BEZ’S BLOG #12: ACUTE CHILDHOOD EXPERIENCES (ACE’s)
 |
| One current use of the word trauma evolved from the study of adverse childhood experiences (ACE’s) that began in the 1970s. That study[1] began at the Kaiser Permanente Clinic in San Diego where Dr. Vincent Felitti was using supervised fasting to help control rising obesity in his patients. Under clinical conditions he was able to get some patients to lose a hundred pounds in a year. Unexpectedly, many of the women participants (4100+) would quickly put that weight back on. From them he learned that with such weight loss they would become more? sexually attractive to men. Regaining the weight made that less of a hazard, as they perceived it. He discovered that these women had been sexually abused as children. Their over weight was their ‘body armor.’Together with Dr. Robert Anda, Dr. Felitti wanted to see how common such adverse experiences (ACE’s) were. They followed those enrolled in their clinic for many years to see what happened to adult health among those abused as children. These people were not the indigent as they had healthcare insurance. Their astounding results were published in 1998. More than half of the survey population had one or more ACEs out of a possible range of 7. Three categories of abuse were delineated: physical, emotional and sexual. Then there is emotional and physical neglect. Finally, household dysfunction was characterized as mental illness, an incarcerated relative, mother treated violently, substance abuse and divorce. The more ACEs (abuse during childhood) the more adverse adult health behaviors they engaged in and the more adult diseases they had including heart attacks, cancer, lung disease, skeletal fractures (the other kind of trauma) and liver disease, all of which are leading causes of death.Those with higher ACE scores were more likely to be on antipsychotic drugs, engage in early sexual intercourse, and experience teen pregnancy and paternity, injection drug use, suicide attempts, not to mention early death.Learning about ACE’s has been one of those game changers for me. I attended a conference where Dr. Felitti gave a presentation that you can watch.Not unsurprisingly the higher the ACE score, the greater the risk of dying before average life expectancy. There are now ten ACEs as the term is used in the US. Poorer people have more ACEs but they are seen all the way up to the top of the socioeconomic spectrum. There is increasing media attention to such trauma and books that delve into trauma such as Van Der Kolk’s book[2] mentioned last month.Felitti and Anda observe that “Clearly, much of what we see in adult medical practice and as current major public health problems has its origins in what was present but unrecognized in pediatrics. There is a need to move from our current symptom-responsive approach in primary care to the comprehensive approach that was conceived but not attained—a biopsychosocial approach.”[3]ACEs, more broadly, can be considered to have three realms: those that happen within the family (the ACE’s study); those that happen in the community (substandard wages, jobs, poverty, violence, racism); and those that are environmental (earthquakes, air pollution, climate crisis).Having many ACE’s doesn’t doom you, of course. Some seem to sail through them because of factors termed “resilience.” However, there is no prescription for a pill that will give you resilience. Felitti feels that acknowledging ACE’s in people is the first step in therapy. Trauma informed-care is another important ‘treatment’ to consider. What is required, in the absence of a rapid remedy, are societal or political changes. Van Der Kolk writes: “When I give presentations on trauma and trauma treatment, participants sometimes ask me to leave out the politics and confine myself to talking about neuroscience and therapy. I wish I could separate trauma from politics, but as long as we continue to live in denial and treat only trauma while ignoring its origins, we are bound to fail. ” Appropriate parenting is one salve required. That and politics are the topics of a future blog. With this one, though, I wanted to continue emphasizing the absolute importance of the early years of life on health and wellbeing, and that they go well beyond the physical or pathological. Stephen Bezruchka, Seattle, Washington [1] Felitti, V. J. (2019). “Origins of the ACE Study.” American Journal of Preventive Medicine 56(6): 787-789. [2] Van der Kolk, B. A. (2014). The body keeps the score: brain, mind, and body in the healing of trauma. New York, New York : Viking. [3] Felitti, V. J. and R. F. Anda (2014). The Lifelong Effects Of Adverse Childhood Experiences. Chadwick’s child maltreatment. Sexual Abuse and Psychological Maltreatment. D. L. Chadwick, R. Alexander, A. P. Giardino, D. Essemio-Jenssen and J. D. Thackeray. Saint Louis, MO, STM Learning. Volume 2: 203-215. |
PLANETARY HEALTH WEEKLY 