The Cost of Emotional Illiteracy (And a lesson about Depression)

The Cost of Emotional Illiteracy (And a lesson about Depression)
Chapter 15, Emotional Intelligence, Daniel Goleman
    
It began as a small dispute, but had escalated. Ian Moore, a senior at Thomas Jefferson High School in Brooklyn, and Tyrone Sinkler, a junior, had had a falling-out with a buddy, fifteen-year-old Khalil Sumpter. Then they had started picking on him and making threats. Now it exploded.

Khalil, scared that Ian and Tyrone were going to beat him up, brought a .38 caliber pistol to school one morning, and, fifteen feet from a school guard, shot both boys to death at point-blank range in the school's hallway.

The incident, chilling as it is, can be read as yet another sign of a desperate need for lessons in handling emotions, settling disagreements peaceably, and just plain getting along. Educators, long disturbed by school children's lagging scores in math and reading, are realizing there is a different and more alarming deficiency: emotional illiteracy. And while laudable efforts are being made to raise academic standards, this new and troubling deficiency is not being addressed in the standard school curriculum. As one Brooklyn teacher put it, the present emphasis in schools suggests that "we care more about how well school children can read and write than whether they'll be alive next week."

Signs of the deficiency can be seen in violent incidents such as the shooting of Ian and Tyrone, growing ever more common in American schools. But these are more than isolated events; the heightening of the turmoil of adolescence and troubles of childhood can be read for the United States—a bellwether of world trends—in statistics such as these:

In 1990, compared to the previous two decades, the United States saw the highest juvenile arrest rate for violent crimes ever; teen arrests for forcible rape had doubled; teen murder rates quadrupled, mostly due to an increase in shootings. During those same two decades, the suicide rate for teenagers tripled, as did the number of children under fourteen who are murder victims.
More, and younger, teenage girls are getting pregnant. As of 1993 the birthrate among girls ten to fourteen has risen steadily for five years in a row—some call it "babies having babies"—as has the proportion of unwanted teen pregnancies and peer pressure to have sex. Rates of venereal disease among teenagers have tripled over the last three decades.

While these figures are discouraging, if the focus is on African-American youth, especially in the inner city, they are utterly bleak—all the rates are higher by far, sometimes doubled, sometimes tripled or higher. For example, heroin and cocaine use among white youth climbed about 300 percent over the two decades before the 1990s; for African-American youth it jumped to a staggering 13 times the rate of twenty years before.

The most common cause of disability among teenagers is mental illness.
Symptoms of depression, whether major or minor, affect up to one third of teenagers; for girls, the incidence of depression doubles at puberty. The frequency of eating disorders in teenage girls has skyrocketed.

Finally, unless things change, the long-term prospects for today's children marrying and having a fruitful, stable life together are growing more dismal with each generation. As we saw in Chapter 9, while during the 1970s and 1980s the divorce rate was around 50 percent, as we entered the 1990s the rate among newlyweds predicted that two out of three marriages of young people would end in divorce.

AN EMOTIONAL MALAISE

These alarming statistics are like the canary in the coal miner's tunnel whose death warns of too little oxygen. Beyond such sobering numbers, the plight of today's children can be seen at more subtle levels, in day-to-day problems that have not yet blossomed into outright crises. Perhaps the most telling data of all —a direct barometer of dropping levels of emotional competence—are from a national sample of American children, ages seven to sixteen, comparing their emotional condition in the mid-1970s and at the end of the 1980s. Based on parents' and teachers' assessments, there was a steady worsening. No one problem stood out; all indicators simply crept steadily in the wrong direction.

Children, on average, were doing more poorly in these specific ways:

• Withdrawal or social problems: preferring to be alone; being secretive; sulking a lot; lacking energy; feeling unhappy; being overly dependent 

• Anxious and depressed: being lonely; having many fears and worries; needing to be perfect; feeling unloved; feeling nervous or sad and depressed 

• Attention or thinking problems: unable to pay attention or sit still; daydreaming; acting without thinking; being too nervous to concentrate; doing poorly on schoolwork; unable to get mind off thoughts 

• Delinquent or aggressive: hanging around kids who get in trouble; lying and cheating; arguing a lot; being mean to other people; demanding attention; destroying other people's things; disobeying at home and at school; being stubborn and moody; talking too much; teasing a lot; having a hot temper 

While any of these problems in isolation raises no eyebrows, taken as a group they are barometers of a sea change, a new kind of toxicity seeping into and poisoning the very experience of childhood, signifying sweeping deficits in emotional competences. This emotional malaise seems to be a universal price of modern life for children. While Americans often decry their problems as particularly bad compared to other cultures', studies around the world have found rates on a par with or worse than in the United States. For example, in the 1980s teachers and parents in the Netherlands, China, and Germany rated children at about the same level of problems as were found for American children in 1976.

And some countries had children in worse shape than current U.S. levels, including Australia, France, and Thailand. But this may not remain true for long.
The larger forces that propel the downward spiral in emotional competence seem to be picking up speed in the United States relative to many other developed nations.

No children, rich or poor, are exempt from risk; these problems are universal, occurring in all ethnic, racial, and income groups. Thus while children in poverty have the worst record on indices of emotional skills, their rate of deterioration over the decades was no worse than for middle-class children or for wealthy children: all show the same steady slide. There has also been a corresponding threefold rise in the number of children who have gotten psychological help (perhaps a good sign, signaling that help is more available), as well as a near doubling of the number of children who have enough emotional problems that they should get such help but have not (a bad sign)—from about 9 percent in 1976 to 18 percent in 1989.

Urie Bronfenbrenner, the eminent Cornell University developmental psychologist who did an international comparison of children's well-being, says: "In the absence of good support systems, external stresses have become so great that even strong families are falling apart. The hecticness, instability, and inconsistency of daily family life are rampant in all segments of our society, including the well-educated and well-to-do. What is at stake is nothing less than the next generation, particularly males, who in growing up are especially vulnerable to such disruptive forces as the devastating effects of divorce, poverty, and unemployment. The status of American children and families is as desperate as ever.... We are depriving millions of children of their competence and moral character."

This is not just an American phenomenon but a global one, with worldwide competition to drive down labor costs creating economic forces that press on the family. These are times of financially besieged families in which both parents work long hours, so that children are left to their own devices or the TV baby-sits; when more children than ever grow up in poverty; when the one-parent family is becoming ever more commonplace; when more infants and toddlers are left in day care so poorly run that it amounts to neglect. All this means, even for well-intentioned parents, the erosion of the countless small, nourishing exchanges between parent and child that build emotional competences.

If families no longer function effectively to put all our children on a firm footing for life, what are we to do? A more careful look at the mechanics of specific problems suggests how given deficits in emotional or social competences lay the foundation for grave problems—and how well-aimed correctives or preventives could keep more children on track.

TAMING AGGRESSION

In my elementary school the tough kid was Jimmy, a fourth grader when I was in first grade. He was the kid who would steal your lunch money, take your bike, slug you as soon as talk to you. Jimmy was the classic bully, starting fights with the least provocation, or none at all. We all stood in awe of Jimmy—and we all stood at a distance. Everyone hated and feared Jimmy; no one would play with him. It was as though everywhere he went on the playground an invisible bodyguard cleared kids out of his way.

