. Full information: For example, the Planetree program at Pacific Presbyterian Hospital in San Francisco will do searches of medical and lay research on any medical topic for anyone who requests it.

49. Making patients effective: One program has been developed by Dr. Mack Lipkin, Jr., at New York University Medical School.

50. Emotional preparation for surgery: I wrote about this in The New York Times (Dec. 10, 1987).

51. Family care in the hospital: Again, Planetree is a model, as are the Ronald McDonald houses that allow parents to stay next door to hospitals where their children are patients.

52. Mindfulness and medicine: See Jon Kabat-Zinn, Full Catastrophe Living (New York: Delacorte, 1991).

53. Program for reversing heart disease: See Dean Ornish, Dr. Dean Ornish's Program for Reversing Heart Disease (New York: Ballantine, 1991).

54. Relationship-centered medicine: Health Professions Education and Relationship-Centered Care. Report of the Pew-Fetzer Task Force on Advancing Psychosocial Health Education, Pew Health Professions Commission and Fetzer Institute at The Center of Health Professions, University of California at San Francisco, San Francisco (Aug. 1994).

55. Left the hospital early: Strain, "Cost Offset."

56. Unethical not to treat depression in heart disease patients: Redford Williams and Margaret Chesney, "Psychosocial Factors and Prognosis in Established Coronary Heart Disease," Journal of the American Medical Association (Oct. 20,1993).

57. An open letter to a surgeon: A. Stanley Kramer, "A Prescription for Healing," Newsweek (June 7,1993).

PART FOUR: WINDOWS Of OPPORTUNITY

Chapter 12. The Family Crucible

1. Leslie and the video game: Beverly Wilson and John Gottman, "Marital Conflict and Parenting: The Role of Negativity in Families," in M. H. Bornstein, ed., Handbook of Parenting, vol. 4 (Hillsdale, NJ: Lawrence Erlbaum, 1994).

2. The research on emotions in the family was an extension of John Gottman's marital studies reviewed in Chapter 9. See Carole Hooven, Lynn Katz, and John Gottman, "The Family as a Meta-emotion Culture," Cognition and Emotion (Spring 1994).

3. The benefits for children of having emotionally adept parents: Hooven, Katz, and Gottman, "The Family as a Meta-emotion Culture."

4. Optimistic infants: T. Berry Brazelton, in the preface to Heart Start: The Emotional Foundations of School Readiness (Arlington, VA: National Center for Clinical Infant Programs, 1992).

5. Emotional predictors of school success: Heart Start.

6. Elements of school readiness: Heart Start, p. 7.

7. Infants and mothers: Heart Start, p. 9.

8. Damage from neglect: M. Erickson et al., "The Relationship Between Quality of Attachment and Behavior Problems in Preschool in a High-Risk Sample," in I. Betherton and E. Waters, eds., Monographs of the Society of Research in Child Development 50, series no. 209-

9. Lasting lessons of first four years: Heart Start, p. 13.

10. The follow-up of aggressive children: L. R. Huesman, Leonard Eron, and Patty Warnicke-Yarmel, "Intellectual Function and Aggression," The Journal of Personality and Social Psychology (Jan. 1987). Similar findings were reported by Alexander Thomas and Stella Chess, in the September 1988 issue of Child Development, in their study of seventy-five children who were assessed at regular intervals since 1956, when they were between seven and twelve years old. Alexander Thomas et al., "Longitudinal Study of Negative Emotional States and Adjustments From Early Childhood Through Adolescence," Child Development 59 (1988). A decade later the children who parents and teachers had said were the most aggressive in grade school were having the most emotional turmoil in late adolescence. These were children (about twice as many boys as girls) who not only continually picked fights, but who also were belittling or openly hostile toward other children, and even toward their families and teachers. Their hostility was unchanged over the years; as adolescents they were having trouble getting along with classmates and with their families, and were in trouble at school. And, when contacted as adults, their difficulties ranged from tangles with the law to anxiety problems and depression.

11. Lack of empathy in abused children: The day-care observations and findings are reported in Mary Main and Carol George, "Responses of Abused and Disadvantaged Toddlers to Distress in Agemates: A Study in the Day-Care Setting," Developmental Psychology 21, 3 (1985). The findings have been repeated with preschoolers as well: Bonnie Klimes-Dougan and Janet Kistner, "Physically Abused Preschoolers' Responses to Peers' Distress," Developmental Psychology 26 (1990).

12. Difficulties of abused children: Robert Emery, "Family Violence," American Psychologist (Feb. 1989).

13. Abuse over generations: Whether abused children grow up to be abusing parents is a point of scientific debate. See, for example, Cathy Spatz Widom, "Child Abuse, Neglect and Adult Behavior," American Journal of Orthopsychiatry (July 1989).

Chapter 13. Trauma and Emotional Relearning

1. I wrote about the lasting trauma of the killings at Cleveland Elementary School in The New York Times "Education Life" section (Jan. 7, 1990).

2. The examples of PTSD in crime victims were offered by Dr. Shelly Niederbach, a psychologist at the Victims' Counseling Service, Brooklyn.

