Emotional Intelligence – Daniel Goleman

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Chapter 6

The Master Aptitude
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What seems to set apart those at the very top of competitive pursuits from others of roughly equal ability is the degree to which, beginning early in life, they can pursue an arduous practice routine for years and years. And that doggedness depends on emotional traits-enthusiasm and persistence in the face of setbacks-above all else.

The added payoff for life success from motivation, apart from other innate abilities, can be seen in the remarkable performance of Asian students in American schools and professions. One thorough review of the evidence suggests that Asian-American children may have an average IQ advantage over whites of just two or three points. Yet on the basis of the professions, such as law and medicine, that many Asian-Americans end up in, as a group they behave as though their IQ were much higher-the equivalent of an IQ of 110 for Japanese-Americans and of 120 for Chinese Americans. The reason seems to be that from the earliest years of school, Asian children work harder than whites. Sanford Dorenbusch, a Stanford sociologist who studied more than ten thousand high-school students, found that Asian-Americans spent 40 percent more time doing homework than did other students. “While most American parents are willing to accept a child’s weak areas and emphasize the strengths, for Asians, the attitude is that if you’re not doing well, the answer is to study later at night, and if you still don’t do well, to get up and study earlier in the morning. They believe that anyone can do well in school with the right effort.” In short, a strong cultural work ethic translates into higher motivation, zeal, and persistence-an emotional edge.

To the degree that our emotions get in the way of or enhance our ability to think and plan, to pursue training for a distant goal, to solve problems and the like, they define the limits of our capacity to use our innate mental abilities, and so determine how we do in life. And to the degree to which we are motivated by feelings of enthusiasm and pleasure in what we door even by an optimal degree of anxiety-they propel us to accomplishment. It is in this sense that emotional intelligence is a master aptitude, a capacity that profoundly affects all other abilities, either facilitating or interfering with them.

Impulse Control: The Marshmallow Test

Just imagine you’re four years old, and someone makes the following proposal: If you’ll wait until after he runs an errand, you can have two marshmallows for a treat. If you can’t wait until then, you can have only one-but you can have it right now. It is a challenge sure to try the soul of any four year-old, a microcosm of the eternal battle between impulse and restraint, id and ego, desire and self-control, gratification and delay. Which of these choices a child makes is a telling test; it offers a quick reading not just of character, but of the trajectory that child will probably take through life.

There is perhaps no psychological skill more fundamental than resisting impulse. It is the root of all emotional self-control, since all emotions, by their very nature, lead to one or another impulse to act. The root meaning of the word emotion, remember, is “to move.” The capacity to resist that impulse to act, to squelch the incipient movement, most likely translates at the level of brain function into inhibition of limbic signals to the motor cortex, though such an interpretation must remain speculative for now.

At any rate, a remarkable study in which the marshmallow challenge was posed to four-year-olds shows just how fundamental is the ability to restrain the emotions and so delay impulse. Begun by psychologist Walter Mischel during the 1960s at a preschool on the Stanford University campus and involving mainly children of Stanford faculty, graduate students, and other employees, the study tracked down the four-year-olds as they were graduating from high school.

Some four-year-olds were able to wait what must surely have seemed an endless fifteen to twenty minutes for the experimenter- to return. To sustain themselves in their struggle they covered their eyes so they wouldn’t have to stare at temptation, or rested their heads in their arms, talked to themselves, sang, played games with their hands and feet, even tried to go to sleep. These plucky preschoolers got the two-marshmallow reward. But others, more impulsive, grabbed the one marshmallow, almost always within seconds of the experimenter’s leaving the room on his “errand.”

The diagnostic power of how this moment of impulse was handled became clear some twelve to fourteen years later, when these same children were tracked down as adolescents. The emotional and social difference between the grab-the-marshmallow preschoolers and their gratification delaying peers was dramatic. Those who had resisted temptation at four were now, as adolescents, more socially competent: personally effective, self-assertive, and better able to cope with the frustrations of life. They were less likely to go to pieces, freeze, or regress under stress, or become rattled and disorganized when pressured; they embraced challenges and pursued them instead of giving up even in the face of difficulties; they were self-reliant and confident, trustworthy and dependable; and they took initiative and plunged into projects. And, more than a decade later, they were still able to delay gratification in pursuit of their goals.

The third or so who grabbed for the marshmallow, however, tended to have fewer of these qualities, and shared instead a relatively more troubled psychological portrait. In adolescence they were more likely to be seen as shying away from social contacts; to be stubborn and indecisive; to be easily upset by frustrations; to think of themselves as “bad” or unworthy; to regress or become immobilized by stress; to be mistrustful and resentful about not “getting enough”; to be prone to jealousy and envy; to overreact to irritations with a sharp temper, so provoking arguments and fights. And, after all those years, they still were unable to put off gratification.

