S1E1: Adverse Childhood Experiences (ACEs)
Adverse Childhood Experiences (ACEs) affect nearly everyone. How do these experiences live on in our bodies and how do we recover from them? This first episode of Season One introduces the topic of ACEs. Throughout this season we'll dive deep into the science, experiences and recovery from childhood adversity.
Resources
In this episode we referenced several ideas that you may want to learn more about.
Original ACE study done by Vincent Felliti and colleagues. Published in 1998 in the American Journal of Preventative Medicine.
The Deepest Well by Nadine Burke-Harris tells the backstory of Felliti's discovery and subsequent study. This book also looks in-depth into the science of ACEs and how we can heal.
Brain Rules for Baby by John Medina has more information on how early childhood experiences have long term impact.
The Social Transformation of American Medicine by Paul Starr talks about the separation of medical doctors from preventative and public health approaches to health.
When the Body Says No by Gabor Mate discusses the movement in medicine becoming more and more specialized and less holistic.
Transcript
Athalie: Hi, welcome to today's episode, which is the first episode of the Social Cure podcast.
Today we're talking about Adverse Childhood Experiences, or ACEs for short, which is a list of 10 adverse experiences that children could be exposed to. Research has found strong correlations between these experiences and significant health issues later in life.
It's also worth noting that the research can paint a pretty bleak picture, but there is also a lot of hope in understanding ACEs. Initially we'll focus on the statistics and challenges associated with these experience, but later in the conversation, and throughout this season, we'll focus on recovery and what you can do to move forward in your own journey.
I do want to provide a trigger warning on this episode. We'll be touching on difficult topics including physical and sexual abuse. If this doesn't feel like the right moment to listen to this conversation, trust your instinct and come back later.
Joining me today is my friend, Joseph, who is someone that I've had a lot of conversations about, really everything, but especially focusing on things like how our experiences shape the way we view and interact with the world. He is someone like me who approaches the world with a lot of curiosity. And so I think conversations will be very interesting as we delve into the topic of ACEs.
Joseph: Well, thanks for having me.
Athalie: I wanted to start with a story, that happened in the late 1990s. There was a doctor working in a weight loss clinic in California, and part of his study was looking at people who tried to lose weight, and were either unable to, or would successfully lose weight, and then a few years would go by and they would gain back all of the weight that they had lost. At one point, he stumbled onto a answer to a question that really struck him as surprising.
One of the questions he would ask patients is how old they were when they had their first sexual encounter. One time, instead of asking the age, he asked her how much she weighed at her first sexual encounter. And she told him 40 pounds and he thought that must be an error.
Couldn't be true. So he asked more questions, found out that she had a history of childhood sexual abuse. Over the next few months of time interviewing patients, he started asking them about childhood sexual abuse and found that the majority of the patients that were struggling to lose weight had experienced this.
This was part of their story. This launched him and some colleagues on a search to understand how this experience might relate to these patients. Long-term health effects like inability to lose weight is correlated with a number of health conditions like heart disease and diabetes, which are some of the biggest killers in the US of people that die prematurely. At the culmination of this study which looked at more than 17,000 participants they found three components of adverse childhood experiences: different forms of abuse, different forms of neglect and exposure to violence or incarceration in their family. And for people that had experienced any of these, their risks of later in life developing chronic and debilitating medical conditions was significantly higher. And they were shocked by this, which I find very interesting.
And I think I find it shocking that it took until 1998 for people to discover that our childhood experiences affect our long-term health.
So that is kind of the start of really looking at how trauma impacts our health. That has spiked this whole movement in healthcare called trauma informed care, to try to understand these things better.
And despite the research that has been done on this, I think a lot of people are not familiar with these concepts or don't know how they relate to them as an individual patient. And it's part of what I want to talk about on this podcast. I want to bring this to individual people and help us understand how we can heal ourselves and then heal the institutions that are caring for us.
Joseph: I really liked the back story on that, because like you said, the data has always been there, but it just recently, you know, has surfaced and hopefully, the medical practitioners are going to begin to factor that into their work. But I also like the angle of self-healing and I know that moving forward, you're going to talk a little bit more about that and give us action steps. Because I have experience with, adverse childhood, things that happened in my own past, which I will go into a little bit more detail in later, but I really liked the angle of self-healing and hopefully me being a curious student here today, will take something away that will help me. And also anyone listening, wherever you are, you can take something with you that will help you see how you can move forward in spite of all the experiences you had in your past. So thank you.
Athalie: Yeah. Well, the other thing that's interesting with this initial study is that, it might seem like this was something that people living in poverty, or we would expect given what we know about racial disparities in health, to be a problem with marginalized people in some way. But this initial study was actually done, with mostly white middle-class, 70% of them were college educated, community, in California and the high rates of these adverse childhood experiences that they found in that group shows that this stuff touches people everywhere.
So having a high income, having high levels of education does not necessarily protect you from experiencing these things.
Joseph: So I have a question real quick.