3. The Vietnam memory is from M. Davis, "Analysis of Aversive Memories Using the Fear-Potentiated Startle Paradigm," in N. Butters and L. R Squire, eds., The Neuro-psychology of Memory (New York: Guilford Press, 1992).

4. LeDoux makes the scientific case for these memories being especially enduring in "Indelibility of Subcortical Emotional Memories," Journal of Cognitive Neuroscience (1989), vol. 1, 238-43.

5. I interviewed Dr. Charney in The New York Times (June 12, 1990).

6. The experiments with paired laboratory animals were described to me by Dr. John Krystal, and have been repeated at several scientific laboratories. The major studies were done by Dr. Jay Weiss at Duke University.

7. The best account of the brain changes underlying PTSD, and the role of the amygdala in them, is in Dennis Charney et al., "Psychobiologic Mechanisms of Posttraumatic Stress Disorder," Archives of General Psychiatry 50 (April 1993), 294-305.

8. Some of the evidence for trauma-induced changes in this brain network comes from experiments in which Vietnam vets with PTSD were injected with yohimbine, a drug used on the tips of arrows by South American Indians to render their prey helpless. In tiny doses yohimbine blocks the action of a specific receptor (the point on a neuron that receives a neurotransmitter) that ordinarily acts as a brake on the catecholamines. Yohimbine takes the brakes off, keeping these receptors from sensing the secretion of catecholamines; the result is increasing catecholamine levels. With the neural brakes on anxiety disarmed by the drug injections, the yohimbine triggered panic in 9 of 15 PTSD patients, and lifelike flashbacks in 6. One vet had a hallucination of a helicopter being shot down in a trail of smoke and a bright flash; another saw the explosion by a land mine of a Jeep with his buddies in it—the same scene that had haunted his nightmares and appeared as flashbacks for more than 20 years. The yohimbine study was conducted by Dr. John Krystal, director of the Laboratory of Clinical Psychopharmacology at the National Center for PTSD at the West Haven, Conn., VA Hospital.

9. Fewer alpha-2 receptors in men with PTSD: see Charney, "Psychobiologic Mechanisms."

10. The brain, trying to lower the rate of CRF secretion, compensates by decreasing the number of receptors that release it. One telltale sign that this is what happens in people with PTSD comes from a study in which eight patients being treated for the problem were injected with CRF. Ordinarily, an injection of CRF triggers a flood of ACTH, the hormone that streams through the body to trigger catecholamines. But in the PTSD patients, unlike a comparison group of people without PTSD, there was no discernible change in levels of ACTH—a sign that their brains had cut back on CRF receptors because they already were overloaded with the stress hormone. The research was described to me by Charles Nemeroff, a Duke University psychiatrist.

11. I interviewed Dr. Nemeroff in The New York Times (June 12, 1990).

12. Something similar seems to occur in PTSD: For instance, in one experiment Vietnam vets with a PTSD diagnosis were shown a specially edited 15-minute film of graphic combat scenes from the movie Platoon. In one group, the vets were injected with naloxone, a substance that blocks endorphins; after watching the movie, these vets showed no change in their sensitivity to pain. But in the group without the endorphin blocker, the men's pain sensitivity decreased 30 percent, indicating an increase in endorphin secretion. The same scene had no such effect on veterans who did not have PTSD, suggesting that in the PTSD victims the nerve pathways that regulate endorphins were overly sensitive or hyperactive—an effect that became apparent only when they were reexposed to something reminiscent of the original trauma. In this sequence the amygdala first evaluates the emotional importance of what we see. The study was done by Dr. Roger Pitman, a Harvard psychiatrist. As with other symptoms of PTSD, this brain change is not only learned under duress, but can be triggered once again if there is something reminiscent of the original terrible event. For example, Pitman found that when laboratory rats were shocked in a cage, they developed the same endorphin-based analgesia found in the Vietnam vets shown Platoon. Weeks later, when the rats were put into the cages where they had been shocked—but without any current being turned on—they once again became insensitive to pain, as they originally had been when shocked. See Roger Pitman, "Naloxone-Reversible Analgesic Response to Combat-Related Stimuli in Posttraumatic Stress Disorder," Archives ofGeneral Medicine (June 1990). See also Hillel Glover, "Emotional Numbing: A Possible Endorphin-Mediated Phenomenon Associated with Post-Traumatic Stress Disorders and Other Allied Psychopathologic States," Journal of Traumatic Stress 5, 4 (1992).

13. The brain evidence reviewed in this section is based on Dennis Charney's excellent article, "Psychobiologic Mechanisms."