What shows up in a small way early in life blossoms into a wide range of social and emotional competences as life goes on. The capacity to impose a delay on impulse is at the root of a plethora of efforts, from staying on a diet to pursuing a medical degree. Some children, even at four, had mastered the basics: they were able to read the social situation as one where delay was beneficial, to pry their attention from focusing on the temptation at hand, and to distract themselves while maintaining the necessary perseverance toward their goal-the two marshmallows.

Even more surprising, when the tested children were evaluated again as they were finishing high school, those who had waited patiently at four were far superior as students to those who had acted on whim. According to their parents’ evaluations, they were more academically competent: better able to put their ideas into words, to use and respond to reason, to concentrate, to make plans and follow through on them, and more eager to learn. Most astonishingly, they had dramatically higher scores on their SAT tests. The third of children who at four grabbed for the marshmallow most eagerly had an average verbal score of 524 and quantitative (or “math”) score of 528; the third who waited longest had average scores of 610 and 652, respectively-a 210-point difference in total score. At age four, how children do on this test of delay of gratification is twice as powerful a predictor of what their SAT scores will be as is IQ at age four; IQ becomes a stronger predictor of SAT only after children learn to read. This suggests that the ability to delay gratification contributes powerfully to intellectual potential quite apart from IQ itself. (Poor impulse control in childhood is also a powerful predictor of later delinquency, again more so than IQ.) As we shall see in Part Five, while some argue that IQ cannot be changed and so represents an unbendable limitation on a child’s life potential, there is ample evidence that emotional skills such as impulse control and accurately reading a social situation can be learned.
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The spontaneous pleasure, grace, and effectiveness that characterize flow are incompatible with emotional hijackings, in which limbic surges capture the rest of the brain. The quality of attention in flow is relaxed yet highly focused. It is a concentration very different from straining to pay attention when we are tired or bored, or when our focus is under siege from intrusive feelings such as anxiety or anger.

Flow is a state devoid of emotional static, save for a compelling, highly motivating feeling of mild ecstasy. That ecstasy seems to be a by-product of the attentional focus that is a prerequisite of flow. Indeed, the classic literature of contemplative traditions describes states of absorption that are experienced as pure bliss: flow induced by nothing more than intense concentration.

Watching someone in flow gives the impression that the difficult is easy; peak performance appears natural and ordinary. This impression parallels what is going on within the brain, where a similar paradox is repeated: the most challenging tasks are done with a minimum expenditure of mental energy. In flow the brain is in a “cool” state, its arousal and inhibition of neural circuitry attuned to the demand of the moment. When people are engaged in activities that effortlessly capture and hold their attention, their brain “quiets down” in the sense that there is a lessening of cortical arousal. That discovery is remarkable, given that flow allows people to tackle the most challenging tasks in a given domain, whether playing against a chess master or solving a complex mathematical problem. The expectation would be that such challenging tasks would require more cortical activity, not less. But a key to flow is that it occurs only within reach of the summit of ability, where skills are well-rehearsed and neural circuits are most efficient.

A strained concentration-a focus fueled by worry-produces increased cortical activation. But the zone of flow and optimal performance seems to be an oasis of cortical efficiency, with a bare minimum of mental energy expended. That makes sense, perhaps, in terms of the skilled practice that allows people to get into flow: having mastered the moves of a task, whether a physical one such as rock climbing or a mental one such as computer programming, means that the brain can be more efficient in performing them. Well-practiced moves require much less brain effort than do ones just being learned, or those that are still too hard. Likewise, when the brain is working less efficiently because of fatigue or nervousness, as happens at the end of a long, stressful day, there is a blurring of the precision of cortical effort, with too many superfluous areas being activated-a neural state experienced as being highly distracted. The same happens in boredom. But when the brain is operating at peak efficiency, as in flow, there is a precise relation between the active areas and the demands of the task. In this state even hard work can seem refreshing or replenishing rather than draining.

Learning and Flow: New Model for Education

Because flow emerges in the zone in which an activity challenges people to the fullest of their capacities, as their skills increase it takes a heightened challenge to get into flow. If a task is too simple, it is boring; if too challenging, the result is anxiety rather than flow. It can be argued that mastery in a craft or skill is spurred on by the experience of flow-that the motivation to get better and better at something, be it playing the violin, dancing, or gene-splicing, is at least in part to stay in flow while doing it. Indeed, in a study of two hundred artists eighteen years after they left art school, Csikszentmihalyi found that it was those who in their student days had savored the sheer joy of painting itself who had become serious painters. Those who had been motivated in art school by dreams of fame and wealth for the most part drifted away from art after graduating.
Csikszentmihalyi concludes: “Painters must want to paint above all else. If the artist in front of the canvas begins to wonder how much he will sell it for, or what the critics will think of it, he won’t be able to pursue original avenues. Creative achievements depend on single-minded immersion.”