Is it standard? I don't know how medical practitioners go about their work, but the question that the, the doctor asked is that standard for a doctor to ask someone questions like this, when they go in for like medical checkups and things like this,
Athalie: It is not, and that is actually something that I'm working with in the clinic where I work to start asking people these questions and engaging them in a conversation about these experiences and helping them even just to understand that those things they experienced may still be affecting them later in life. There are things that can be used to heal this, like mindfulness and different forms of therapy. And the first step in, in this healing is realizing that there's something going on in the first place. And so I think that's a really important conversation that doctors can have. But also we can be having with each other and with the people in our lives to understand how the things we've experienced in the past connect with our current situation and the current things we're facing, but that doesn't need to come from a doctor that can also just come from conversation and general awareness of these things.
So just wanted to throw out a few of the statistics that were kind of shocking from this initial study. Again, this is in this middle to upper middle class, mostly white, mostly highly educated, group of people.
A quarter of them had suffered, repeated physical abuse before the age of 18.
Almost a third of the women had experienced sexual abuse and one six of the men.
Two thirds of the participants in the study had experienced at least one adverse childhood experience and the vast majority had two or more.
The correlations they found are for people that have four or more of these experiences as a child:
They're much more likely to have depression
Have twice the risk of heart disease
Three and a half times the risk of developing chronic obstructive pulmonary disease, which is a chronic lung disease.
If you have experienced six or more of these:
You have a 50 times greater likelihood of attempting suicide
46 times greater likelihood of IV drug use
Twice the chance of having cancer
And four times greater chance of having emphysema, which is a chronic lung inflammation problem.
So, these numbers are staggering.
And when we look at our healthcare system in the US, we're spending a lot of money addressing these problems after they've started. And there's not been a lot invested in figuring out where these things come from and how we could possibly prevent them.
Joseph: Yeah. Those are staggering numbers. I'll share some of my numbers with you. How about that? So I did take my ACE score. I believe that those resources will be available, but I did take the ACE score and I was score five and, and we can go, I don't know. Do you want to go over each of the questions or can I just go with my, my score and then that will be available for the listeners at some point?
Athalie: Yeah. So based on this initial study, they came up with 10 different experiences that were correlated with these effects later in life. These are:
Did a parent or other adult in your household often or very often swear at you insult you, put you down or humiliate you or act in a way that made you afraid you might be physically hurt.
Did a parent or other adult in the household often or very often push grab, slap, or throw something at you or ever hit you so hard. You had marks or were injured.
Did an adult or person at least five years older than you ever touch or fondle you or have you touched their body in a sexual way? Or attempt to actually have oral, anal or vaginal intercourse with you.
Did you often or very often feel that no one in your family loved you or thought you were important or special, or your family didn't look out for each other, feel close to each other or support each other.
Did you often or very often feel that you didn't have enough to eat, had to wear dirty clothes and had no one to protect you or your parents were too drunk or high to take care of you or take you to the doctor if you needed it.
Were your parents ever separated or divorced?
Was your mother or stepmother often or very often pushed, grabbed, slapped, or had something thrown at her. Sometimes often or very often kicked bitten, hit with a fist or hit with something hard or ever repeatedly hit at least a few minutes or threatened with a gun or knife.
Did you ever live with anyone who was a problem drinker or alcoholic or who used street drugs?
Was a household member depressed or mentally ill, or did a household member attempt suicide?
Did a household member go to prison?
So looking at these 10 different yes or no questions is how they people arrived at the score.
So your score could be from zero to 10. Two-thirds of people in the study had experienced at least one and the vast majority had actually experienced two or more of these things.
One of the things I think is really interesting about this study that did not come up, was the components of looking at racial issues. That was not a question that was asked. And since then, a lot of studies have tried to quantify the effect of living in a racially segregated community, and also the effects of being a refugee or an immigrant, which are also traumatic, life experiences, especially when experienced as a child or experiencing things like living in a war zone. Those things were not part of the initial study, but people have tried to add later.
Joseph: So listening to you go through the 10 identified experiences. I identify five of those that I experienced growing up as a kid. And a lot of what you said, like having suicidal tendencies. I have gone through that phase. I had my elder brother, he went to, he didn't go to prison, he went to jail, I believe it was at the time. I didn't know what was going on. But it's interesting that I spoke to him a couple of weeks ago and he had some problems with his heart and he's a relatively young person. And so this information coming for me, it's, it's a huge deal. And when I see my score five, it's actually pretty troubling because I don't know. I mean, I do know how it has affected me in the past. I've had some problems with substance use. Like I said, I had suicidal tendencies and all of that. And so one of the questions I have is, and I think I asked you this earlier, before we actually started.
If someone experiences multiple of these adverse conditions, what does that mean?
Athalie: Yeah. So one of the terms they use to describe this in statistics is a dose response relationship. So if you were to graph this the more experiences that you answered yes to the greater the effect it has on your health.