14. Charney, "Psychobiologic Mechanisms," 300.

15. Role of prefrontal cortex in unlearning fear: In Richard Davidson's study, volunteers had their sweat response measured (a barometer of anxiety) while they heard a tone. followed by a loud, obnoxious noise. The loud noise triggered a rise in sweat. After a time, the tone alone was enough to trigger the same rise, showing that the volunteers had learned an aversion to the tone. As they continued to hear the tone without the obnoxious noise, the learned aversion faded away—the tone sounded without any increase in sweat. The more active the volunteers' left prefrontal cortex, the more quickly they lost the learned fear. In another experiment showing the prefrontal lobes' role in getting over a fear, lab rats—as is so often the case in these studies—learned to fear a tone paired with an electric shock. The rats then had what amounts to a lobotomy, a surgical lesion in their brain that cut off the prefrontal lobes from the amygdala. For the next several days the rats heard the tone without getting an electric shock. Slowly, over a period of days, rats who have once learned to fear a tone will gradually lose their fear. But for the rats with the disconnected prefrontal lobes, it took nearly twice as long to unlearn the fear—suggesting a crucial role for the prefrontal lobes in managing fear and, more generally, in mastering emotional lessons. This experiment was done by Maria Morgan, a graduate student of Joseph LeDoux's at the Center for Neural Science, New York University.

16. Recovery from PTSD: I was told about this study by Rachel Yehuda, a neurochemist and director of the Traumatic Stress Studies Program at the Mt. Sinai School of Medicine in Manhattan. I reported on the results in The New York Times (Oct. 6,1992).

17. Childhood trauma: Lenore Terr, Too Scared to Cry (New York: HarperCollins, 1990).

18. Pathway to recovery from trauma: Judith Lewis Herman, Trauma and Recovery (New York: Basic Books, 1992).

19. "Dosing" of trauma: Mardi Horowitz, Stress Response Syndromes (Northvale, NJ: Jason Aronson, 1986).

20. Another level at which relearning goes on, at least for adults, is philosophical. The eternal question of the victim—"Why me?"—needs to be addressed. Being the victim of trauma shatters a person's faith that the world is a place that can be trusted, and that what happens to us in life is just—that is, that we can have control over our destiny by living a righteous life. The answers to the victim's conundrum, of course, need not be philosophical or religious; the task is to rebuild a system of belief or faith that allows living once again as though the world and the people in it can be trusted.

21. That the original fear persists, even if subdued, has been shown in studies where lab rats were conditioned to fear a sound, such as a bell, when it was paired with an electric shock. Afterward, when they heard the bell they reacted with fear, even though no shock accompanied it. Gradually, over the course of a year (a very long time for a rat—about a third of its life), the rats lost their fearfulness of the bell. But the fear was restored in full force when the sound of the bell was once again paired with a shock. The fear came back in a single instant—but took months and months to subside. The parallel in humans, of course, is when a traumatic fear from long ago, dormant for years, floods back in full force with some reminder of the original trauma.

22. Luborsky's therapy research is detailed in Lester Luborsky and Paul Crits-Christoph, Understanding Transference: The CCRT Method (New York: Basic Books, 1990).

Chapter 14. Temperament Is Not Destiny

1. See, for example, Jerome Kagan et al., "Initial Reactions to Unfamiliarity," Current Directions in Psychological Science (Dec. 1992). The fullest description of the biology of temperament is in Kagan, Galen's Prophecy.

2. Tom and Ralph, archetypically timid and bold types, are described in Kagan, Galen's Prophecy, pp. 155-57.

3. Lifelong problems of the shy child: Iris Bell, "Increased Prevalence of Stress-related Symptoms in Middle-aged Women Who Report Childhood Shyness," Annals of Behavior Medicine 16 (1994).

4. The heightened heart rate: Iris R. Bell et al., "Failure of Heart Rate Habituation During Cognitive and Olfactory Laboratory Stressors in Young Adults With Childhood Shyness," Annals of Behavior Medicine 16 (1994).

5. Panic in teenagers: Chris Hayward et al., "Pubertal Stage and Panic Attack History in Sixth-and Seventh-grade Girls," American Journal of Psychiatry vol. 149(9) (Sept. 1992), pp. 1239-43; Jerold Rosenbaum et al., "Behavioral Inhibition in Childhood: A Risk Factor for Anxiety Disorders," Harvard Review of Psychiatry (May 1993).

6. The research on personality and hemispheric differences was done by Dr. Richard Davidson at the University of Wisconsin, and by Dr. Andrew Tomarken, a psychologist at Vanderbilt University: see Andrew Tomarken and Richard Davidson, "Frontal Brain Activation in Repressors and Nonrepressors," Journal of Abnormal Psychology 103 (1994).

7. The observations of how mothers can help timid infants become bolder were done with Doreen Arcus. Details are in Kagan, Galen's Prophecy.

8. Kagan, Galen's Prophecy, pp. 194-95.

9. Growing less shy: Jens Asendorpf, "The Malleability of Behavioral Inhibition: A Study of Individual Developmental Functions," Developmental Psychology 30, 6 (1994).

10. Hubel and Wiesel: David H. Hubel, Thorsten Wiesel, and S. Levay, "Plasticity of Ocular Columns in Monkey Striate Cortex," Philosophical Transactions of the Royal Society of London 278 (1977).

11. Experience and the rat's brain: The work of Marian Diamond and others is described in Richard Thompson, The Brain (San Francisco: W. H. Freeman, 1985).

