The long arm of childhood: How chronic stress impacts Oakland teens in body and mind
This is Part 1 of a series that examines the impact of stress on teenagers in Oakland, Calif.
Part 2: Weathering childhood: Stressors that jeopardize teen health
Part 3: Surviving and thriving: What works to make teens stronger, more resilient
It was at the funeral of the boy he wanted to graduate with that Torrance Hampton finally cracked.
Standing near the altar, he thought hard about what to say. Both seniors, Torrance and Marquis Woolfolk had bonded instantly in September, sharing laughs and stories and hopes. Both had survived wild times and poor choices.
Now both were determined to graduate.
For three months, they stayed after school, working hard to make up the classes they'd missed.
In fact, the Friday before Thanksgiving, Torrance and Marquis had traded high-fives after turning in assignments that earned them three credits each toward graduation.
"Man," Marquis had said, "I think we're going make it."
Two days later, he was one of four boys shot as they stood on the porch of an East Oakland house. Two other boys were treated at Highland Hospital. Marquis died in the ambulance.
Tough parts of city
To a teen living in the rough areas of East Oakland, sorrow is no stranger. Random violence, worry about the future and a constant battle for basics such as healthy food, good schools and physical exercise, add up to a kind of life that can make an East Oakland teen far older than his or her chronological age.
Research shows that like adults, teens exposed to chronic stress can suffer from anxiety, insomnia, depression and eating disorders; they experience short-term memory loss and inability to focus or to manage time.
As teens age, there is an even bigger physical toll: Adolescents exposed to chronic stress have higher adult rates of asthma, obesity and Type 2 diabetes, and are at higher risk for some cancers and stroke.
Chronic stress will upset a teens' neurobiology, reducing their ability to regulate key hormones that restore equilibrium after stress, whether it's a bad grade on a science quiz or a friend's slaying.
It can also raise the level of inflammatory proteins in teens' body, putting their immune system on permanent alert, and worsening both the risk and the symptoms of illnesses that include inflammation, from asthma and eczema to diabetes and heart disease.
Ironically, chronic stress hits teens just as they're developing the brains and bodies to withstand it. In a 2008 study, researchers at King's College in London speculated that teens are more severely affected because adult stress "acts on a more developed system."
Len Syme, a professor emeritus at UC Berkeley's School of Public Health, says there's no doubt about the link between adolescent stress and adult health, which some researchers call "the long arm of childhood."
"When you're in difficult circumstances, those circumstances get compounded, and they wear people down," said Syme, the principal investigator of a 2002-06 study that examined the effect of violence and poverty on middle school students living in Richmond and San Pablo. "These things occur early in life, develop into adult life, and that's (called) weathering."
A close-up look at teens who are living and learning at East Oakland's Castlemont Campus of Small Schools -- including interviews with and writings by nearly 100 students at East Oakland School of the Arts, Castlemont Business and Information Technology School and Leadership Preparatory High School -- reveals how stress affects them in body and mind.
Asked to describe what stress feels like, Perla Quinones, a 17-year-old Castlemont business technology school senior, has no trouble.
"I can tell when I'm stressed because my stomach starts to hurt, my hands get sweaty and my body feels funny," she writes.
"I can tell when I'm stressed because I don't really have an appetite and (I) want to sleep a lot," writes Shay-Nesha George, also a senior.
"Mentally, it makes me feel drained ... physically, my body gets tired."
The students' descriptions couldn't be more medically accurate. A teen body responds to stress in a way perfected by millions of years of practice. Confronted by danger, the brain's sympathetic adrenal medullary (SAM) axis kicks into gear, and the adrenal gland starts to flood the body with epinephrine and norepinephrine.
Together, these stress hormones trigger a cascade of changes: blood pressure rises, heartbeat quickens, blood vessels constrict. The body is ready to fight -- or flee. But once danger abates, the body strives for balance: The hypothalamic-pituitary-adrenal (HPA) axis takes over and the adrenal gland starts releasing cortisol, which slows the body down and restores equilibrium.
When they work, SAM and HPA are like two ends of a teeter-totter, raising the body's defenses to danger and then lowering them as danger disappears. But overstimulation -- too much stress, too often -- throws the balance off.
Unlike adults, teens exposed to chronic stress are less responsive to cortisol, researchers believe.
Researchers warn that a constant flood of epinephrine and norepinephrine can suppress immune systems; provoke variations in heart rhythms; produce neurochemical imbalances that cause psychiatric disorders; and destroy neurons in the hippocampus, where today's pop quiz becomes tomorrow's ability to write long essays or solve complex equations.
