It has been called “the greatest
public health issue of our times,” a condition that a strong body of scientific
research shows can make people two times more likely to smoke, seven times more likely to struggle with alcoholism, 10 times
more likely to use drugs, and 12 times more likely to attempt suicide. Children
with this condition are 32 times more likely to exhibit behavioral problems in
school. As adults, they are twice as likely to be diagnosed with cancer and four times more likely
to have emphysema as well as other medical issues. The condition? Significant
childhood adversity.
This information was new
to me, even having been a practicing social worker for more than 10 years. (Current
social work students are taught about this research.) It was less surprising to
Chana, a wonderful wife and mother, who shared with me that she had experienced
at least four adverse experiences as a child, including having a parent with an
addiction and mental health issues and another parent who was verbally abusive.
She also remembers experiencing significant stress and anxiety as a child when
witnessing her parent hurting some of her siblings in an out-of-control rage.
Chana definitely feels
that the cumulative effect of these experiences contributed to a number of
physical and mental health challenges that she experienced as a young adult. “Baruch Hashem, I am in a completely different place now, but when I was
eighteen, I struggled with severe anxiety, rapidly cycling moods (with extreme
highs and lows), self-harm, and suicidal ideation among other issues. Because
my inner world was so crazy and painful, I was attracted to unhealthy
relationships that made things even worse for me.”
In addition to her mental
challenges, Chana struggled with a number of medical issues including a hormone
imbalance that sometimes got so bad that she would get migraines, vomiting, and
severe cramping. “I also had a pain that is hard to explain,” continues Chana.
“It was a hot crawling sensation so intense that made me want to rip my skin
off.”
Shira is another survivor
of childhood adversity. Her childhood was less dramatic than Chana’s but
traumatic nevertheless. “I grew up in a very stressful and chaotic home. When I
was at home, I always felt stressed out and anxious. I did not feel like I
could speak to my parents about my feelings – or like they cared about my inner
world.” Today, as a mother to five challenging children, Shira experiences a
lot of stress in her life and has had a number of medical issues that she feels
may be related to her early childhood experiences, including frequent headaches
and irritable bowel syndrome. She has also struggled with anxiety and
depression throughout her adulthood.
* *
*
The groundbreaking study that
clarified Chana’s and Shira’s conditions was done by Kaiser Permanente and the
CDC in 1997. A group of 17,000 individuals was asked about 10 specific types of
adverse childhood experiences (called ACEs). They included various types of
abuse and neglect, exposure to domestic violence, household substance abuse,
household mental illness, parental separation or divorce, or an incarcerated
household member.
Two thirds of the
subjects reported experiencing at least one adverse childhood experience and 40
percent had experienced two or more. The number of ACEs experienced correlated
with increased health, social, emotional, and behavioral challenges as people
aged. More surprisingly, ACE scores also correlated with many health issues,
including depression, heart disease, cancer,
and chronic lung disease. Those with especially high ACE scores lived, on
average, 20 years less than their peers.
This groundbreaking study
demonstrated a clear connection between early childhood experiences and later
life behavioral, emotional and medical issues. These challenges persist even as
people age, with new research showing an increase in dementia rates among those
who experienced significant adversity as children.
Shira’s experience with
physical illness can be understood in light of new ACE research. At the time of
the original ACE study, it was unclear how childhood trauma could impact
a person’s body and brain in such a long-lasting way. Since then, many
biological mechanisms have been identified and studied. In particular, it is
now understood that significant adversity or trauma causes the brain to be
thrust into “fight or flight” mode. According to Donna Jackson Nakazawa, an
author of a number of books related to ACEs and health, this state of hyper-arousal
can become chronic – which means that the person is being exposed to numerous
stress hormones and inflammatory chemicals on a daily basis. This is especially
destructive for children, whose brains and bodies are still developing.
Nakazawa explains that this causes long-term physiological damage and chronic
inflammatory health problems such as high blood pressure, diabetes, strokes,
autoimmune disease, asthma, bowel issues and even heart disease.
Of course, early
adversity is very common and usually not apparent to outsiders. Unlike parental
divorce or incarceration, ACEs like emotional abuse or other serious stressors
that lead to a state of chronic stress are more subtle and easier to cover up
but are just as harmful to development. Thankfully, some environmental factors,
such as having a supportive caring adult involved in the child’s life, can
buffer the effect of ACEs on a person’s life.