12. Brain changes in treating obsessive-compulsive disorder: L. R. Baxter et al., "Caudate Glucose Metabolism Rate Changes With Both Drug and Behavior Therapy for Obsessive-Compulsive Disorder," Archives of General Psychiatry 49 (1992).

13. Increased activity in prefrontal lobes: L. R. Baxter et al., "Local Cerebral Glucose Metabolic Rates in Obsessive-Compulsive Disorder," Archives of General Psychiatry AA (1987).

14. Prefrontal lobes maturity: Bryan Kolb, "Brain Development, Plasticity, and Behavior," American Psychologist AA (1989).

15. Childhood experience and prefrontal pruning: Richard Davidson, "Asymmetric Brain Function, Affective Style and Psychopathology: The Role of Early Experience and Plasticity," Development and Psychopathology vol. 6 (1994), pp. 741-58.

16. Biological attunement and brain growth: Schore, Affect Regulation.

17. M. E. Phelps et al, "PET: A Biochemical Image of the Brain at Work," in N. A. Lassen et al., Brain Work and Mental Activity: Quantitative Studies with Radioactive Tracers (Copenhagen: Munksgaard, 1991).

PART FIVE: EMOTIONAL LITERACY

Chapter 15. The Cost of Emotional Illiteracy

1. Emotional literacy: I wrote about such courses in The New York Times (March 3,1992).

2. The statistics on teen crime rates are from the Uniform Crime Reports, Crime in the U.S., 1991, published by the Department of Justice.

3. Violent crimes in teenagers: In 1990 the juvenile arrest rate for violent crimes climbed to 430 per 100,000, a 27 percent jump over the 1980 rate. Teen arrest rates for forcible rape rose from 10.9 per 100,000 in 1965 to 21.9 per 100,000 in 1990. Teen murder rates more than quadrupled from 1965 to 1990, from 2.8 per 100,000 to 12.1; by 1990 three of four teenage murders were with guns, a 79 percent increase over the decade. Aggravated assault by teenagers jumped by 64 percent from 1980 to 1990. See, e.g., Ruby Takanashi, "The Opportunities of Adolescence," American Psychologist (Feb. 1993).

4. In 1950 the suicide rate for those 15 to 24 was 4.5 per 100,000. By 1989 it was three times higher, 13.3. Suicide rates for children 10 to 14 almost tripled between 1968 and 1985. Figures on suicide, homicide victims, and pregnancies are from Health, 1991, U.S. Department of Health and Human Services, and Children's Safety Network, A Data Book of Child and Adolescent Injury (Washington, DC: National Center for Education in Maternal and Child Health, 1991).

5. Over the three decades since 1960, rates of gonorrhea jumped to a level four times higher among children 10 to 14, and three times higher among those 15 to 19. By 1990, 20 percent of AIDS patients were in their twenties, many having become infected during their teen years. Pressure to have sex early is getting stronger. A survey in the 1990s found that more than a third of younger women say that pressure from peers made them decide to have sex the first time; a generation earlier just 13 percent of women said so. See Ruby Takanashi, "The Opportunities of Adolescence," and Children's Safety Network, A Data Book of Child and Adolescent Injury.

6. Heroin and cocaine use for whites rose from 18 per 100,000 in 1970 to a rate of 68 in 1990—about three times higher. But over the same two decades among blacks, the rise was from a 1970 rate of 53 per 100,000 to a staggering 766 in 1990—close to 13 times the rate 20 years before. Drug use rates are from Crime in the U.S., 1991, U.S. Department of Justice.

7. As many as one in five children have psychological difficulties that impair their lives in some way, according to surveys done in the United States, New Zealand, Canada, and Puerto Rico. Anxiety is the most common problem in children under 11, afflicting 10 percent with phobias severe enough to interfere with normal life, another 5 percent with generalized anxiety and constant worry, and another 4 percent with intense anxiety about being separated from their parents. Binge drinking climbs during the teenage years among boys to a rate of about 20 percent by age 20. I reported much of this data on emotional disorders in children in The New York Times (Jan. 10, 1989).

8. The national study of children's emotional problems, and comparison with other countries: Thomas Achenbach and Catherine Howell, "Are America's Children's Problems Getting Worse? A 13-Year Comparison, "Journal of the American Academy of Child and Adolescent Psychiatry (Nov. 1989).

9. The comparison across nations was by Urie Bronfenbrenner, in Michael Lamb and Kathleen Sternberg, Child Care in Context: Cross-Cultural Perspectives (Englewood, NJ: Lawrence Erlbaum, 1992).

10. Urie Bronfenbrenner was speaking at a symposium at Cornell University (Sept. 24, 1993).

11. Longitudinal studies of aggressive and delinquent children: see, for example, Alexander Thomas et al., "Longitudinal Study of Negative Emotional States and Adjustments from Early Childhood Through Adolescence," Child Development, vol. 59 (Sept. 1988).

12. The bully experiment: John Lochman, "Social-Cognitive Processes of Severely Violent, Moderately Aggressive, and Nonaggressive Boys," Journal of Clinical and Consulting Psychology, 199'4.

13. The aggressive boys research: Kenneth A. Dodge, "Emotion and Social Information Processing," in J. Garber and K. Dodge, The Development ofEmotion Regulation and Dysregulation (New York: Cambridge University Press, 1991).

