Speakers describe systemic sources of, prescribe empathic responses to, early life stress

A powerful series of speakers at the Picower Institute’s biennial Spring Symposium, “Early Life Stress and Mental Health,” blended personal stories and rigorous research to demonstrate that while remedying the lifelong toxic stress and disadvantage many people incur during childhood can be difficult, it is by no means intractable.

Picower Institute Director Li-Huei Tsai opened the symposium, co-produced with the JPB Foundation led by Barbara Picower, with the observation that while problems such as poverty, racism, injustice and child abuse have been around for a long time, finding and implementing ways to fight the health problems that can result has become increasingly urgent.

“This feels especially so right now as we grapple with a time in which many of us have seen young people endure historic stresses,” she said. “The many tragedies and disruptions of the Covid-19 pandemic and stark examples of racial and social injustice have made this a particularly difficult time to grow up.”

Stories of systemic stress

Educator Geoffrey Canada, founder and president of the Harlem Children’s Zone, emphasized that the current moment is especially crucial in the black community.

“If I am right about what I suspect is going to happen in this country, I can just say for those of us who care about toxic stress we haven't seen nothing yet,” he said. “What's coming in my opinion, is sort of unprecedented.”

Canada, who grew up in the impoverished South Bronx, recounted several episodes in which generations of his family encountered racism, sometimes at the hands of police and health care providers. Many black people have come to regard such stresses as “the price of living in America,” he said. But after observing the disproportionately terrible impacts of Covid-19 in his and other communities of color, his concern is heightened further.

“I think it's very clear in this country, your race determines largely whether you lived or died, whether you got sick, whether you ended up working at home or being on the front lines,” he said, “whether your children got an education, and whether or not you're going to have anything that looks like a recovery from this experience.”

Moreover, the murder of George Floyd and other police killings were “seared into the psyche,” adding even more to the stresses black children now face.

Lawyer Bryan Stevenson, founder of the Equal Justice Initiative, called out other harms the justice system has inflicted, particularly on women and children. But he also recommended a prescription for the nation to reconsider policies that have led to mass incarceration and prosecution of children as adults.

“Over the last 25 years the percentage of women going to jails and prisons has increased 800%,” he said. “Eighty percent of the women that we put in our jails and prisons are single parents with minor children which means that the lives of a generation of children are being disrupted by these carceral policies.”

Moreover, in a country where 1 in 3 black and 1 in 6 Latino boys are projected to be in prison during their lives, Stevenson said that when he sits down with pre-teens in poor communities, “they’ll say things that break my heart. I’ve talked to too many children who tell me that they expect to be in jail.”

He called for more people to get “proximate” to families struggling with poverty, addiction, and other difficulties because proximity promotes understanding and empathy and provides an opportunity to provide the affirmation, care, safety and opportunity that children growing up among violence need. Proximity, for instance, can help undo the discredited but persistent narrative that juveniles accused of crimes are somehow “super predators” and not still children. It can combat the politics of fear and anger, he said, that led the country to treat addiction disorders through the legal system rather than as a health care problem. And it can dispel, he said, a sense in America, lingering since slavery and the genocide of Native Americans, of a racial hierarchy.

Jose Antonio Vargas put a similar emphasis on inspiring empathy through storytelling. The organization he founded, Define American, is a culture change organization that uses the power of narrative to humanize conversations about immigrants. Vargas, who came to the U.S. from the Philippines as a child, discovered his undocumented status when he was a teenager. As difficult as living undocumented can be under typical circumstances—he drew a parallel between limitations on travel many felt during the Covid-19 pandemic with the restrictions undocumented people consistently face—becoming a public advocate amid intense policy debate can add to that stress.

Define American has therefore spearheaded research with the University of Massachusetts, Amherst, funded by the National Geographic Society, to survey immigration advocates for signs of PTSD, stress, depression, and other signs of mental health troubles, as well as resilience. Full results, he said, will be published this summer, but reflect high rates of both trauma and resilience.

Science begets solutions

Several symposium speakers emphasized that much as personal stories and proximity can aid reveal the roots of toxic stress, scientific data and research can also lead to remedies by discovering the mechanisms that underly health problems.