Just as flow is a prerequisite for mastery in a craft, profession, or art, so too with learning. Students who get into flow as they study do better, quite apart from their potential as measured by achievement tests. Students in a special Chicago high school for the sciences-all of whom had scored in the top 5 percent on a test of math proficiency-were rated by their math teachers as high or low achievers. Then the way these students spent their time was monitored, each student carrying a beeper that signaled them at random times during the day to write down what they were doing and what their mood was. Not surprisingly, the low achievers spent only about fifteen hours a week studying at home, much less than the twenty-seven hours a week of homework done by their high-achieving peers. The low achievers spent most of the hours during which they were not studying in socializing, hanging out with friends and family.
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Chapter 7

The Roots of Empathy
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The Well Attuned Child

Sarah was twenty-five when she gave birth to twin boys, Mark and Fred. Mark, she felt, was more like herself; Fred was more like his father. That perception may have been the seed of a telling but subtle difference in how she treated each boy. When the boys were just three months old, Sarah would often try to catch Fred’s gaze, and when he would avert his face, she would try to catch his eye again; Fred would respond by turning away more emphatically. Once she would look away, Fred would look back at her, and the cycle of pursuit and aversion would begin again-often leaving Fred in tears. But with Mark, Sarah virtually never tried to impose eye contact as she did with Fred. Instead Mark could break off eye contact whenever he wanted, and she would not pursue.

A small act, but telling. A year later, Fred was noticeably more fearful and dependent than Mark; one way he showed his fearfulness was by. breaking off eye contact with other people, as he had done with his mother at three months, turning his face down and away. Mark, on the other hand, looked people straight in the eye; when he wanted to break off contact, he’d turn his head slightly upward and to the side, with a winning smile.

The twins and their mother were observed so minutely when they took part in research “by Daniel Stem, a psychiatrist then at Cornell University School of Medicine. Stem is fascinated by the small, repeated exchanges that take place between parent and child; he believes that the most basic lessons of emotional life are laid down in these intimate moments. Of all such moments, the most critical are those that let the child know her emotions are met with empathy, accepted, and reciprocated, in a process Stem calls attunement. The twins’ mother was attuned with Mark, but out of emotional synch with Fred.  Stem contends that the countlessly repeated moments of attunement or misattunement between parent and child shape the emotional expectations adults bring to their close relationships-perhaps far more than the more dramatic events of childhood.

Attunement occurs tacitly, as part of the rhythm of relationship. Stem has studied it with microscopic precision through videotaping hours of mothers with their infants. He finds that through attunement mothers let their infants know they have a sense of what the infant is feeling. A baby squeals with delight, for example, and the mother affirms that delight by giving the baby a gentle shake, cooing, or matching the pitch of her voice to the baby’s squeal. Or a baby shakes his rattle, and she gives him a quick shimmy in response. In such an interaction the affirming message is in the mother more or less matching the baby’s level of excitement. Such small attunements give an infant the reassuring feeling of being emotionally connected, a message that Stem finds mothers send about once a minute when they interact with their babies.

Attunement is very different from simple imitation. “If you just imitate a baby,” Stem told me, “that only shows you know what he did, not how he felt. To let him know you sense how he feels, you have to play back his inner feelings in another way. Then the baby knows he is understood.”

Making love is perhaps the closest approximation in adult life to this intimate attunement between infant and mother. Lovemaking, Stem writes, “involves the experience of sensing the other’s subjective state: shared desire, aligned intentions, and mutual states of simultaneously shifting arousal,” with lovers responding to each other in a synchrony that gives the tacit sense of deep rapport. Lovemaking is, at its best, an act of empathy; at its worst it lacks any such emotional mutuality.
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Chapter 10

Managing With Heart
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Organizational Savvy and the Group IQ
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Perhaps the most rudimentary form of organizational teamwork is the meeting, that inescapable part of an executive’s lot-in a boardroom, on a conference call, in someone’s office. Meetings-bodies in the same room are but the most obvious, and a somewhat antiquated, example of the sense in which work is shared. Electronic networks, e-mail, teleconferences, work teams, informal networks, and the like are emerging as new functional entities in organizations. To the degree that the explicit hierarchy as mapped on an organizational chart is the skeleton of an organization, these human touchpoints are its central nervous system.