14. Dislike for bullies within hours: J. D. Coie and J. B. Kupersmidt, "A Behavioral Analysis of Emerging Social Status in Boys' Groups," Child Development 54 (1983).

15. Up to half of unruly children: See, for example, Dan Offord et al., "Outcome, Prognosis, and Risk in a Longitudinal Follow-up Study," Journal of the American Academy of Child and Adolescent Psychiatry 31 0992).

16. Aggressive children and crime: Richard Tremblay et al., "Predicting Early Onset of Male Antisocial Behavior from Preschool Behavior," Archives of General Psychiatry (Sept. 1994).

17. What happens in a child's family before the child reaches school is, of course, crucial in creating a predisposition to aggression. One study, for example, showed that children whose mothers rejected them at age 1, and whose birth was more complicated, were four times as likely as others to commit a violent crime by age 18. Adriane Raines et al., "Birth Complications Combined with Early Maternal Rejection at Age One Predispose to Violent Crime at Age 18 Years," Archives of General Psychiatry (Dec. 1994).

18. While low verbal IQ has appeared to predict delinquency (one study found an eight-point difference in these scores between delinquents and nondelinquents), there is evidence that impulsivity is more directly and powerfully at cause for both the low IQ scores and delinquency. As for the low scores, impulsive children don't pay attention well enough to learn the language and reasoning skills on which verbal IQ scores are based, and so impulsivity lowers those scores. In the Pittsburgh Youth Study, a well-designed longitudinal project where both IQ and impulsivity were assessed in ten-to twelve-year-olds, impulsivity was almost three times more powerful than verbal IQ in predicting delinquency. See the discussion in: Jack Block, "On the Relation Between IQ, Impulsivity, and Delinquency," Journal of Abnormal Psychology 104 (1995).

19. "Bad" girls and pregnancy: Marion Underwood and Melinda Albert, "Fourth-Grade Peer Status as a Predictor of Adolescent Pregnancy," paper presented at the meeting of the Society for Research on Child Development, Kansas City, Missouri (Apr. 1989).

20. The trajectory to delinquency: Gerald R. Patterson, "Orderly Change in a Stable World: The Antisocial Trait as Chimera, "Journal of Clinical and Consulting Psychology 62 (1993).

21. Mind-set of aggression: Ronald Slaby and Nancy Guerra, "Cognitive Mediators of Aggression in Adolescent Offenders," Developmental Psychology 24 (1988).

22. The case of Dana: from Laura Mufson et al., Interpersonal Psychotherapy for Depressed Adolescents (New York: Guilford Press, 1993).

23. Rising rates of depression worldwide: Cross-National Collaborative Group, "The Changing Rate of Major Depression: Cross-National Comparisons," Journal of the American Medical Association (Dec. 2, 1992).

24. Ten times greater chance of depression: Peter Lewinsohn et al., "Age-Cohort Changes in the Lifetime Occurrence of Depression and Other Mental Disorders," Journal of Abnormal Psychology 102 0993).

25. Epidemiology of depression: Patricia Cohen et al., New York Psychiatric Institute, 1988; Peter Lewinsohn et al., "Adolescent Psychopathology: I. Prevalence and Incidence of Depression in High School Students, "Journal of Abnormal Psychology 102 0993). See also Mufson et al., Interpersonal Psychotherapy. For a review of lower estimates: E. Costello, "Developments in Child Psychiatric Epidemiology," Journal of the Academy of Child and Adolescent Psychiatry 28 (1989).

26. Patterns of depression in youth: Maria Kovacs and Leo Bastiaens, "The Psychotherapeutic Management of Major Depressive and Dysthymic Disorders in Childhood and Adolescence: Issues and Prospects," in I. M. Goodyer, ed., Mood Disorders in Childhood and Adolescence (New York: Cambridge University Press, 1994).

27. Depression in children: Kovacs, op. cit.

28. I interviewed Maria Kovacs in The New York Times (Jan. 11, 1994).

29. Social and emotional lag in depressed children: Maria Kovacs and David Goldston, "Cognitive and Social Development of Depressed Children and Adolescents," Journal of the American Academy of Child and Adolescent Psychiatry (May 1991).

30. Helplessness and depression: John Weiss et al., "Control-related Beliefs and Self-reported Depressive Symptoms in Late Childhood," Journal of Abnormal Psychology 102 (1993).

31. Pessimism and depression in children: Judy Garber, Vanderbilt University. See, e.g., Ruth Hilsman and Judy Garber, "A Test of the Cognitive Diathesis Model of Depression in Children: Academic Stressors, Attributional Style, Perceived Competence and Control," Journal of Personality and Social Psychology 67 (1994); Judith Garber, "Cognitions, Depressive Symptoms, and Development in Adolescents," Journal of Abnormal Psychology 102 (1993).

32. Garber, "Cognitions."

33. Garber, "Cognitions."

34. Susan Nolen-Hoeksema et al., "Predictors and Consequences of Childhood Depressive Symptoms: A Five-Year Longitudinal Study," Journal of Abnormal Psychology 101 (1992).