*
* *
Neither Chana nor Shira initially
identified their early trauma as the factor contributing to their challenges as
adults but found healing when they eventually made the connection.
Over the years, Chana has
found multiple interventions that have helped her. She participated in both
individual and group therapy. The therapy that was most helpful for her,
however, was the one that addressed her trauma directly and taught her to treat
herself (and her “inner child”) with kindness. On a practical level, she found
Dialectical Behavioral Therapy (DBT) – which includes tools for better coping,
mindfulness, and communication – to be “life-changing” and extremely useful in
her healing process. Chana shared, “In addition to therapy, improving my
nutrition and incorporating yoga into my life has really helped my healing. I
also feel grateful to have started a support group for women who have
experienced similar issues and it gives me a lot of satisfaction.”
Shira also found therapy
helpful. “Before seeing a therapist, I saw many medical professionals regarding
my irritable bowel symptoms, but had minimal relief from the interventions I
tried,” Shira said. “After starting therapy and addressing some of the
experiences I had been through, my IBS has almost completely gone away and my
mood has improved significantly. It also helped me understand some of the roots
of the stress I experience when dealing with my children.”
Donna Jackson Nakazawa’s
books are full of hope for those who have experienced early adversity. In Childhood Disrupted: How Your Biography
Becomes Your Biology, and How You Can Heal, she writes, “No matter how old
you are, or how old your child may be, there are scientifically supported and
relatively simple steps that you can take to reboot the brain, create new
pathways that promote healing, and come back to who it is you were meant to
be.”
Chana says, “When I
finally surrendered and handed my heart, brain, and hormones to Hashem, it was
life-changing. Things calmed down a lot after that. I am doing so much better
now, and I try to keep my life light, positive and simple. I also found that
being in a healthy marriage with someone who is safe and feeling true love and
belonging is healing beyond words.”
Like Chana, many others
have found that healthy, supportive relationships and connecting to
spirituality have helped them navigate the inevitable challenges that occur in
their lives. And many individuals who have worked through the significant
adversities they have experienced, emerge with a deeper perspective on their own
challenges and those of others, and lead very successful, fulfilling lives.
Chana reflects, “I really
feel that I have gifts that came from my experiences. While I would never want
to go back there, I have gained invaluable life skills, perspective, and emunah that give me solid strength and
joy on a daily basis.” As Nakazawa writes, “Ultimately,…you don’t just become
who you might have been if you hadn’t so much childhood suffering…. You gain
something better: the hard-earned gift of life wisdom, which you bring forward
into every arena of your life.”
“Post-traumatic growth,”
a concept from positive psychology, may explain this phenomenon.
As Shira points out, “I
really feel that my experiences, while very difficult and stressful, have
helped me become a deeper and more sensitive person. I am able to relate better
to those who are struggling around me and be a better wife and mother to a
large family. I’m not sure I would ask for the challenges I had, but I
definitely can see how they have helped me grow as a person.”
*
* *
The ACE study demonstrated the need
for us to take childhood trauma seriously and by doing so find ways to manage
its impact on our health and mental health as a society. Thankfully, many
solutions and interventions are being studied and recommended at this time, and
there are multiple paths to healing and gaining the tools to help us lead long,
healthy lives. Next month, in part two of this article, I will discuss these
interventions in detail.
Bracha
Poliakoff, LCSW-C, is a clinical social worker and a
licensed provider of continuing education for mental health professionals who
lectures on a variety of topics including the impact of trauma throughout the
lifespan.
Sidebar
Resources
·
TED
Talk by Nadine Burke Harris on ACEs: www.ted.com/talks/nadine_burke_harris_how_childhood_trauma_affects_health_across_a_lifetime
·
Website
about ACE research: www.acesconnection.comand www.acestoohigh.com
·
Resources
for families with ACEs: www.stresshealth.org
·
The Deepest Well: Healing the Long-Term
Effects of Childhood Adversity by
Nadine Burke Harris
·
Childhood Disrupted: How your Biography
Becomes your Biology and How You Can Heal and The Last Best Cure by Donna Jackson Nakazawa
·
The Body Keeps the Score: Brain, Mind,
and Body in the Healing of Trauma by
Bessel van der Kolk, MD