Kids like Jimmy are clearly troubled. But what may be less obvious is that being so flagrantly aggressive in childhood is a mark of emotional and other troubles to come. Jimmy was in jail for assault by the time he reached sixteen.

The lifelong legacy of childhood aggressiveness in kids like Jimmy has emerged from many studies. As we have seen, the family life of such aggressive children typically includes parents who alternate neglect with harsh and capricious punishments, a pattern that, perhaps understandably, makes the children a bit paranoid or combative.
Not all angry children are bullies; some are withdrawn social outcasts who overreact to being teased or to what they perceive as slights or unfairness. But the one perceptual flaw that unites such children is that they perceive slights where none were intended, imagining their peers to be more hostile toward them than they actually are. This leads them to misperceive neutral acts as threatening ones—an innocent bump is seen as a vendetta—and to attack in return. That, of course, leads other children to shun them, isolating them further. Such angry, isolated children are highly sensitive to injustices and being treated unfairly.

They typically see themselves as victims and can recite a list of instances when, say, teachers blamed them for doing something when in fact they were innocent.
Another trait of such children is that once they are in the heat of anger they can think of only one way to react: by lashing out.

These perceptual biases can be seen at work in an experiment in which bullies are paired with a more peaceable child to watch videos. In one video, a boy drops his books when another knocks into him, and children standing nearby laugh; the boy who dropped the books gets angry and tries to hit one of those who laughed. When the boys who watched the video talk about it afterward, the bully always sees the boy who struck out as justified. Even more telling, when they have to rate how aggressive the boys were during their discussion of the video, the bullies see the boy who knocked into the other as more combative, and the anger of the boy who struck out as justified.

This jump to judgment testifies to a deep perceptual bias in people who are unusually aggressive: they act on the basis of the assumption of hostility or threat, paying too little attention to what is actually going on. Once they assume threat, they leapfrog to action. For instance, if an aggressive boy is playing checkers with another who moves a piece out of turn, he'll interpret the move as "cheating" without pausing to find out if it had been an innocent mistake. His presumption is of malevolence rather than innocence; his reaction is automatic hostility. Along with the knee-jerk perception of a hostile act is entwined an equally automatic aggression; instead of, say, pointing out to the other boy that equally automatic aggression; instead of, say, pointing out to the other boy that he made a mistake, he will jump to accusation, yelling, hitting. And the more such children do this, the more automatic aggression becomes for them, and the more the repertoire of alternatives — politeness, joking — shrinks.

Such children are emotionally vulnerable in the sense that they have a low threshold for upset, getting peeved more often by more things; once upset, their thinking is muddled, so that they see benign acts as hostile and fall back on their overlearned habit of striking out.

These perceptual biases toward hostility are already in place by the early grades. While most children, and especially boys, are rambunctious in kindergarten and first grade, the more aggressive children fail to learn a modicum of self-control by second grade. Where other children have started to learn negotiation and compromise for playground disagreements, the bullies rely more and more on force and bluster. They pay a social price: within two or three hours of a first playground contact with a bully, other children already say they dislike him.

But studies that have followed children from the preschool years into the teenage ones find that up to half of first graders who are disruptive, unable to get along with other kids, disobedient with their parents, and resistant with teachers will become delinquents in their teen years. Of course, not all such aggressive children are on the trajectory that leads to violence and criminality in later life.

But of all children, these are the ones most at risk for eventually committing violent crimes.
The drift toward crime shows up surprisingly early in these children's lives.
When children in a Montreal kindergarten were rated for hostility and trouble making, those highest at age five already had far greater evidence of delinquency just five to eight years later, in their early teens. They were about three times as likely as other children to admit they had beaten up someone who had not done anything to them, to have shoplifted, to have used a weapon in a fight, to have broken into or stolen parts from a car, and to have been drunk—and all this before they reached fourteen years of age.

The prototypical pathway to violence and criminality starts with children who are aggressive and hard to handle in first and second grade. Typically, from the earliest school years their poor impulse control also contributes to their being poor students, seen as, and seeing themselves as, "dumb"—a judgment confirmed by their being shunted to special-education classes (and though such children may have a higher rate of "hyperactivity" or learning disorders, by nomeans all do). Children who on entering school already have learned in their homes a "coercive" style—that is, bullying—are also written off by their teachers, who have to spend too much time keeping the children in line. The defiance of classroom rules that comes naturally to these children means that they waste time that would otherwise be used in learning; their destined academic failure is usually obvious by about third grade. While boys on a trajectory toward delinquency tend to have lower IQ scores than their peers, their impulsivity is more directly at cause: impulsivity in ten-year-old boys is almost three times as powerful a predictor of their later delinquency as is their IQ.

By fourth or fifth grade these kids—by now seen as bullies or just "difficult"—are rejected by their peers and are unable to make friends easily, if at all, and have become academic failures. Feeling themselves friendless, they gravitate to other social outcasts. Between grade four and grade nine they commit themselves to their outcast group and a life of defying the law: they show a five fold increase in their truancy, drinking, and drug taking, with the biggest boost between seventh and eighth grade. By the middle-school years, they are joined by another type of "late starters," who are attracted to their defiant style; these late starters are often youngsters who are completely unsupervised at home and have started roaming the streets on their own in grade school. In the high-school years this outcast group typically drops out of school in a drift toward delinquency, engaging in petty crimes such as shoplifting, theft, and drug dealing.

(A telling difference emerges in this trajectory between boys and girls. A study of fourth-grade girls who were "bad"—getting in trouble with teachers and breaking rules, but not unpopular with their peers—found that 40 percent had a child by the time they finished the high-school years. That was three times the average pregnancy rate for girls in their schools. In other words, antisocial teenage girls don't get violent—they get pregnant.) There is, of course, no single pathway to violence and criminality, and many other factors can put a child at risk: being born in a high-crime neighborhood where they are exposed to more temptations to crime and violence, coming from a family under high levels of stress, or living in poverty. But none of these factors makes a life of violent crime inevitable. All things being equal, the psychological forces at work in aggressive children greatly intensify the likelihood of their ending up as violent criminals. As Gerald Patterson, a psychologist who has closely followed the careers of hundreds of boys into young adulthood, puts it, "the antisocial acts of a five-year-old may be prototypic of the acts of the delinquent adolescent."

SCHOOL FOR BULLIES

The bent of mind that aggressive children take with them through life is one that almost ensures they will end up in trouble. A study of juvenile offenders convicted of violent crimes and of aggressive high-school students found a common mind-set: When they have difficulties with someone, they immediately see the other person in an antagonistic way, jumping to conclusions about the other person's hostility toward them without seeking any further information or trying to think of a peaceful way to settle their differences. At the same time, the negative consequence of a violent solution—a fight, typically—never crosses their mind. Their aggressive bent is justified in their mind by beliefs like:
"It's okay to hit someone if you just go crazy from anger"; 
"If you back down from a fight everyone will think you're a coward"; and 
"People who get beaten up badly don't really suffer that much."