35. Depression rate halved: Gregory Clarke, University of Oregon Health Sciences Center, "Prevention of Depression in At-Risk High School Adolescents," paper delivered at the American Academy of Child and Adolescent Psychiatry (Oct. 1993).

36. Garber, "Cognitions."

37. Hilda Bruch, "Hunger and Instinct," Journal of Nervous and Mental Disease 149 (1969). Her seminal book, The Golden Cage: The Enigma of Anorexia Nervosa (Cambridge, MA: Harvard University Press) was not published until 1978.

38. The study of eating disorders: Gloria R. Leon et al., "Personality and Behavioral Vulnerabilities Associated with Risk Status for Eating Disorders in Adolescent Girls," Journal of Abnormal Psychology 102 (1993).

39. The six-year-old who felt fat was a patient of Dr. William Feldman, a pediatrician at the University of Ottawa.

40. Noted by Sifneos, "Affect, Emotional Conflict, and Deficit."

41. The vignette of Ben's rebuff is from Steven Asher and Sonda Gabriel, "The Social World of Peer-Rejected Children," paper presented at the annual meeting of the American Educational Research Association, San Francisco (Mar. 1989).

42. The dropout rate among socially rejected children: Asher and Gabriel, "The Social World of Peer-Rejected Children."

43. The findings on the poor emotional competence of unpopular children are from Kenneth Dodge and Esther Feldman, "Social Cognition and Sociometric Status," in Steven Asher and John Coie, eds., Peer Rejection in Childhood (New York-. Cambridge University Press, 1990).

44. Emory Cowen et al., "Longterm Follow-up of Early Detected Vulnerable Children," Journal of Clinical and Consulting Psychology 41 (1973).

45. Best friends and the rejected: Jeffrey Parker and Steven Asher, "Friendship Adjustment, Group Acceptance and Social Dissatisfaction in Childhood," paper presented at the annual meeting of the American Educational Research Association, Boston (1990).

46. The coaching for socially rejected children: Steven Asher and Gladys Williams, "Helping Children Without Friends in Home and School Contexts," in Children's Social Development: Information for Parents and Teachers (Urbana and Champaign: University of Illinois Press, 1987).

47. Similar results: Stephen Nowicki, "A Remediation Procedure for Nonverbal Processing Deficits," unpublished manuscript, Duke University (1989).

48. Two fifths are heavy drinkers: a survey at the University of Massachusetts by Project Pulse, reported in The Daily Hampshire Gazette (Nov. 13, 1993).

49. Binge drinking: Figures are from Harvey Wechsler, director of College Alcohol Studies at the Harvard School of Public Health (Aug. 1994).

50. More women drink to get drunk, and risk of rape: report by the Columbia University Center on Addiction and Substance Abuse (May 1993).

51. Leading cause of death: Alan Marlatt, report at the annual meeting of the American Psychological Association (Aug. 1994).

52. Data on alcoholism and cocaine addiction are from Meyer Glantz, acting chief of the Etiology Research Section of the National Institute for Drug and Alcohol Abuse.

53. Distress and abuse: Jeanne Tschann, "Initiation of Substance Abuse in Early Adolescence," Health Psychology A (1994).

54. I interviewed Ralph Tarter in The New York Times (Apr. 26, 1990).

55. Tension levels in sons of alcoholics: Howard Moss et al., "Plasma GABA-like Activity in Response to Ethanol Challenge in Men at High Risk for Alcoholism" Biological Psychiatry 27(6) (Mar. 1990).

56. Frontal lobe deficit in sons of alcoholics: Philip Harden and Robert Pihl, "Cognitive Function, Cardiovascular Reactivity, and Behavior in Boys at High Risk for Alcoholism," Journal of Abnormal Psychology 104 (1995).

57. Kathleen Merikangas et al., "Familial Transmission of Depression and Alcoholism," Archives of General Psychiatry (Kpt. 1985).

58. The restless and impulsive alcoholic: Moss et al.

59. Cocaine and depression: Edward Khantzian, "Psychiatric and Psychodynamic Factors in Cocaine Addiction," in Arnold Washton and Mark Gold, eds., Cocaine: A Clinician's Handbook (NewYork: Guilford Press, 1987).

60. Heroin addiction and anger: Edward Khantzian, Harvard Medical School, in conversation, based on over 200 patients he has treated who were addicted to heroin.

61. No more wars: The phrase was suggested to me by Tim Shriver of the Collaborative for the Advancement of Social and Emotional Learning at the Yale Child Studies Center.

62. Emotional impact of poverty: "Economic Deprivation and Early Childhood Development" and "Poverty Experiences of Young Children and the Quality of Their Home Environments." Greg Duncan and Patricia Garrett each described their research findings in separate articles in Child Development (Kpv. 1994).

63. Traits of resilient children: Norman Garmezy, The Invulnerable Child (New York: Guilford Press, 1987). I wrote about children who thrive despite hardship in The New York Times (Oct. 13, 1987).