Whenever people come together to collaborate, whether it be in an executive planning meeting or as a team working toward a shared product, there is a very real sense in which they have a group IQ, the sum total of the talents and skills of all those involved. And how well they accomplish their task will be determined by how high that IQ is. The single most important element in group intelligence, it turns out, is not the average IQ in the academic sense, but rather in terms of emotional intelligence. The key to a high group IQ is social harmony. It is this ability to harmonize that, all other things being equal, will make one group especially talented, productive, and successful, and another-with members whose talent and skill are equal in other regards-do poorly.

The idea that there is a group intelligence at all comes from Robert Sternberg, the Yale psychologist, and Wendy Williams, a graduate student, who were seeking to understand why some groups are far more effective than others. After all, when people come together to work as a group, each brings certain talents-say, a high verbal fluency, creativity, empathy, or technical expertise. While a group can be no “smarter” than the sum total of all these specific strengths, it can be much dumber if its internal workings don’t allow people to share their talents. This maxim became evident when Sternberg and Williams recruited people to take part in groups that were given the creative challenge of coming up with an effective advertising campaign for a fictitious sweetener that showed promise as a sugar substitute.

One surprise was that people who were too eager to take part were a drag on the group, lowering its overall performance; these eager beavers were too controlling or domineering. Such people seemed to lack a basic element of social intelligence, the ability to recognize what is apt and what inappropriate in give-and-take. Another negative was having deadweight, members who did not participate.

The single most important factor in maximizing the excellence of a group’s product was the degree to which the members were able to create a state of internal harmony, which lets them take advantage of the full talent of their members. The overall performance of harmonious groups was helped by having a member who was particularly talented; groups with more friction were far less able to capitalize on having members of great ability. In groups where there are high levels of emotional and social static-whether it be from fear or anger, from rivalries or resentments-people cannot offer their best. But harmony allows a group to take maximum advantage of its most creative and talented members’ abilities.

While the moral of this tale is quite clear for, say, work teams, it has a more general implication for anyone who works within an organization. Many things people do at work depend on their ability to call on a loose network of fellow workers; different tasks can mean calling on different members of the network. In effect, this creates the chance for ad hoc groups, each with a membership tailored to offer an optimal array of talents, expertise, and placement. Just how well people can “work” a network-in effect, make it into a temporary, ad hoc team-is a crucial factor in on-the-job success.

Consider, for example, a study of star performers at Bell Labs, the world famous scientific think tank near Princeton. The labs are peopled by engineers and scientists who are all at the top on academic IQ tests. But within this pool of talent, some emerge as stars, while others are only average in their output. What makes the difference between stars and the others is not their academic IQ, but their emotional IQ. They are better able to motivate themselves, and better able to work their informal networks into ad hoc teams.

The “stars” were studied in one division at the labs, a unit that creates and designs the electronic switches that control telephone systems-a highly sophisticated and demanding piece of electronic engineering. Because the work is beyond the capacity of anyone person to tackle, it is done in teams that can range from just 5 or so engineers to 150. No single engineer knows enough to do the job alone; getting things done demands tapping other people’s expertise. To find out what made the difference between those who were highly productive and those who were only average, Robert Kelley and Janet Caplan had managers and peers nominate the 10 to 15 percent of engineers who stood out as stars.

When they compared the stars with everyone else, the most dramatic finding, at ,first, was the paucity of differences between the two groups. “Based on a wide range of cognitive and social measures, from standard tests for IQ to personality inventories, there’s little meaningful difference in innate abilities,” Kelley and Caplan wrote in the Haroard Business Review. “As it develops, academic talent was not a good predictor of on-the-job productivity,” nor was IQ.

But after detailed interviews, the critical differences emerged in the internal and interpersonal strategies “stars” used to get their work done. One of the most important turned out to be a rapport with a network of key people. Things go more smoothly for the standouts because they put time into cultivating good relationships with people whose services might be needed in a crunch as part of an instant ad hoc team to solve a problem or handle a crisis. “A middle performer at Bell Labs talked about being stumped by a technical problem,” Kelley and Caplan observed. “He painstakingly called various technical gurus and then waited, wasting valuable time while calls went unreturned and e-mail messages unanswered. Star performers, however, rarely face such situations because they do the work of building reliable networks before they actually need them. When they call someone for advice, stars almost always get a faster answer.”

Informal networks are especially critical for handling unanticipated problems. “The formal organization is set up to handle easily anticipated problems,” one study of these networks observes. “But when unexpected problems arise, the informal organization kicks in. Its complex web of social ties form every time colleagues communicate, and solidify over time into surprisingly stable networks. Highly adaptive, informal networks move diagonally and elliptically, skipping entire functions to get things done.”