But timely help can change these attitudes and stop a child's trajectory toward delinquency; several experimental programs have had some success in helping such aggressive kids learn to control their antisocial bent before it leads to more serious trouble. One, at Duke University, worked with anger-ridden grade-school troublemakers in training sessions for forty minutes twice a week for six to twelve weeks. The boys were taught, for example, to see how some of the social cues they interpreted as hostile were in fact neutral or friendly. They learned to take the perspective of other children, to get a sense of how they were being seen and of what other children might be thinking and feeling in the encounters that had gotten them so angry. They also got direct training in anger control through enacting scenes, such as being teased, that might lead them to lose their temper.
One of the key skills for anger control was monitoring their feelings—becoming aware of their body's sensations, such as flushing or muscle tensing, as they were getting angry, and to take those feelings as a cue to stop and consider what to do next rather than strike out impulsively.

John Lochman, a Duke University psychologist who was one of the designers of the program, told me, "They'll discuss situations they've been in recently, like being bumped in the hallway when they think it was on purpose. The kids will talk about how they might have handled it. One kid said, for example, that he just stared at the boy who bumped him and told him not to do it again, and walked away. That put him in the position of exerting some control and keeping walked away. That put him in the position of exerting some control and keeping his self-esteem, without starting a fight."

This appeals; many such aggressive boys are unhappy that they lose their temper so easily, and so are receptive to learning to control it. In the heat of the moment, of course, such cool-headed responses as walking away or counting to ten so the impulse to hit will pass before reacting are not automatic; the boys practice such alternatives in role-playing scenes such as getting on a bus where other kids are taunting them. That way they can try out friendly responses that preserve their dignity while giving them an alternative to hitting, crying, or running away in shame.
Three years after the boys had been through the training, Lochman compared these boys with others who had been just as aggressive, but did not have the benefit of the anger-control sessions. He found that, in adolescence, the boys who graduated from the program were much less disruptive in class, had more positive feelings about themselves, and were less likely to drink or take drugs.
And the longer they had been in the program, the less aggressive they were as teenagers.

PREVENTING DEPRESSION

Dana, sixteen, had always seemed to get along. But now, suddenly, she just could not relate with other girls, and, more troubling for her, she could not find a way to hold on to boyfriends, even though she slept with them. Morose and constantly fatigued, Dana lost interest in eating, in having fun of any kind; she said she felt hopeless and helpless to do anything to escape her mood, and was thinking of suicide.
The drop into depression had been triggered by her most recent breakup. She said she didn't know how to go out with a boy without getting sexually involved right away—even if she was uncomfortable about it—and that she did not know how to end a relationship even if it was unsatisfying. She went to bed with boys, she said, when all she really wanted to do was get to know them better.

She had just moved to a new school, and felt shy and anxious about making friends with girls there. For instance, she held back from starting conversations, only talking once someone spoke to her. She felt unable to let them know what she was like, and didn't even feel she knew what to say after "Hello, how are you?"

Dana went for therapy to an experimental program for depressed adolescents at Columbia University. Her treatment focused on helping her learn how to handle her relationships better: how to develop a friendship, how to feel more confident with other teens, how to assert limits on sexual closeness, how to be intimate, how to express her feelings. In essence, it was a remedial tutorial in some of the most basic emotional skills. And it worked; her depression lifted.

Particularly in young people, problems in relationships are a trigger for depression. The difficulty is as often in children's relationships with their parents as it is with their peers. Depressed children and teenagers are frequently unable or unwilling to talk about their sadness. They seem unable to label their feelings accurately, showing instead a sullen irritability, impatience, crankiness, and anger—especially toward their parents. This, in turn, makes it harder for their parents to offer the emotional support and guidance the depressed child actually needs, setting in motion a downward spiral that typically ends in constant arguments and alienation.

A new look at the causes of depression in the young pinpoints deficits in two areas of emotional competence: 
# relationship skills, on the one hand, and 
# a depression-promoting way of interpreting setbacks, on the other. 

While some of the tendency to depression almost certainly is due to genetic destiny, some of that tendency seems due to reversible, pessimistic habits of thought that predispose children to react to life's small defeats—a bad grade, arguments with parents, a social rejection—by becoming depressed. And there is evidence to suggest that the predisposition to depression, whatever its basis, is becoming ever more widespread among the young.

A COST OF MODERNITY: RISING RATES OF DEPRESSION

These millennial years are ushering in an Age of Melancholy, just as the twentieth century became an Age of Anxiety. International data show what seems to be a modern epidemic of depression, one that is spreading side by side with the adoption throughout the world of modern ways. Each successive generation worldwide since the opening of the century has lived with a higher risk than their parents of suffering a major depression—not just sadness, but a paralyzing listlessness, dejection, and self-pity, and an overwhelminghopelessness—over the course of life. And those episodes are beginning at earlier and earlier ages. Childhood depression, once virtually unknown (or, at least, unrecognized) is emerging as a fixture of the modern scene.
Although the likelihood of becoming depressed rises with age, the greatest increases are among young people. For those born after 1955 the likelihood they will suffer a major depression at some point in life is, in many countries, three times or more greater than for their grandparents. Among Americans born before 1905, the rate of those having a major depression over a lifetime was just 1 percent; for those born since 1955, by age twenty-four about 6 percent had become depressed. For those born between 1945 and 1954, the chances of having had a major depression before age thirty-four are ten times greater than for those born between 1905 and 1914. And for each generation the onset of a person's first episode of depression has tended to occur at an ever-earlier age.

A worldwide study of more than thirty-nine thousand people found the same trend in Puerto Rico, Canada, Italy, Germany, France, Taiwan, Lebanon, and New Zealand. In Beirut, the rise of depression tracked political events closely, the upward trends rocketing during periods of civil war. In Germany, for those born before 1914 the rate of depression by age thirty-five is 4 percent; for those born in the decade before 1944 it is 14 percent at age thirty-five. Worldwide, generations that came of age during politically troubled times had higher rates of depression, though the overall upward trend holds apart from any political events.

The lowering into childhood of the age when people first experience depression also seems to hold worldwide. When I asked experts to hazard a guess as to why, there were several theories.
Dr. Frederick Goodwin, then director of the National Institute of Mental Health, speculated, "There's been a tremendous erosion of the nuclear family—a doubling of the divorce rate, a drop in parents' time available to children, and an increase in mobility. You don't grow up knowing your extended family much anymore. The losses of these stable sources of self-identification mean a greater susceptibility to depression."

Dr. David Kupfer, chairman of psychiatry at the University of Pittsburgh medical school, pointed to another trend: "With the spread of industrialization after World War II, in a sense nobody was home anymore. In more and more families there has been growing parental indifference to children's needs as they grow up. This is not a direct cause of depression, but it sets up a vulnerability.

Early emotional stressors may affect neuron development, which can lead to a depression when you are under great stress even decades later."

Martin Seligman, the University of Pennsylvania psychologist, proposed: "For the last thirty or forty years we've seen the ascendance of individualism and a waning of larger beliefs in religion, and in supports from the community and extended family. That means a loss of resources that can buffer you against setbacks and failures. To the extent you see a failure as something that is lasting and which you magnify to taint everything in your life, you are prone to let a momentary defeat become a lasting source of hopelessness. But if you have a larger perspective, like a belief in God and an afterlife, and you lose your job, it's just a temporary defeat."

Whatever the cause, depression in the young is a pressing problem. In the United States, estimates vary widely for how many children and teens are depressed in any given year, as opposed to vulnerability over their lifetime.