The link between stress and asthma is particularly strong. A 2006 public health report compared Los Angeles ZIP codes and found a positive link between hospitalization rates for asthma and assault.
Despite a drop in asthma hospitalization rates statewide, emergency room visits and hospitalization rates in Oakland, San Leandro and Richmond are substantially higher than in surrounding cities, two recent county reports show.
In a 2001 article, researcher Rosalind Wright of Harvard University described a Boston high school student who developed wheezing symptoms Sunday nights before the school week began. Researchers discovered that the girl had been robbed by a group of girls on the subway.
When they were found guilty, the girl's symptoms abated. But after they were released, the girl's asthma returned, and she was hospitalized twice in two months.
"Psychological stress disrupts the same biological pathways as does breathing in air pollution or tobacco smoke," Wright wrote.
Torrance's experience is typical of a traumatized teen. Speaking at his friend's funeral, the words went past in a blur.
Then it was over, and Torrance was walking back to his pew when it hit him: I am exactly like Marquis. I am Marquis. I am 17, the child of a single mother, a young black man. It could have been me.
Torrance ran out of the funeral home at the corner of Telegraph Avenue and MacArthur Boulevard. He started crying and waving his arms, black parka flying. He stumbled over the curb and into the street. People began shouting from the sidewalk.
But Torrance didn't respond. He raved and waved his arms and walked in circles, and then he fell down and he stayed there, in the middle of the street on a bright fall morning, rocking and moaning to himself as the cars sped by, horns blaring.
Finally a teacher got Torrance back onto the sidewalk and hugged him hard until he stopped moving.
"What do they want from us?" Torrance cried, rage subsiding into anger and anger melting into tears. "This is the sixth person I know who died. The sixth person; I shook his hand. What do they want from us? What do they want from a black man? I'm scared. I'm scared."
Since January, a spike in teen homicides has put Oakland students on edge. So far this school year, 13 students have lost their lives to violence, including Ditiyan Franklin, 17, a senior at Castlemont's Leadership Preparatory High School who was shot and killed in broad daylight May 25 while riding his bike.
Violence takes toll
In interview after interview, Castlemont students cited fear of random violence, of being "jumped" or "jacked," as a major life stress.
Those who die aren't the only victims. According to research at the American Academy of Child and Adolescent Psychiatry in October, nearly half of all inner-city youth may suffer from post-traumatic stress disorder, including symptoms such as flashbacks, emotional numbness and hyperarousal.
"I would estimate that 100 percent of our students are impacted by violence in some way or form," says Matin Abdel-Qawi, East Oakland School of the Arts principal. "There's no way you cannot be, in our community."
He should know.
A favorite student, senior Christopher Jones, 17, was the last homicide of 2010, shot New Year's Eve in front of his house after buckling his niece into her car seat. Police called the killing a case of mistaken identity.
For East Oakland School of the Arts senior Dejai Johnson, Christopher's funeral in January was the fourth of the school year.
Asked if he was concerned for his personal safety, however, Dejai replied, "not really, because I'm the type of person who stays in the house."
"My mother really don't let me out," said Dejai, an 18-year-old who hopes to study sports broadcasting at Clark Atlanta University in Georgia next fall. "If I'm going (out) with my girlfriend, she comes over to my house... I really don't worry too much because I know I don't do anything."
When he wants to exercise, freshman Edwin Shy asks a friend's mother to drive him to Lake Merritt, almost 10 miles away, because walking near school is too unsafe. A week after Christopher died, Edwin accepted an aunt's offer to move to Houston.
"I don't want to stay here and deal with the violence," he said. "I really couldn't get any sleep after (Jones' killing). I keep thinking, who could be next? Will it be someone I care about the most? Will it be me?"
While Edwin talks openly, other students "front," hiding their emotions.
"What worries me is that (the deaths are) happening so much, it's becoming normalized," said Barbara McClung, mental health coordinator for the Oakland Unified School District.
"If we have one trauma, we have resiliency, and so we bounce back. But if, before we recover, there's another trauma, it becomes compounded," McClung said. "If you have one trauma after another, after another, you shut down (and) your body is stressed. Sometimes we become depressed."
Despite his grief, Torrance Hampton managed to graduate one month after Marquis died. His birthday was May 4.
"I was happy to make 19 (years old)," said Torrance. Getting a job and making it to next May are his new goals.
"(Marquis) had potential and (a) hunger to move on in life," Torrance said. "Young black men like me need some role models, someone to get me through the next five years, because we don't ever know if we're going to make it through to 20."