The analysis of informal networks shows that just because people work together day to day they will not necessarily trust each other with sensitive information (such as a desire to change jobs, or resentment about how a manager or peer behaves), nor turn to them in crisis. Indeed, a more sophisticated view of informal networks shows that there are at least three varieties: communications webs-who talks to whom; expertise networks, based on which people are turned to for advice; and trust networks. Being a main node in the expertise network means someone will have a reputation for technical excellence, which often leads to a promotion. But there is virtually no relationship between being an expert and being seen as someone people can trust with their secrets, doubts, and vulnerabilities. A petty office tyrant or micromanager may be high on expertise, but will be so low on trust that it will undermine their ability to manage, and effectively exclude them from informal networks. The stars of an organization are often those who have thick connections on all networks, whether communications, expertise, or trust.

Beyond a mastery of these essential networks, other forms of organizational savvy the Bell Labs stars had mastered included effectively coordinating their efforts in teamwork; being leaders in building consensus; being able to see things from the perspective of others, such as customers or others on a work team; persuasiveness; and promoting cooperation while avoiding conflicts. While all of these rely on social skills, the stars also displayed another kind of knack: taking initiative-being self-motivated enough to take on responsibilities above and beyond their stated job-and self-management in the sense of regulating their time and work commitments well. All such skills, of course, are aspects of emotional intelligence.

Chapter 11

Mind and Medicine
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The Body’s Mind: How Emotions Matter for Health

In 1974 a finding in a laboratory at the School of Medicine and Dentistry, University of Rochester, rewrote biology’s map of the body: Robert Ader, a psychologist, discovered that the immune system, like the brain, could learn. His result was a shock; the prevailing wisdom in medicine had been that only the brain and central nervous system could respond to experience by changing how they behaved. Ader’s finding led to the investigation of what are turning out to be myriad ways the central nervous system and the immune system communicate-biological pathways that make the mind, the emotions, and the body not separate, but intimately entwined.

In his experiment white rats had been given a medication that artificially suppressed the quantity of disease-fighting T cells circulating in their blood. Each time they received the medication, they ate it along with saccharin laced water. But Ader discovered that giving the rats the saccharin-flavored water alone, without the suppressive medication, still resulted in a lowering of the T-cell count-to the point that some of the rats were getting sick and dying. Their immune system had learned to suppress T cells in response to the flavored water. That just should not have happened, according to the best scientific understanding at the time.

The immune system is the “body’s brain,” as neuroscientist Francisco Varela, at Paris’s Ecole Polytechnique, puts it, defining the body’s own sense of self-of what belongs within it and what does not. Immune cells travel in the bloodstream throughout the entire body, contacting virtually every other cell. Those cells they recognize, they leave alone; those they fail to recognize, they attack. The attack either defends us against viruses, bacteria, and cancer or, if the immune cells misidentify some of the body’s own cells, creates an autoimmune disease such as allergy or lupus. Until the day Ader made his serendipitous discovery, every anatomist, every physician, and every biologist believed that the brain (along with its extensions throughout the body via the central nervous system) and the immune system were separate entities, neither able to influence the operation of the other. There was no pathway that could connect the brain centers monitoring what the rat tasted with the areas of bone marrow that manufacture T cells. Or so it had been thought for a century.

Over the years since then, Ader’s-modest discovery has forced a new look at the links between the immune system and the central nervous system. The field that studies this, psychoneuroimmunology, or PNI, is now a leading edge medical science. Its very name acknowledges the links: psycho, or “mind”; neuro, for the neuroendocrine system (which subsumes the nervous system and hormone systems); and immunology, for the immune system.

A network of researchers is finding that the chemical messengers that operate most extensively in both brain and immune system are those that are most dense in neural areas that regulate emotion. Some of the strongest evidence for a direct physical pathway allowing emotions to impact the immune system has come from David Felten, a colleague of Ader’s. Felten began by noting that emotions have a powerful effect on the autonomic nervous system, which regulates everything from how much insulin is secreted to blood-pressure levels. Felten, working with his wife, Suzanne, and other colleagues, then detected a meeting point where the autonomic nervous system directly talks to lymphocytes and macrophages, cells of the immune system.

In electron-microscope studies, they found synapse like contacts where the nerve terminals of the autonomic system have endings that directly abut these immune cells. This physical contact point allows the nerve cells to release neurotransmitters to regulate the immune cells; indeed, they signal back and forth. The finding is revolutionary. No one had suspected that immune cells could be targets of messages from the nerves.