Some epidemiological studies using strict criteria—the official diagnostic symptoms for depression—have found that for boys and girls between ten and thirteen the rate of major depression over the course of a year is as high as 8 or 9 percent, though other studies place it at about half that rate (and some as low as about 2 percent). At puberty, some data suggest, the rate nearly doubles for girls; up to 16 percent of girls between fourteen and sixteen suffer a bout of depression, while the rate is unchanged for boys.25

THE COURSE OF DEPRESSION IN THE YOUNG

That depression should not just be treated, but prevented, in children is clear from an alarming discovery: Even mild episodes of depression in a child can augur more severe episodes later in life. This challenges the old assumption that depression in childhood does not matter in the long run, since children supposedly "grow out of it." Of course, every child gets sad from time to time; childhood and adolescence are, like adulthood, times of occasional disappointments and losses large and small with the attendant grief. The need for prevention is not for these times, but for those children for whom sadness spirals downward into a gloom that leaves them despairing, irritable, and withdrawn—a far more severe melancholy.

Among children whose depression was severe enough that they were referred for treatment, three quarters had a subsequent episode of severe depression, according to data collected by Maria Kovacs, a psychologist at Western Psychiatric Institute and Clinic in Pittsburgh. Kovacs studied children diagnosed with depression when they were as young as eight years old, assessing them every few years until some were as old as twenty-four.

The children with major depression had episodes lasting about eleven months on average, though in one in six of them it persisted for as long as eighteen months. Mild depression, which began as early as age five in some children, was less incapacitating but lasted far longer—an average of about four years. And, Kovacs found, children who have a minor depression are more likely to have it intensify into major depression—a so-called double depression. Those who develop double depression are much more prone to suffer recurring episodes as the years go on. As children who had an episode of depression grew into adolescence and early adulthood, they suffered from depression or manic-depressive disorder, on average, one year in three.

The cost to children goes beyond the suffering caused by depression itself.

Kovacs told me, "Kids learn social skills in their peer relations—for example, what to do if you want something and aren't getting it, seeing how other children handle the situation and then trying it yourself. But depressed kids are likely to be among the neglected children in a school, the ones other kids don't play with much."

The sullenness or sadness such children feel leads them to avoid initiating social contacts, or to look away when another child is trying to engage them—a social signal the other child only takes as a rebuff; the end result is that depressed children end up rejected or neglected on the playground. This lacuna in their interpersonal experience means they miss out on what they would normally learn in the rough-and-tumble of play, and so can leave them social and emotional laggards, with much catching up to do after the depression lifts.

Indeed, when depressed children have been compared to those without depression, they have been found to be more socially inept, to have fewer friends, to be less preferred than others as playmates, to be less liked, and to have more troubled relationships with other children.
Another cost to these children is doing poorly in school; depression interferes with their memory and concentration, making it harder to pay attention in class and retain what is taught. A child who feels no joy in anything will find it hard to marshal the energy to master challenging lessons, let alone experience flow in learning. Understandably, the longer children in Kovacs's study were depressed, the more their grades dropped and the poorer they did on achievement tests, so that they were more likely to be held back in school. In fact, there was a direct correlation between the length of time a child had been depressed and his grade- point average, with a steady plummet over the course of the episode. All of thispoint average, with a steady plummet over the course of the episode. All of this academic rough going, of course, compounds the depression. As Kovacs observes, "Imagine you're already feeling depressed, and you start flunking out of school, and you sit home by yourself instead of playing with other kids."

DEPRESSIONOGENIC WAYS OF THOUGHT

Just as with adults, pessimistic ways of interpreting life's defeats seem to feed the sense of helplessness and hopelessness at the heart of children's depression.
That people who are already depressed think in these ways has long been known. What has only recently emerged, though, is that children who are most prone to melancholy tend toward this pessimistic outlook before they become depressed. This insight suggests a window of opportunity for inoculating them against depression before it strikes.

One line of evidence comes from studies of children's beliefs about their own ability to control what happens in their lives—for example, being able to change things for the better. This is assessed by children's ratings of themselves in such terms as "When I have problems at home I'm better than most kids at helping to solve the problems" and "When I work hard I get good grades." Children who say none of these positive descriptions fits them have little sense that they can do anything to change things; this sense of helplessness is highest in those children who are most depressed.

A telling study looked at fifth and sixth graders in the few days after they received report cards. As we all remember, report cards are one of the greatest sources of elation and despair in childhood. But researchers find a marked consequence in how children assess their role when they get a worse grade than they expected. Those who see a bad grade as due to some personal flaw ("I'm stupid") feel more depressed than those who explain it away in terms of something they could change ("If I work harder on my math homework I'll get a better grade").

Researchers identified a group of third, fourth, and fifth graders whom classmates had rejected, and tracked which ones continued to be social outcasts in their new classes the following year. How the children explained the rejection to themselves seemed crucial to whether they became depressed. Those who saw their rejection as due to some flaw in themselves grew more depressed. But the optimists, who felt that they could do something to change things for the better, were not especially depressed despite the continuing rejection. And in a study of children making the notoriously stressful transition to seventh grade, those who had the pessimistic attitude responded to high levels of hassles at school and to any additional stress at home by becoming depressed.

The most direct evidence that a pessimistic outlook makes children highly susceptible to depression comes from a five-year study of children beginning when they were in third grade.

Among the younger children, the strongest predictor that they would become depressed was a pessimistic outlook coupled with a major blow such as parents divorcing or a death in the family, which left the child upset, unsettled, and, presumably, with parents less able to offer a nurturing buffer. As the children grew through the elementary-school years, there was a telling shift in their thinking about the good and bad events of their lives, with the children increasingly ascribing them to their own traits: "I'm getting good grades because I'm smart"; "I don't have many friends because I'm no fun." This shift seems to set in gradually over the third to fifth grades. As this happens those children who develop a pessimistic outlook—attributing the setbacks in their lives to some dire flaw in themselves—begin to fall prey to depressed moods in reaction to setbacks. What's more, the experience of depression itself seems to reinforce these pessimistic ways of thinking, so that even after the depression lifts, the child is left with what amounts to an emotional scar, a set of convictions fed by the depression and solidified in the mind: that he can't do well in school, is unlikable, and can do nothing to escape his own brooding moods. These fixed ideas can make the child all the more vulnerable to another depression down the road.

SHORT-CIRCUITING DEPRESSION

The good news: there is every sign that teaching children more productive ways of looking at their difficulties lowers their risk of depression. In a study of one Oregon high school, about one in four students had what psychologists call a "low-level depression," not severe enough to say it was beyond ordinary unhappiness as yet. Some may have been in the early weeks or months of what was to become a depression.

In a special after-school class seventy-five of the mildly depressed students learned to challenge the thinking patterns associated with depression, to becomemore adept at making friends, to get along better with their parents, and to engage in more social activities they found pleasant. By the end of the eight- week program, 55 percent of the students had recovered from their mild depression, while only about a quarter of equally depressed students who were not in the program had begun to pull out of their depression. A year later a quarter of those in the comparison group had gone on to fall into a major depression, as opposed to only 14 percent of students in the depression- prevention program. Though they lasted just eight sessions, the classes seemed to have cut the risk of depression in half.

