Stress and learning

Why are we not teaching our students the barriers to learning? We are teaching them to learn calculus, chemistry, physics, history, Jose Rizal, etc., but we are not teaching them how the brain functions and learns, which I think should be a basic skill like the three Rs.

About 35 years ago, we convinced a group of parents with asthmatic children to attend a monthly lecture on the lungs and the medications they can use at home so they can cut back on visits to the emergency room and hospitalizations. Three of us, two pediatricians and an allergist, alternated in giving the monthly talks. After several months we noticed a reduction in the number of asthmatic children visiting the emergency room and being confined in the hospital.

Years later, this became a standard practice called the Asthma Education Program and given to all parents whose children ended in the hospital because of the parents’ failed home management. This model is now used in almost all children with chronic medical problems like cystic fibrosis, autism, diabetes, allergy, depression, etc.

If this is effective in the medical field, I think it will also benefit parents and educators to be told about how the brain works and the factors that can derail learning.

There are a number of factors that result in school failure. The biggest one is stress—not physical but emotional. All parents as well as educators should know how stress affects the brain and retards learning.

Most of you have heard of the term “PTSD,” or post-traumatic stress disorder. This condition was first described in American soldiers who fought in Vietnam. When looking at the brain of those soldiers who died from other causes but had a history of PTSD, researchers found that the part of the brain called the hippocampus, the memory center, had evidence of cell damage. But those soldiers who died without a history of PTSD had a normal hippocampus.

When monkeys are chronically stressed and their brain is put under the electronic microscope, they showed similar findings in the memory brain cells. This is a result of the stress hormone called glucocorticoids, which goes up and stays elevated during prolonged stress. With reduced functioning memory cells, it is easy to understand why learning is compromised.

When I was a premed student, we had several teachers who we called “toxic.” They were strict and shouted at us when a student gave a wrong answer. I was stressed out when attending their lectures, and I cannot remember most of the lectures. However, when our teachers were funny and never raised their voice, I learned much better and I felt good.

Students suffering from chronic stress don’t do well in math, don’t process language efficiently, have poor memory, and cannot easily adapt old information to new problems. In any performance testing, stressed students or workers generally perform poorly. In one study, adults with high stress levels performed 50 percent lower than those with low stress in life.

Unfortunately, the effects of stress are not limited to learning and are also the harbinger of depression. Prolonged stress, especially when severe, can push students to depression and even to suicide. In a recent flight to Manila, I read a newspaper article saying that the suicide rate among students in a certain region in South Korea was the highest in the world because the competition for admission to the best university was highly valued. In that area during the time of examinations, the environment should be as quiet as possible to the extent that even airplanes are not allowed to land or take off.

In my second year of medical school, one student in our university system committed suicide. It was also a time when I felt I was at the end of the rope of persistence. I was stressed because of my studies and the financial situation of my parents. Neither of them finished high school. We survived on the earnings of their small tailoring shop and beauty parlor. There was a semester when my mother could not come up with my tuition. One night I could not take it anymore. I started shouting, crying, and throwing soft drink bottles at our cemented fence. When my mother came out of the house, I told her I wanted to quit medical school. After hearing her calm voice and plea that I continue with my studies, I settled down.

I remember that during our first few days in college, we were oriented on the library and told the time and days it was open, how to borrow a book, when to return it, and the fine for lateness.

If we can teach students about the library, why not teach them also how the brain works so they can learn better and reduce school failure, just like parents with an asthmatic child reducing the visits to an emergency room and hospital confinement?

We are lucky that the 21st century has brought us many new cognitive research results that can be used in our classrooms. To get the benefit from these results, it is our duty to use them.

Welcome to the age of evidence-based education.

Leonardo Leonidas, MD, graduated from the University of the Philippines College of Medicine in 1968. He is assistant clinical professor in pediatrics and recipient of the Distinguished Career Teaching Award (2009) at Tufts University School of Medicine in Boston in the United States. He was named outstanding UP alumnus in 2010.