To test how important these nerve endings were in the workings of the immune system, Felten went a step further. In experiments with animals he removed some nerves from lymph nodes and spleen-where immune cells are stored or made-and then used viruses to challenge the immune system. The result: a huge drop in immune response to the virus. His conclusion is that without those nerve endings the immune system simply does not respond as it should to the challenge of an invading virus or bacterium. In short, the nervous system not only connects to the immune system, but is essential for proper immune function.

Another key pathway linking emotions and the immune system is via the influence of the hormones released under stress. The catecholamines (epinephrine and norepinephrine-otherwise known as adrenaline and noradrenaline), cortisol and prolactin, and the natural opiates beta-endorphin and enkephalin are all released during stress arousal. Each has a strong impact on immune cells. While the relationships are complex, the main influence is that while these hormones surge through the body, the immune cells are hampered in their function: stress suppresses immune resistance, at least temporarily, presumably in a conservation of energy that puts a priority on the more immediate emergency, which is more pressing for survival. But if stress is constant and intense, that suppression may become long-lasting.

Microbiologists and other scientists are finding more and more such connections between the brain and the cardiovascular and immune systems having first had to accept the once-radical notion that they exist at all.
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Toxic Emotions: The Clinical Data
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This finding is part of a larger network of evidence emerging from dozens of studies pointing to the power of anger to damage the heart. The old idea has not held up that a hurried, high-pressure Type-A personality is at great risk from heart disease, but from that failed theory has emerged a new finding: it is hostility that puts people at risk.

Much of the data on hostility has come from research by Dr. Redford Williams at Duke University. For example, Williams found that those physicians who had had the highest scores on a test of hostility while still in medical school were seven times as likely to have died by the age of fifty as were those with low hostility scores-being prone to anger was a stronger predictor of dying young than were other risk factors such as smoking, high blood pressure, and high cholesterol. And findings by a colleague, Dr. John Barefoot at the University of North Carolina, show that in heart patients undergoing angiography, in which a tube is inserted into the coronary artery to measure lesions, scores on a test of hostility correlate with the extent and severity of coronary artery disease.

Of course, no one is saying that anger alone causes coronary artery disease; it is one of several interacting factors. As Peter Kaufman, acting chief of the Behavioral Medicine Branch of the National Heart, Lung, and Blood Institute, explained to me, “We can’t yet sort out whether anger and hostility play a causal role in the early development of coronary artery disease, or whether it intensifies the problem once heart disease has begun, or both. But take a twenty-year-old who repeatedly gets angry. Each episode of anger adds an additional stress to the heart by increasing his heart rate and blood pressure. When that is repeated over and over again, it can do damage,” especially because the turbulence of blood flowing through the coronary artery with each heartbeat “can cause microtears in the vessel, where plaque develops. If your heart rate is faster and blood pressure is higher because you’re habitually angry, then over thirty years that may lead to a faster buildup of plaque, and so lead to coronary artery disease.”

Once heart disease develops, the mechanisms triggered by anger affect the very efficiency of the heart as a pump, as was shown in the study of angry memories in heart patients. The net effect is to make anger particularly lethal in those who already have heart disease. For instance, a Stanford University Medical School study of 1,012 men and women who suffered from a first heart attack and then were followed for up to eight years showed that those men who were most aggressive and hostile at the outset suffered the highest rate of second heart attacks. There were similar results in a Yale School of Medicine study of 929 men who had survived heart attacks and were tracked for up to ten years. Those who had been rated as easily roused to anger were three times more likely to die of cardiac arrest than those who were more even-tempered. If they also had high cholesterol levels, the added risk from anger was five times higher.

The Yale researchers point out that if may not be anger alone that heightens the risk of death from heart disease, but rather intense negative emotionality of any kind that regularly sends surges of stress hormones through the body. But overall, the strongest scientific links between emotions and heart disease are to anger: a Harvard Medical School study asked more than fifteen hundred men and women who had suffered heart attacks to describe their emotional state in the hours before the attack. Being angry more than doubled the risk of cardiac arrest in people who already had heart disease; the heightened risk lasted for about two hours after the anger was aroused.

These findings do not mean that people should try to suppress anger when it is appropriate. Indeed, there is evidence that trying to completely suppress such feelings in the heat of the moment actually results in magnifying the body’s agitation and may raise blood pressure. On the other hand, as we saw in Chapter 5, the net effect of ventilating anger every time it is felt is simply to feed it, making it a more likely response to any annoying situation. Williams resolves this paradox by concluding that whether anger is expressed or not is less important than whether it is chronic. An occasional display of hostility is not dangerous to health; the problem arises when hostility becomes so constant as to define an antagonistic personal styleone marked by repeated feelings of mistrust and cynicism and the propensity to snide comments and put-downs, as well as more obvious bouts of temper and rage.