Similarly promising findings came from a special once-a-week class given to ten-to thirteen-year-old youngsters at odds with their parents and showing some signs of depression. In after-school sessions they learned some basic emotional skills, including handling disagreements, thinking before acting, and, perhaps most important, challenging the pessimistic beliefs associated with depression— for example, resolving to study harder after doing poorly on an exam instead of thinking, "I'm just not smart enough."
"What a child learns in these classes is that moods like anxiety, sadness, and anger don't just descend on you without your having any control over them, but that you can change the way you feel by what you think," points out psychologist Martin Seligman, one of the developers of the twelve-week program. Because disputing the depressing thoughts vanquishes the gathering mood of gloom, Seligman added, "it's an instant reinforcer that becomes a habit."
Again the special sessions lowered depression rates by one half—and did so as long as two years later. A year after the classes ended, just 8 percent of those who participated scored at a moderate-to-severe level on a test of depression, versus 29 percent of children in a comparison group. And after two years, about 20 percent of those in the course were showing some signs of at least mild depression, compared to 44 percent of those in the comparison group.

Learning these emotional skills at the cusp of adolescence may be especially helpful. Seligman observes, "These kids seem to be better at handling the routine teenage agonies of rejection. They seem to have learned this at a crucial window for risk of depression, just as they enter the teen years. And the lesson seems to persist and grow a bit stronger over the course of the years after they learn it, suggesting the kids are actually using it in their day-to-day lives."
Other experts on childhood depression applaud the new programs. "If you want to make a real difference for psychiatric illness like depression, you have to do something before the kids get sick in the first place," Kovacs commented.do something before the kids get sick in the first place," Kovacs commented.
"The real solution is a psychological inoculation."

EATING DISORDERS

During my days as a graduate student in clinical psychology in the late 1960s, I knew two women who suffered from eating disorders, though I realized this only after many years had passed. One was a brilliant graduate student in mathematics at Harvard, a friend from my undergraduate days; the other was on the staff at M.I.T. The mathematician, though skeletally thin, simply could not bring herself to eat; food, she said, repulsed her. The librarian had an ample figure and was given to bingeing on ice cream, Sara Lee carrot cake, and other desserts; then—as she once confided with some embarrassment—she would secretly go off to the bathroom and make herself vomit. Today the mathematician would be diagnosed with anorexia nervosa, the librarian with bulimia.
In those years there were no such labels. Clinicians were just beginning to comment on the problem; Hilda Bruch, the pioneer in this movement, published her seminal article on eating disorders in 1969.37 Bruch, puzzled by women who were starving themselves to death, proposed that one of the several underlying causes lay in an inability to label and respond appropriately to bodily urges— notably, of course, hunger. Since then the clinical literature on eating disorders has mushroomed, with a multitude of hypotheses about the causes, ranging from ever-younger girls feeling compelled to compete with unattainably high standards of female beauty, to intrusive mothers who enmesh their daughters in a controlling web of guilt and blame.
Most of these hypotheses suffered from one great drawback: they were extrapolations from observations made during therapy. Far more desirable, from a scientific viewpoint, are studies of large groups of people over a period of several years, to see who among them eventually comes down with the problem.
That kind of study allows a clean comparison that can tell, for example, if having controlling parents predisposes a girl to eating disorders. Beyond that, it can identify the cluster of conditions that leads to the problem, and distinguish them from conditions that might seem to be a cause, but which actually are found as often in people without the problem as in those who come for treatment.
When just such a study was done with more than nine hundred girls in theseventh through tenth grades, emotional deficits—particularly a failure to tell distressing feelings from one another and to control them—were found to be key among the factors leading to eating disorders.38 Even by tenth grade, there were sixty-one girls in this affluent, suburban Minneapolis high school who already had serious symptoms of anorexia or bulimia. The greater the problem, the more the girls reacted to setbacks, difficulties, and minor annoyances with intense negative feelings that they could not soothe, and the less their awareness of what, exactly, they were feeling. When these two emotional tendencies were coupled with being highly dissatisfied with their body, then the outcome was anorexia or bulimia. Overly controlling parents were found not to play a prime role in causing eating disorders. (As Bruch herself had warned, theories based on hindsight were unlikely to be accurate; for example, parents can easily become intensely controlling in response to their daughter's eating disorder, out of desperation to help her.) Also judged irrelevant were such popular explanations as fear of sexuality, early onset of puberty, and low self-esteem.
Instead, the causal chain this prospective study revealed began with the effects on young girls of growing up in a society preoccupied with unnatural thinness as a sign of female beauty. Well in advance of adolescence, girls are already self- conscious about their weight. One six-year-old, for example, broke into tears when her mother asked her to go for a swim, saying she'd look fat in a swimsuit.

In fact, says her pediatrician, who tells the story, her weight was normal for her height. In one study of 271 young teenagers, half the girls thought they were too fat, even though the vast majority of them were normal in weight. But the Minneapolis study showed that an obsession with being overweight is not in and of itself sufficient to explain why some girls go on to develop eating disorders.

Some obese people are unable to tell the difference between being scared, angry, and hungry, and so lump all those feelings together as signifying hunger, which leads them to overeat whenever they feel upset. Something similar seems to be happening in these girls. Gloria Leon, the University of Minnesota psychologist who did the study of young girls and eating disorders, observed that these girls "have poor awareness of their feelings and body signals; that was the strongest single predictor that they would go on to develop an eating disorder within the next two years. Most children learn to distinguish among their sensations, to tell if they're feeling bored, angry, depressed, or hungry—it's a basic part of emotional learning. But these girls have trouble distinguishing among their most basic feelings. They may have a problem with their boyfriend, and not be sure whether they're angry, or anxious, or depressed—they justexperience a diffuse emotional storm that they do not know how to deal with effectively. Instead they learn to make themselves feel better by eating; that can become a strongly entrenched emotional habit."

But when this habit for soothing themselves interacts with the pressures girls feel to stay thin, the way is paved for eating disorders to develop. "At first she might start with binge eating," Leon observes. "But to stay thin she may turn to vomiting or laxatives, or intense physical exertion to undo the weight gain from overeating. Another avenue this struggle to handle emotional confusion can take is for the girl not to eat at all—it can be a way to feel you have at least some control over these overwhelming feelings."
The combination of poor inner awareness and weak social skills means that these girls, when upset by friends or parents, fail to act effectively to soothe either the relationship or their own distress. Instead their upset triggers the eating disorder, whether it be that of bulimia or anorexia, or simply binge eating.
Effective treatments for such girls, Leon believes, need to include some remedial instruction in the emotional skills they lack. "Clinicians find," she told me, "that if you address the deficits therapy works better. These girls need to learn to identify their feelings and learn ways to soothe themselves or handle their relationships better, without turning to their maladaptive eating habits to do the job."