64. Prevalence of mental disorders: Ronald C. Kessler et al., "Lifetime and 12-month Prevalence of DSM-III-R Psychiatric Disorders in the U.S.," Archives of General Psychiatry (Jan. 1994).

65. The figure for boys and girls reporting sexual abuse in the United States are from Malcolm Brown of the Violence and Traumatic Stress Branch of the National Institute of Mental Health; the number of substantiated cases is from the National Committee for the Prevention of Child Abuse and Neglect. A national survey of children found the rates to be 32 percent for girls and 0.6 percent for boys in a given year: David Finkelhor and Jennifer Dziuba-Leatherman, "Children as Victims of Violence: A National Survey," Pediatrics (Oct. 1984).

66. The national survey of children about sexual abuse prevention programs was done by David Finkelhor, a sociologist at the University of New Hampshire.

67. The figures on how many victims child molesters have are from an interview with Malcolm Gordon, a psychologist at the Violence and Traumatic Stress Branch of the National Institute of Mental Health.

68. W. T. Grant Consortium on the School-Based Promotion of Social Competence, "Drug and Alcohol Prevention Curricula," in J. David Hawkins et al., Communities That Care (San Francisco: Jossey-Bass, 1992).

69. W. T. Grant Consortium, "Drug and Alcohol Prevention Curricula," p. 136.

Chapter 16. Schooling the Emotions

1. I interviewed Karen Stone McCown in The New York Times (Nov. 7, 1993).

2. Karen F. Stone and Harold Q. Dillehunt, Self Science: The Subject Is Me (Santa Monica: Goodyear Publishing Co., 1978).

3. Committee for Children, "Guide to Feelings," Second Step 4-5(1992), p. 84.

4. The Child Development Project: See, e.g., Daniel Solomon et al., "Enhancing Children's Prosocial Behavior in the Classroom," American Educational Research Journal ( Winter 1988).

5. Benefits from Head Start: Report by High/Scope Educational Research Foundation, Ypsilanti, Michigan (Apr. 1993).

6. The emotional timetable: Carolyn Saarni, "Emotional Competence: How Emotions and Relationships Become Integrated," in R. A. Thompson, ed., Socioemotional Development/Nebraska Symposium on Motivation 36 (1990).

7. The transition to grade school and middle school: David Hamburg, Today's Children: Creating a Future for a Generation in Crisis (New York: Times Books, 1992).

8. Hamburg, Today's Children, pp. 171-72.

9. Hamburg, Today's Children, p. 182.

10. I interviewed Linda Lantieri in The New York Times (Mar. 3, 1992).

11. Emotional-literacy programs as primary prevention: Hawkins et al., Communities That Care.

12. Schools as caring communities: Hawkins et al., Communities That Care.

13. The story of the girl who was not pregnant: Roger P. Weisberg et al., "Promoting Positive Social Development and Health Practice in Young Urban Adolescents," in M. J. Elias, ed., Social Decision-making in the Middle School (Gaithersburg, MD: Aspen Publishers, 1992).

14. Character-building and moral conduct: Amitai Etzioni, The Spirit of Community (New York: Crown, 1993).

15. Moral lessons: Steven C. Rockefeller, John Dewey. Religious Faith and Democratic Humanism (New York: Columbia University Press, 1991).

16. Doing right by others: Thomas Lickona, Educating for Character (New York: Bantam, 1991).

17. The arts of democracy: Francis Moore Lappe and Paul Martin DuBois, The Quickening of America (San Francisco: Jossey-Bass, 1994).

18. Cultivating character: Amitai Etzioni et al., Character Building for a Democratic, Civil Society (Washington, DC: The Communitarian Network, 1994).

19. Three percent rise in murder rates: "Murders Across Nation Rise by 3 Percent, but Overall Violent Crime Is Down," The New York Times  (May 2, 1994).

20. Jump in juvenile crime: "Serious Crimes by Juveniles Soar," Associated Press (July 25, 1994).

Appendix B. Hallmarks of the Emotional Mind

1. I have written about Seymour Epstein's model of the "experiential unconscious" on several occasions in The New York Times, and much of this summary of it is based on conversations with him, letters to me, his article, "Integration of the Cognitive and Psychodynamic Unconscious" (American Psychologist AA (1994), and his book with Archie Brodsky, You're Smarter Than You Think (New York: Simon & Schuster, 1993). While his model of the experiential mind informs my own about the "emotional mind," I have made my own interpretation.

2. Paul Ekman, "An Argument for the Basic Emotions," Cognition and Emotion, 6,1992, p. 175. The list of traits that distinguish emotions is a bit longer, but these are the traits that will concern us here.

3. Ekman, op cit., p. 187.

4. Ekman, op cit., p. 189.

5. Epstein, 1993, p. 55.

6. J. Toobey and L. Cosmides, "The Past Explains the Present: Emotional Adaptations and the Structure of Ancestral Environments," Ethology and Sociobiology, 11, pp. 418-19-

7. While it may seem self-evident that each emotion has its own biological pattern, it has not been so for those studying the psychophysiology of emotion. A highly technical debate continues over whether emotional arousal is basically the same for all emotions, or whether unique patterns can be teased out. Without going into the details of the debate, I have presented the case for those who hold to unique biological profiles for each major emotion.

