Consider the case of an African American girl, born to a single mother into abject poverty. She was raped at age 9, and pregnant at 14. Or think about a young Latina, the child of an alcoholic father and a depressed mother. This girl developed diabetes at age 8 and lost her father the following year.
You might think neither girl had much hope of success.
Yet the first child grew up to be entertainment mogul Oprah Winfrey; the second, Supreme Court Justice Sonia Sotomayor.
Closer to home and closer to now is a patient of mine, a 14-year-old African American male, one of four sons of a single mother, all living in deep poverty in Philadelphia, dad not involved. What will his future hold?
Philadelphia is home to 135,000 children born into poverty, concentrated in areas with pleasant-sounding names like Nicetown, Swampoodle, Fairhill, Strawberry Mansion, Mantua, Grays Ferry. Statistically, a child born poor has more than a 70 percent chance of staying poor as an adult.
Living in the toxic stress created by poverty, violence, and neglect creates real physical consequences to body and brain that science has documented abundantly. The physical and emotional damage leads to dramatically shorter life spans for residents of poor areas than neighbors just a mile or so away enjoy, studies show.
So how do people like Winfrey and Sotomayor manage to flourish? What accounts for those resilient children who -- to borrow the original meaning of resilience -- "jump again"?
We know that children who are exposed to multiple adverse child experiences such as abuse, single parenthood, and having a parent with mental health or substance-abuse issues are 70 percent more likely to develop cardiovascular disease and are more than 50 percent more likely to have major depressive disorder as adults.
But why isn't it 100 percent with the negative outcome? Is there a resilience gene? Can you be born with grit? Or can we help kids to become more resilient?
Norman Garmezy, a developmental psychologist, dedicated his career to trying to answer these questions, to identify protective factors that promote resiliency and health. Alzheimer's disease ended his career, but his work helped clinicians focus on resilience research and interventions. Among the key factors researchers have identified in children who overcome adverse circumstances include having a strong bond with a supportive, constant adult, and having an "internal locus of control" -- meaning a child believes he has control over what happens to him.
The physiological stress response is another intriguing avenue of inquiry. George Bonanno at Columbia University theorizes that the system that starts in the hypothalamus in the mid-brain signals the adrenal glands to release hormones in either life-saving or life-disturbing quantities. His big question: Why can some people use this system to their advantage? For instance, a potentially traumatic event, such as the sudden death of a loved one, might shatter one person but make another stronger.
Meanwhile, for families and their advocates, here are the teachable factors that appear to help make a child resilient, rather than at-risk.
Measures like these can be, must be, thought of as medical interventions that can benefit health for a lifetime. Medical providers who care for vulnerable families, and political leaders who decide which social and economic services to fund, must emphasize promoting resilience.
Programs like Mayor Kenney's Shared Prosperity initiative, which focuses on decreasing poverty and the effects of poverty, along with his focus on pre-K, community schools, and Out-of-School Time, can expose thousands of children in Philadelphia to positive role models, increase resiliency, and potentially alter their trajectories.
Now, back to that 14-year-old boy.
I had the pleasure of seeing him in our clinic last week for his regular checkup. He told me about his latest problem: how to choose from among the excellent private and parochial schools in Philadelphia that offered him full scholarships for his outstanding academic achievements. His mother, who wisely learned to encourage her son's resiliency from the start, beamed with pride.