Picower Institute neuroscientist Gloria Choi, Associate Professor in the MIT Department of Brain and Cognitive Sciences (BCS), for example, shared her research tracing a long observed but never explained link between pregnant women getting sick from infection and the emergence of autism-like symptoms in their children. Her research in mouse models showed that when specific bacteria are in the gut microbiome of pregnant dams, infection during a specific time of pregnancy stimulates the release of cytokine molecules from immune cells. Those cytokines reach neurons in the S1DZ region of the cortex of the fetus, disrupting the development of inhibitory neurons. That in turn leads to hyperactivity of circuits governing social behaviors, causing the autism-like neurodevelopmental disorder.

By achieving this kind of detailed, causal understanding, Choi said, scientists poinpiont targets for therapeutic interventions.

“We scientists, to be able to help children, I think we need to understand at mechanistic levels as to how mother's health can shape that of her child,” she said.

At a population level, as well, extracting cause and effect from data can help guide public health and policy remedies, said social epidemiologist Mariana Arcaya, associate professor in MIT’s Department of Urban Studies and Planning. She made the case that while many researchers have shown that neighborhood characteristics such as poverty and violence can undermine health, fewer have studied what may be an equally important link – existing health conditions can make it harder for families to move. Appreciating this bidirectional relationship between health and geography should not be overlooked in devising interventions, she said. Her research has helped to document it.

“If poor health is a factor that is going to limit socioeconomic and geographic mobility, and we know that there's huge baseline disparities in health in the United States,” Arcaya said, “then we really need to be concerned about the kind co-production of health and neighborhood and housing conditions and how some families may be in a kind of cyclical disadvantage for both health outcomes and socioeconomic and neighborhood outcomes.”

As the first Surgeon General of the State of California, physician Nadine Burke Harris has galvanized a science-based statewide response to the public health crisis of adverse childhood experiences (ACEs), such as abuse, neglect or disruptions in home life. More than 60 percent of adults have experienced at least one ACE and 15.8 percent have experienced four or more. Research shows that ACEs accumulate to raise the risk of serious health problems including Alzheimer’s disease and suicide. In all, ACE-related health problems, she said, add $112.5 billion to annual health care costs in California and more than $1 trillion across North America and Europe as a whole. On top of those, poverty and racism are also risk factors for future health difficulties.

“Over the last several decades we’ve begun to explore the biological mechanisms for how this happens,” she said. “We’ve heard that trauma, especially in childhood, is damaging to our physical health, our mental health, but now we want to understand why because when we understand the mechanism, that gives us tools to be able to unpack this.”

In affected people, she said, ACEs trigger toxic stress – an abnormally sustained stress hormone and immune system response, as well as epigenetic changes that alter expression of genes. These factors, many of which act directly on the brain, lead to health risks. They can be mitigated, however, by providing safe, stable, and nurturing relationships and environments, as well as with stress management and medication.

So California has launched programs that have trained more than 17,000 primary care providers to screen more than 300,000 patients for ACEs and toxic stress risk. From there doctors can help families with strategies to better manage the response. Moreover, the state has invested more than $30 million this year in grants covering 27 counties to link medical, social, educational and community service providers together in “trauma-informed networks of care” that support families more broadly.

Extending opportunities

In a panel discussion, moderated by Laura Schulz, a Professor in BCS and the department’s associate head for Diversity, Equity Inclusion and Justice Initiatives, the symposium also highlighted another dimension of harmful inequity that prevents people from reaching their full potential: the lack of diversity in science, technology, engineering and mathematics, or “STEM.”  Mirroring the focus other speakers put on seeking solutions, the panel featured people at MIT who are working to improve diversity in STEM and participants in some of those programs who described what involvement has meant for them.

Picower Institute postdoc Héctor De Jesús-Cortés,, a member of Picower Professor Mark Bear’s lab, for example, described how his participation as a student in Puerto Rico in the NIH-funded Minority Access for Research Careers program enabled him to do full time research and to launch his scientific career. That and other opportunities inspired him to co-found the Sagrado MIT Neuroscience Pre-College Program, which helps high school students all over Puerto Rico to gain more exposure to science and knowledge about science careers. Of the 11 juniors who participated last year, many are now headed for colleges such as Stanford, Yale, Emory, Cornell and Georgia Tech, he said.