ONLY THE LONELY: DROPOUTS

It's a grade-school drama: Ben, a fourth grader with few friends, has just heard from his one buddy, Jason, that they aren't going to play together this lunch period—Jason wants to play with another boy, Chad, instead. Ben, crushed, hangs his head and cries. After his sobs subside, Ben goes over to the lunch table where Jason and Chad are eating.
"I hate your guts!" Ben yells at Jason.
"Why?" Jason asks.
"Because you lied," Ben says, his tone accusatory. "You said this whole week that you were gonna play with me and you lied."
Ben then stalks off to his empty table, crying quietly. Jason and Chad go over to him and try to talk to him, but Ben puts his fingers in his ears, determinedly ignoring them, and runs out of the lunchroom to hide behind the school Dumpster. A group of girls who have witnessed the exchange try to play a peacemaker role, finding Ben and telling him that Jason is willing to play with him too. But Ben will have none of it, and tells them to leave him alone. Henurses his wounds, sulking and sobbing, defiantly alone.41
A poignant moment, to be sure; the feeling of being rejected and friendless is one most everyone goes through at some point in childhood or adolescence. But what is most telling about Ben's reaction is his failure to respond to Jason's efforts to repair their friendship, a stance that extends his plight when it might have ended. Such an inability to seize key cues is typical of children who are unpopular; as we saw in Chapter 8, socially rejected children typically are poor at reading emotional and social signals; even when they do read such signals, they may have limited repertoires for response.
Dropping out of school is a particular risk for children who are social rejects.
The dropout rate for children who are rejected by their peers is between two and eight times greater than for children who have friends. One study found, for example, that about 25 percent of children who were unpopular in elementary school had dropped out before completing high school, compared to a general rate of 8 percent.42 Small wonder: imagine spending thirty hours a week in a place where no one likes you.
Two kinds of emotional proclivities lead children to end up as social outcasts.
As we have seen, one is the propensity to angry outbursts and to perceive hostility even where none is intended. The second is being timid, anxious, and socially shy. But over and above these temperamental factors, it is children who are "off—whose awkwardness repeatedly makes people uncomfortable—who tend to be shunted aside.
One way these children are "off is in the emotional signals they send. When grade schoolers with few friends were asked to match an emotion such as disgust or anger with faces that displayed a range of emotions, they made far more mismatches than did children who were popular. When kindergarteners were asked to explain ways they might make friends with someone or keep from having a fight, it was the unpopular children—the ones others shied away from playing with—who came up with self-defeating answers ("Punch him" for what to do when both children wanted the same toy, for example), or vague appeals for help from a grown-up. And when teenagers were asked to role-play being sad, angry, or mischievous, the more unpopular among them gave the least convincing performances. It is perhaps no surprise that such children come to feel that they are helpless to do any better at making friends; their social incompetence becomes a self-fulfilling prophecy. Instead of learning new approaches to making friends, they simply keep doing the same things that have not worked for them in the past, or come up with even more inept responses.

In the lottery of liking, these children fall short on key emotional criteria: theyIn the lottery of liking, these children fall short on key emotional criteria: they are not seen as fun to be with, and they don't know how to make another child feel good. Observations of unpopular children at play show, for example, that they are much more likely than others to cheat, sulk, quit when losing, or show off and brag about winning. Of course, most children want to win at a game— but win or lose, most children are able to contain their emotional reaction so that it does not undermine the relationship with the friend they play games with.
While children who are socially tone-deaf—who continually have trouble reading and responding to emotions—end up as social isolates, this does not apply, of course, to children who go through a temporary period of feeling left out. But for those who are continually excluded and rejected, their painful outcast status clings to them as they continue their school years. The consequences of ending up at the social margins are potentially great as a child continues on into adulthood. For one, it is in the cauldron of close friendships and the tumult of play that children refine the social and emotional skills that they will bring to relationships later in life. Children who are excluded from this realm of learning are, inevitably, disadvantaged.
Understandably, those who are rejected report great anxiety and many worries, as well as being depressed and lonely. In fact, how popular a child was in third grade has been shown to be a better predictor of mental-health problems at age eighteen than anything else—teachers' and nurses' ratings, school performance and IQ, even scores on psychological tests.44 And, as we have seen, in later stages of life people who have few friends and are chronically lonely are at greater risk for medical diseases and an early death.
As psychoanalyst Harry Stack Sullivan pointed out, we learn how to negotiate intimate relations—to work out differences and share our deepest feelings—in our first close friendships with same-sex chums. But children who are socially rejected are only half as likely as their peers to have a best friend during the crucial years of elementary school, and so miss out on one of the essential chances for emotional growth.45 One friend can make the difference—even when all others turn their backs (and even when that friendship is not all that solid).
COACHING FOR FRIENDSHIP
There is hope for rejected children, despite their ineptness. Steven Asher, aUniversity of Illinois psychologist, has designed a series of "friendship coaching" sessions for unpopular children that has shown some success.46
Identifying third and fourth graders who were the least liked in their classes,
Asher gave them six sessions in how to "make playing games more fun" through being "friendly, fun, and nice." To avoid stigma, the children were told that they were acting as "consultants" to the coach, who was trying to learn what kinds of things make it more enjoyable to play games.
The children were coached to act in ways Asher had found typical of more popular children. For example, they were encouraged to think of alternative suggestions and compromises (rather than fighting) if they disagree about the rules; to remember to talk with and ask questions about the other child while they play; to listen and look at the other child to see how he's doing; to say something nice when the other person does well; to smile and offer help or suggestions and encouragement. The children also tried out these basic social amenities while playing games such as Pick-up Sticks with a classmate, and were coached afterward on how well they did. This minicourse in getting along had a remarkable effect: a year later the children who were coached—all of whom were selected because they were the least-liked in their class—were now solidly in the middle of classroom popularity. None were social stars, but none were rejects.
Similar results have been found by Stephen Nowicki, an Emory University psychologist.47 His program trains social outcasts to hone their ability to read and respond appropriately to other children's feelings. The children, for example, are videotaped while practicing expression of feelings such as happiness and sadness, and are coached to improve their emotional expressiveness. They then try out their newly honed skills with a child they want to make friends with.
Such programs have reported a 50 to 60 percent success rate in raising the popularity of rejected children. These programs (at least as presently designed) seem to work best for third and fourth graders rather than children in higher grades, and to be more helpful for socially inept children than for highly aggressive ones. But that is all a matter for fine-tuning; the hopeful sign is that many or most rejected children can be brought into the circle of friendship with some basic emotional coaching.

DRINKING AND DRUGS: ADDICTION AS SELF-MEDICATION

Students at the local campus call it drinking to black —bingeing on beer to the point of passing out. One of the techniques: attach a funnel to a garden hose, so that a can of beer can be downed in about ten seconds. The method is not an isolated oddity. One survey found that two fifths of male college students down seven or more drinks at a time, while 11 percent call themselves "heavy drinkers." Another term, of course, might be "alcoholics." About half of college men and almost 40 percent of women have at least two binge-drinking episodes in a month.

While in the United States use of most drugs among young people generally tapered off in the 1980s, there is a steady trend toward more alcohol use at ever- younger ages. A 1993 survey found that 35 percent of college women said they drank to get drunk, while just 10 percent did so in 1977; overall, one in three students drinks to get drunk. That poses other risks: 90 percent of all rapes reported on college campuses happened when either the assailant or the victim— or both—had been drinking. Alcohol-related accidents are the leading cause of death among young people between fifteen and twenty-four.