 

 

Acknowledgments

I first heard the phrase "emotional literacy" from Eileen Rockefeller Growald, then the founder and president of the Institute for the Advancement of Health. It was this casual conversation that piqued my interest and framed the investigations that finally became this book. Over the course of these years it has been a pleasure to watch Eileen as she has nurtured this field along.

Support from the Fetzer Institute in Kalamazoo, Michigan, has allowed me the luxury of time to explore more fully what "emotional literacy" might mean, and I am grateful for the crucial early encouragement of Rob Lehman, president of the Institute, and an ongoing collaboration with David Sluyter, program director there. It was Rob Lehman who, early on in my explorations, urged me to write a book about emotional literacy.

Among my most profound debts is to the hundreds of researchers who over the years have shared their findings with me, and whose efforts are reviewed and synthesized here. To Peter Salovey at Yale I owe the concept of "emotional intelligence." I have also gained much from being privy to the ongoing work of many educators and practitioners of the art of primary prevention, who are at the forefront of the nascent movement in emotional literacy. Their hands-on efforts to bring heightened social and emotional skills to children, and to re-create schools as more humane environments, have been inspiring. Among them are Mark Greenberg and David Hawkins at the University of Washington; David Schaps and Catherine Lewis at the Developmental Studies Center in Oakland, California; Tim Shriver at the Yale Child Studies Center; Roger Weissberg at the University of Illinois at Chicago; Maurice Elias at Rutgers; Shelly Kessler of the Goddard Institute on Teaching and Learning in Boulder, Colorado; Chevy Martin and Karen Stone McCown at the Nueva Learning Center in Hillsborough, California; and Linda Lantieri, director of the National Center for Resolving Conflict Creatively in New York City.

I have a special debt to those who reviewed and commented on parts of this manuscript: Howard Gardner of the Graduate School of Education at Harvard University; Peter Salovey, of the psychology department at Yale University; Paul Ekman, director of the Human Interaction Laboratory at the University of California at San Francisco; Michael Lerner, director of Commonweal in Bolinas, California; Denis Prager, then director of the health program at the John D. and Catherine T. MacArthur Foundation; Mark Gerzon, director of Common Enterprise, Boulder, Colorado; Mary Schwab-Stone, MD, Child Studies Center, Yale University School of Medicine; David Spiegel, MD, Department of Psychiatry, Stanford University Medical School; Mark Greenberg, director of the Fast Track Program, University of Washington; Shoshona Zuboff, Harvard School of Business; Joseph LeDoux, Center for Neural Science, New York University; Richard Davidson, director of the Psychophysiology Laboratory, University of Wisconsin; Paul Kaufman, Mind and Media, Point Reyes, California; Jessica Brackman, Naomi Wolf, and, especially, Fay Goleman.

Helpful scholarly consultations came from Page DuBois, a Greek scholar at the University of Southern California; Matthew Kapstein, a philosopher of ethics and religion at Columbia University; and Steven Rockefeller, intellectual biographer of John Dewey, at Middlebury College. Joy Nolan gathered vignettes of emotional episodes; Margaret Howe and Annette Spychalla prepared the appendix on the effects of emotional literacy curricula. Sam and Susan Harris provided essential equipment.

My editors at The New York Times over the last decade have been marvelously supportive of my many enquiries into new findings on the emotions, which first appeared in the pages of that paper and which inform much of this book.

Toni Burbank, my editor at Bantam Books, offered the editorial enthusiasm and acuity that sharpened my resolve and thinking.

And my wife, Tara Bennett-Goleman, provided the cocoon of warmth, love, and intelligence that nurtured this project along.

 

 

About the Author

DANIEL GOLEMAN, Ph.D., covers the behavioral and brain sciences for The New York Times and his articles appear throughout the world in syndication. He has taught at Harvard (where he received his Ph.D.) and was formerly senior editor at Psychology Today. His previous books include Vital Lies, Simple Truths; The Meditative Mind; and, as co-author, The Creative Spirit.

 

By the same author

Vital Lies, Simple Truths

 

Working with Emotional Intelligence

 

Destructive Emotions

 

 

First published in Great Britain 1996

 

Copyright © Daniel Goleman

 

This electronic edition published 2009 by Bloomsbury Publishing Plc

 

The right of Daniel Goleman to be identified as the author of this work has been asserted by him in accordance with the Copyright, Designs and Patents Act 1988

 

All rights reserved. You may not copy, distribute, transmit, reproduce or otherwise make available this publication (or any part of it) in any form, or by any means (including without limitation electronic, digital, optical, mechanical, photocopying, printing, recording or otherwise), without the prior written permission of the publisher. Any person who does any unauthorised act in relation to this publication may be liable to criminal prosecution and civil claims for damages.

 

Bloomsbury Publishing Plc, 36 Soho Square, London W1D 3QY

 

A CIP catalogue record for this book is available from the British Library

 

eISBN: 978-0-747-52830-2

 

www.bloomsbury.com/danielgoleman

 

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