The hopeful news is that chronic anger need not be a death sentence: hostility is a habit that can change. One group of heart-attack patients at Stanford University Medical School was enrolled in a program designed to help them soften the attitudes that gave them a short temper. This anger control training resulted in a second-heart-attack rate 44 percent lower than for those who had not tried to change their hostility. A program designed by Williams has had similar beneficial results. Like the Stanford program, it teaches basic elements of emotional intelligence, particularly mindfulness of anger as it begins to stir, the ability to regulate it once it has begun, and empathy.
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The Healing Power of Emotional Support

In The Merry Adventures of Robin Hood, Robin advises a young follower: “Tell us thy troubles and speak freely. A flow of words doth ever ease the heart of sorrows; it is like opening the waste where the mill dam is overfull.” This bit of folk wisdom has great merit; unburdening a troubled heart appears to be good medicine. The scientific corroboration of Robin’s advice comes from James Pennebaker, a Southern Methodist University psychologist, who has shown in a series of experiments that getting people to talk about the thoughts that trouble them most has a beneficial medical effect. His method is remarkably simple: he asks people to write, for fifteen to twenty minutes a day over five or so days, about, for example, “the most traumatic experience of your entire life,” or some pressing worry of the moment. What people write can be kept entirely to themselves if they like.

The net effect of this confessional is striking: enhanced immune function, significant drops in health-center visits in the following six months, fewer days missed from work, and even improved liver enzyme function. Moreover, those whose writing showed most evidence of turbulent feelings had the greatest improvements in their immune function. A specific pattern emerged as the “healthiest” way to ventilate troubling feelings: at first expressing a high level of sadness, anxiety, anger-whatever troubling feelings the topic brought up; then, over the course of the next several days weaving a narrative, finding some meaning in the trauma or travail.

That process, of course, seems akin to what happens when people explore such troubles in psychotherapy. Indeed, Pennebaker’s findings suggest one reason why other studies show medical patients given psychotherapy in addition to surgery or medical treatment often fare better medically than do those who receive medical treatment alone. Perhaps the most powerful demonstration of the clinical power of emotional support was in groups at Stanford University Medical School for women with advanced metastatic breast cancer. After an initial treatment, often including surgery, these women’s cancer had returned and was spreading through their bodies. It was only a matter of time, clinically speaking, until the spreading cancer killed them. Dr. David Spiegel, who conducted the study, was himself stunned by the findings, as was the medical community: women with advanced breast cancer who went to weekly meetings with others survived twice as long as did women with the same disease who faced it on their own.

All the women received standard medical care; the only difference was that some also went to the groups, where they were able to unburden themselves with others who understood what they faced and were willing to listen to their fears, their pain, and their anger. Often this was the only place where the women could be open about these emotions, because other people in their lives dreaded talking with them about the cancer and their imminent death. Women who attended the groups lived-for thirty-seven additional months, on average, while those with the disease who did not go to the groups died, on average, in nineteen months-a gain in life expectancy for such patients beyond the reach of any medication or other medical treatment. As Dr. Jimmie Holland, the chief psychiatric oncologist at Sloan-Kettering Memorial Hospital, a cancer treatment center in New York City, put it to me, “Every cancer patient should be in a group like this.” Indeed, if it had been a new drug that produced the extended life expectancy, pharmaceutical companies would be battling to produce it.
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Part Four

Windows of Opportunity
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Temperament is Not Destiny
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Thus we seem by temperament primed to respond to life in either a negative or a positive emotional register. The tendency toward a melancholy or upbeat temperament-like that toward timidity or boldness-emerges within the first year of life, a fact that strongly suggests it too is genetically determined. Like most of the brain, the frontal lobes are still maturing in the first few months of life, and so their activity cannot be reliably measured until the age of ten months or so. But in infants that young, Davidson found that the activity level of the frontal lobes predicted whether they would cry when their mothers left the room. The correlation was virtually 100 percent: of dozens of infants tested this way, every infant who cried had more brain activity on the right side, while those who did not had more activity on the left.

Still, even if this basic dimension of temperament is laid down from birth, or very nearly from birth, those of us who have the morose pattern are not necessarily doomed to go through life brooding and crotchety. The emotional lessons of childhood can have a profound impact on temperament, either amplifying or muting an innate predisposition. The great plasticity of the brain in childhood means that experiences during those years can have a lasting impact on the sculpting of neural pathways for the rest of life. Perhaps the best illustration of the kinds of experiences that can alter temperament for the better is in an observation that emerged from Kagan’s research with timid children.