Experimentation with drugs and alcohol might seem a rite of passage for adolescents, but this first taste can have long-lasting results for some. For most alcoholics and drug abusers, the beginnings of addiction can be traced to their teen years, though few of those who so experiment end up as alcoholics or drug abusers. By the time students leave high school, over 90 percent have tried alcohol, yet only about 14 percent eventually become alcoholics; of the millions of Americans who experimented with cocaine, fewer than 5 percent became addicted. What makes the difference? To be sure, those living in high-crime neighborhoods, where crack is sold on the corner and the drug dealer is the most prominent local model of economic success, are most at risk for substance abuse. Some may end up addicted through becoming small-time dealers themselves, others simply because of the easy access or a peer culture that glamorizes drugs—a factor that heightens the risk of drug use in any neighborhood, even (and perhaps especially) the most well-off.

But still the question remains, of the pool of those exposed to these lures and pressures, and who go on to experiment, which ones are most likely to end up with a lasting habit? One current scientific theory is that those who stay with the habit, becoming increasingly dependent on alcohol or drugs, are using these substances as a medication of sorts, a way to soothe feelings of anxiety, anger, or depression. Through their early experimentation they hit upon a chemical fix, a way to calm the feelings of anxiety or melancholy that have tormented them. Thus of several hundred seventh-and eighth-grade students tracked for two years, it was those who reported higher levels of emotional distress who subsequently went on to have the highest rates of substance abuse. This may explain why so many young people are able to experiment with drugs and drinking without becoming addicted, while others become dependent almost from the start: those most vulnerable to addiction seem to find in the drug or alcohol an instant way to soothe emotions that have distressed them for years.

As Ralph Tarter, a psychologist at the Western Psychiatric Institute and Clinic in Pittsburgh, put it, "For people who are biologically predisposed, the first drink or dose of a drug is immensely reinforcing, in a way others just don't experience. Many recovering drug abusers tell me, 'The moment I took my first drug, I felt normal for the first time.' It stabilizes them physiologically, at least in the short term." 
That, of course, is the devil's bargain of addiction: a short-term good feeling in exchange for the steady meltdown of one's life.

Certain emotional patterns seem to make people more likely to find emotional relief in one substance rather than another. For example, there are two emotional pathways to alcoholism. One starts with someone who was highly-strung and anxious in childhood, who typically discovers as a teenager that alcohol will calm the anxiety. Very often they are children—usually sons—of alcoholics who themselves have turned to alcohol to soothe their nerves. 

One biological marker for this pattern is undersecretion of GABA, a neurotransmitter that regulates anxiety—too little GABA is experienced as a high level of tension. One study found that sons of alcoholic fathers had low levels of GABA and were highly anxious, but when they drank alcohol, their GABA levels rose as their anxiety fell. These sons of alcoholics drink to ease their tension, finding in alcohol a relaxation that they could not seem to get otherwise. Such people may be vulnerable to abusing sedatives as well as alcohol for the same anxiety-reduction effect.

A neuropsychological study of sons of alcoholics who at age twelve showed signs of anxiety such as a heightened heart rate in response to stress, as well as impulsivity, found the boys also had poor frontal lobe functioning. Thus the brain areas that might have helped ease their anxiety or control their impulsiveness brought them less help than in other boys. And since the pre- frontal lobes also handle working memory—which holds in mind the consequences of various routes of action while making a decision—their deficit could support a slide into alcoholism by helping them ignore the long-term drawbacks of drinking, even as they found an immediate sedation from anxiety through alcohol.

This craving for calm seems to be an emotional marker of a genetic susceptibility to alcoholism. A study of thirteen hundred relatives of alcoholics found that the children of alcoholics who were most at risk for becoming alcoholics themselves were those who reported having chronically high levels of anxiety. Indeed, the researchers concluded that alcoholism develops in such people as "self-medication of anxiety symptoms."

A second emotional pathway to alcoholism comes from a high level of agitation, impulsivity, and boredom. This pattern shows up in infancy as being restless, cranky, and hard to handle, in grade school as having the "fidgets," hyperactivity, and getting into trouble, a propensity that, as we have seen, can push such children to seek out friends on the fringe—sometimes leading to a criminal career or the diagnosis of "antisocial personality disorder." Such people (and they are mainly men) have as their main emotional complaint agitation; their main weakness is unrestrained impulsivity; their usual reaction to boredom —which they often feel—is an impulsive search for risk and excitement. As adults, people with this pattern (which may be tied to deficiencies in two other neurotransmitters, serotonin and MAO) find that alcohol can soothe their agitation. And the fact that they can't stand monotony makes them ready to try anything; coupled with their general impulsivity, it makes them prone to abusing an almost random list of drugs besides alcohol.

While depression can drive some to drink, the metabolic effects of alcohol often simply worsen the depression after a short lift. People who turn to alcohol as an emotional palliative do so much more often to calm anxiety than for depression; an entirely different class of drugs soothes the feelings of people who are depressed—at least temporarily. Feeling chronically unhappy puts people at greater risk for addiction to stimulants such as cocaine, which provide a direct antidote to feeling depressed. One study found that more than half the patients being treated at a clinic for cocaine addiction would have been diagnosed with severe depression before they started their habit, and the deeper the preceding depression, the stronger the habit.

Chronic anger may lead to still another kind of susceptibility. In a study of four hundred patients being treated for addiction to heroin and other opioids, the most striking emotional pattern was a lifelong difficulty handling anger and a quickness to rage. Some of the patients themselves said that with opiates theyfinally felt normal and relaxed.60
Though the predisposition to substance abuse may, in many cases, be brain- based, the feelings that drive people to "self-medicate" themselves through drink or drugs can be handled without recourse to medication, as Alcoholics Anonymous and other recovery programs have demonstrated for decades.
Acquiring the ability to handle those feelings—soothing anxiety, lifting depression, calming rage—removes the impetus to use drugs or alcohol in the first place. These basic emotional skills are taught remedially in treatment programs for drug and alcohol abuse. It would be far better, of course, if they were learned early in life, well before the habit became established.

NO MORE WARS: A FINAL COMMON PREVENTIVE PATHWAY

Over the last decade or so "wars" have been proclaimed, in turn, on teen pregnancy, dropping out, drugs, and most recently violence. The trouble with such campaigns, though, is that they come too late, after the targeted problem has reached epidemic proportions and taken firm root in the lives of the young.
They are crisis intervention, the equivalent of solving a problem by sending an ambulance to the rescue rather than giving an inoculation that would ward off the disease in the first place. Instead of more such "wars," what we need is to follow the logic of prevention, offering our children the skills for facing life that will increase their chances of avoiding any and all of these fates.

My focus on the place of emotional and social deficits is not to deny the role of other risk factors, such as growing up in a fragmented, abusive, or chaotic family, or in an impoverished, crime-and drug-ridden neighborhood. Poverty itself delivers emotional blows to children: poorer children at age five are already more fearful, anxious, and sad than their better-off peers, and have more behavior problems such as frequent tantrums and destroying things, a trend that continues through the teen years. The press of poverty corrodes family life too: there tend to be fewer expressions of parental warmth, more depression in mothers (who are often single and jobless), and a greater reliance on harsh punishments such as yelling, hitting, and physical threats.

But there is a role that emotional competence plays over and above family and economic forces—it may be decisive in determining the extent to which anygiven child or teenager is undone by these hardships or finds a core of resilience to survive them. Long-term studies of hundreds of children brought up in poverty, in abusive families, or by a parent with severe mental illness show that those who are resilient even in the face of the most grinding hardships tend to share key emotional skills.63 These include a winning sociability that draws people to them, self-confidence, an optimistic persistence in the face of failure and frustration, the ability to recover quickly from upsets, and an easygoing nature.
But the vast majority of children face such difficulties without these advantages. Of course, many of these skills are innate, the luck of genes—but even qualities of temperament can change for the better, as we saw in Chapter 14. One line of intervention, of course, is political and economic, alleviating the poverty and other social conditions that breed these problems. But apart from these tactics (which seem to move ever lower on the social agenda) there is much that can be offered to children to help them grapple better with such debilitating hardships.

Take the case of emotional disorders, afflictions that about one in two Americans experiences over the course of life. A study of a representative sample of 8,098 Americans found that 48 percent suffered from at least one psychiatric problem during their lifetime.64 Most severely affected were the 14 percent of people who developed three or more psychiatric problems at once.

This group was the most troubled, accounting for 60 percent of all psychiatric disorders occurring at any one time, and 90 percent of the most severe and disabling ones. While they need intensive care now, the optimal approach would be, wherever possible, to prevent these problems in the first place. To be sure, not every mental disorder can be prevented—but there are some, and perhaps many, that can. Ronald Kessler, the University of Michigan sociologist who did the study, told me, "We need to intervene early in life. Take a young girl who has a social phobia in the sixth grade, and starts drinking in junior high school to handle her social anxieties. By her late twenties, when she shows up in our study, she's still fearful, has become both an alcohol and drug abuser, and is depressed because her life is so messed up. The big question is, what could we have done early in her life to have headed off the whole downward spiral?"

The same holds, of course, for dropping out or violence, or most of the litany of perils faced by young people today. Educational programs to prevent one or another specific problem such as drug use and violence have proliferated wildly in the last decade or so, creating a mini-industry within the education marketplace. But many of them—including many of the most slickly marketedmarketplace. But many of them—including many of the most slickly marketed and most widely used—have proven to be ineffective. A few, to the chagrin of educators, even seemed to increase the likelihood of the problems they were meant to head off, particularly drug abuse and teen sex.
Information Is Not Enough An instructive case in point is sexual abuse of children. As of 1993, about two hundred thousand substantiated cases were reported annually in the United States, with that number growing by about 10 percent per year. And while estimates vary widely, most experts agree that between 20 and 30 percent of girls and about half that number of boys are victims of some form of sexual abuse by age seventeen (the figures rise or fall depending on how sexual abuse is defined, among other factors).65 There is no single profile of a child who is particularly vulnerable to sexual abuse, but most feel unprotected, unable to resist on their own, and isolated by what has happened to them.
With these risks in mind, many schools have begun to offer programs to prevent sexual abuse. Most such programs are tightly focused on basic information about sexual abuse, teaching kids, for example, to know the difference between "good" and "bad" touching, alerting them to the dangers, and encouraging them to tell an adult if anything untoward happens to them. But a national survey of two thousand children found that this basic training was little better than nothing—or actually worse than nothing—in helping children do something to prevent being victimized, whether by a school bully or a potential child molester. 66 Worse, the children who had only such basic programs and who had subsequendy become victims of sexual assault were actually half as likely to report it afterward than were children who had had no programs at all.
By contrast, children given more comprehensive training—including related emotional and social competences—were better able to protect themselves against the threat of being victimized: they were far more likely to demand to be left alone, to yell or fight back, to threaten to tell, and to actually tell if something bad did happen to them. This last benefit—reporting the abuse—is preventive in a telling sense: many child molesters victimize hundreds of children. A study of child molesters in their forties found that, on average, they had one victim a month since their teenage years. A report on a bus driver and a high-school computer teacher reveals they molested about three hundred children each year between them—yet not one of the children reported the sexual abuse; the abuse came to light only after one of the boys who had beenabused by the teacher started to sexually abuse his sister.67
Those children who got the more comprehensive programs were three times more likely than those in minimal programs to report abuse. What worked so well? These programs were not one-shot topics, but were given at different levels several times over the course of a child's school career, as part of health or sex education. They enlisted parents to deliver the message to the child along with what was taught in school (children whose parents did this were the very best at resisting threats of sexual abuse).
Beyond that, social and emotional competences made the difference. It is not enough for a child simply to know about "good" and "bad" touching; children need the self-awareness to know when a situation feels wrong or distressing long before the touching begins. This entails not just self-awareness, but also enough self-confidence and assertiveness to trust and act on those feelings of distress, even in the face of an adult who may be trying to reassure her that "it's okay."
And then a child needs a repertoire of ways to disrupt what is about to happen— everything from running away to threatening to tell. For these reasons, the better programs teach children to stand up for what they want, to assert their rights rather than be passive, to know what their boundaries are and defend them.
The most effective programs, then, supplemented the basic sexual-abuse information with essential emotional and social skills. These programs taught children to find ways to solve interpersonal conflicts more positively, to have more self-confidence, not to blame themselves if something happened, and to feel they had a network of support in teachers and parents whom they could turn to. And if something bad did happen to them, they were far more likely to tell.
The Active Ingredients Such findings have led to a reenvisioning of what the ingredients of an optimal prevention program should be, based on those that impartial evaluations showed to be truly effective. In a five-year project sponsored by the W. T. Grant Foundation, a consortium of researchers studied this landscape and distilled the active ingredients that seemed crucial to the success of those programs that worked.68 The list of key skills the consortium concluded should be covered, no matter what specific problem it is designed to prevent, reads like the ingredients of emotional intelligence (see Appendix D for the full list).69
The emotional skills include self-awareness; identifying, expressing, and managing feelings; impulse control and delaying gratification; and handling stress and anxiety. A key ability in impulse control is knowing the differencestress and anxiety. A key ability in impulse control is knowing the difference between feelings and actions, and learning to make better emotional decisions by first controlling the impulse to act, then identifying alternative actions and their consequences before acting. Many competences are interpersonal: reading social and emotional cues, listening, being able to resist negative influences, taking others' perspectives, and understanding what behavior is acceptable in a situation.
These are among the core emotional and social skills for life, and include at least partial remedies for most, if not all, of the difficulties I have discussed in this chapter. The choice of specific problems these skills might inoculate against is nearly arbitrary—similar cases for the role of emotional and social competences could have been made for, say, unwanted teen pregnancy or teen suicide.
To be sure, the causes of all such problems are complex, interweaving differing ratios of biological destiny, family dynamics, the politics of poverty, and the culture of the streets. No single kind of intervention, including one targeting emotions, can claim to do the whole job. But to the degree emotional deficits add to a child's risk—and we have seen that they add a great deal— attention must be paid to emotional remedies, not to the exclusion of other answers, but along with them. The next question is, what would an education in the emotions look like? * In children, unlike adults, medication is not a clear alternative to therapy or preventive education for treating depression; children metabolize medications differently than do adults. Tricyclic antidepressants, often successful with adults, have failed in controlled studies with children to prove better than an inactive placebo drug. Newer depression medications, including Prozac, are as yet untested for use in children. And desipramine, one of the most common (and safest) tricyclics used with adults, has, at this writing, become the focus of FDA scrutiny as a possible cause of death in children.

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