Taming the Overexcitable Amygdala

The encouraging news from Kagan’s studies is that not all fearful infants grow up hanging back from life-temperament is not destiny. The overexcitable amygdala can be tamed, with the right experiences. What makes the difference are the emotional lessons and responses children learn as they grow. For the timid child, what matters at the outset is how they are treated by their parents, and so how they learn to handle their natural timidness. Those parents who engineer gradual emboldening experiences for their children offer them what may be a lifelong corrective to their fearfulness.

About one in three infants who come into the world with all the signs of an overexcitable amygdala have lost their timidness by the time they reach kindergarten. From observations of these once-fearful children at home, it is clear that parents, and especially mothers, play a major role in whether an innately timid child grows bolder with time or continues to shy away from novelty and become upset by challenge. Kagan’s research team found that some of the mothers held to the philosophy that they should protect their timid toddlers from whatever was upsetting; others felt that it was more important to help their timid child learn how to cope with these upsetting moments, and so adapt to life’s small struggles. The protective belief seems to have abetted the fearfulness, probably by depriving the youngsters of opportunities for learning how to overcome their fears. The “learn to adapt” philosophy of child rearing seems to have helped fearful children become braver.

Observations in the homes when the babies were about six months old found that the protective mothers, trying to soothe their infants, picked them up and held them when they fretted or cried, and did so longer than those mothers who tried to help their infants learn to master these moments of upset. The ratio of times the infants were held when calm and when upset showed that the protective mothers held their infants much longer during the upsets than the calm periods.

Another difference emerged when the infants were around one year old: the protective mothers were more lenient and indirect in setting limits for their toddlers when they were doing something that might be harmful, such as mouthing an object they might swallow. The other mothers, by contrast, were emphatic, setting firm limits, giving direct commands, blocking the child’s actions, insisting on obedience.

Why should firmness lead to a reduction in fearfulness? Kagan speculates that there is something learned when a baby has his steady crawl toward what seems to him an intriguing object (but to his mother a dangerous one) interrupted by her warning, “Get away from that!” The infant is suddenly forced to deal with a mild uncertainty. The repetition of this challenge hundreds and hundreds of times during the first year of life gives the infant continual rehearsals, in small doses, of meeting the unexpected in life. For fearful children that is precisely the encounter that has to be mastered, and manageable doses are just right for learning the lesson. When the encounter takes place with parents who, though loving, do not rush to pick up and soothe the toddler over every little upset, he gradually learns to manage such moments on his own. By age two, when these formerly fearful toddlers are brought back to Kagan’s laboratory; they are far less likely to break out into tears when a stranger frowns at them, or an experimenter puts a blood pressure cuff around their arm.

Kagan’s conclusion: “It appears that mothers who protect their highly reactive infants from frustration and anxiety in the hope of effecting a benevolent outcome seem to exacerbate the infant’s uncertainty and produce the opposite effect.” In other words, the protective strategy backfires by depriving timid toddlers of the very opportunity to learn to calm themselves in the face of the unfamiliar, and so gain some small mastery of their fears. At the neurological level, presumably,this means their prefrontal circuits missed the chance to learn alternate responses to knee-jerk fear; instead, their tendency for unbridled fearfulness may have been strengthened simply through repetition.

In contrast, as Kagan told me, “Those children who had become less timid by kindergarten seem to have had parents who put gentle pressure on them to be more outgoing. Although this temperamental trait seems slightly harder than others to change-probably because of its physiological basis-no human quality is beyond change.”

Throughout childhood some timid children grow bolder as experience continues to mold the key neural circuitry. One of the signs that a timid child will be more likely to overcome this natural inhibition is having a higher level of social competence: being cooperative and getting along with other children; being empathic, prone to giving and sharing, and considerate; and being able to develop close friendships. These traits marked a group of children first identified as having a timid temperament at age four, who shook it off by the time they were ten years old.

By contrast, those timid four-year-olds whose temperament changed little over the same six years tended to be less able emotionally: crying and falling apart under stress more easily; being emotionally inappropriate; being fearful, sulky, or whiny; overreacting to minor frustration with anger; having trouble delaying gratification; being overly sensitive to criticism, or mistrustful These emotional lapses are, of course, likely to mean their relationships with other children will be troubled, should they be able to overcome their initial reluctance to engage.

By contrast, it is easy to see why the more emotionally competent though shy by temperament-children spontaneously outgrew their timidity. Being more socially skilled, they were far more likely to have a succession of positive experiences with other children. Even if they were tentative about, say, speaking to a new playmate, once the ice was broken they were able to shine socially. The regular repetition of such social success over many years would naturally tend to make the timid more sure of themselves.
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