So, it's not just have you experienced any of them? Then you're going to have some effect. There's actually greater and greater effect the more you've experienced. This is definitely something I saw in being a foster parent and the known things that had happened to kids I was familiar with in the foster care system. Many of them had experienced 10 out of 10. And even at a young age, some of these health things were becoming apparent while they were still kids.
Joseph: I mean, I can't even begin to imagine someone that has experienced 10 out of 10. But as someone that has five of those things happened in my past, I know the struggle that I've gone through. So this, this conversation really helps me a lot. It's actually, I'm having a very visceral reaction to some of the things you're saying, because I can directly see how that has affected me personally.
Athalie: I like the way you summarize this. As these things are health and happiness inhibitors. Part of it is the physical health effects we have, but our health is more than just physical health. It's also emotional health and how we are able to enjoy our life and how we're able to enjoy the things that we have in front of us.
All of these things are affected by what happens in our childhood.
Joseph: So I have another question real quick before I turn over to you. Some of these adverse experiences that happened can happen to someone in the later stage of life. Is there a distinction between experiencing this as a young person or as an adult? Like they're all negative experiences. I get that, but is there a difference?
Athalie: These things, if they happen to you at any age are traumatic, right? And humans of any age can experience trauma and that has noticeable changes. There's been a lot of studies done about that. The thing that makes it different when it happens to you as a child is that this: it shapes how you develop. How your genes express themselves because you're in a period of rapid growth and especially things that happen in the first 18 months of your life really change how your brain will function for the rest of your life. So, many of these experiences happening in childhood, especially at a young age, are literally shaping the trajectory for the rest of your life, in both how you're going to respond behaviorally to things that are put in front of you, but also how your genes will express and whether a family history of a disease will show up in your life or not at a later point.
So I think that's the biggest difference with measuring what you've experienced as a child versus as an adult. The change is often a lot more lasting.
Joseph: So I have a quick question again. Now, because I have siblings that we have the same experiences or had the same experiences growing up. If I wanted to have this conversation with them, what will be a good way to start conversations like this in the family? Because it's difficult to get everyone together at the same time, or to say, go see a medical professional. How do I start this conversation with them apart from sharing the link to this podcast with them? Like, do you have any thoughts around that?
Athalie: This can be really fraught with tension because these are things that happened in your childhood. Sometimes happened as a result of people that you love and that loved you. And I think it's really important to stay away from blaming people.
And so a way to start the conversation can be talking about your own experience and your journey. One of the things that I know about you is that you have done a lot of work at, mindfulness and practices to come back to center yourself in your body. And that is one of the most studied ways to heal childhood adversity and mitigate those effects long-term. And so I think talking about what you've done and the healing that you've experienced personally, it's a great starting point. And then it really depends on the relationship that you have with your siblings. How you think they would receive that and the things that you can see them caring about or dealing with, like, if you start with a specific thing, like, you know, you have a brother who has heart problems, that could be an entry point.
To talk about these things. I think it's also important to note that we don't know that the only thing that's causing that. So it's often interacting with the genes that we have and other things that we do in life. So it's not that this is the only thing that's causing all these problems, but it's a significant factor.
And it's been really overlooked in the way that we view illness and, social problems in our society.
Joseph: Okay. I have a couple of more questions. So I didn't see the breakdown of the study and so I don't know what the ratio is of the gender of the people in the study but I'm speaking from a man's perspective. And in all the times that I've gone to see my physician, he has never asked me questions about my past or any of these experiences that you just talked about. So I think. "I've never experienced this before," to be honest. And so if I'm speaking as a guy who, because of the way society has molded us, we're guarded on certain things, right?
How do I approach a medical professional and say, "Hey, look, I'm worried about this in my life." And basically open up a conversation around this because as it stands, none of them have brought it up in all the time I've spent with them. So, trying to tell them that without also trying to tell them how to do their job basically. And saying, "Hey, look, I'm worried about certain things that I'm dealing with, like certain addictions, you know, have had some problems, with cigarettes and alcohol and some things like that. Which although I have gotten a lot of help from my spiritual practices, I'll also want to attack this from a medical standpoint.
I feel like there's a lot of help there too. So also just getting some help from me. Like how do I bring this up with my physician?
Athalie: I think that's a really great question. And it's important to note that the initial study happened in 1997.
So there's a huge amount of doctors that received their training and started practicing as doctors long before this was even initially thought of much less became a more mainstream thing to take into account. So part of it is that the training they received. It's also, the way doctors are trained is very focused on diagnosing a problem once it's happened, and then prescribing a treatment as opposed to looking at all of the steps that could lead to something in the future and taking a more preventative approach. There are obviously doctors who do that, and I think that's becoming more a component of training as I've met younger doctors, there's more training in that. But especially for physicians who have been around for awhile, it wasn't how they were trained to look at problems. So I do think that's one, component. Another component is that as a society in the US, we're not comfortable having awkward conversations and we avoid that as much as possible. So I'm guessing some of the reason that it hasn't come up is because people weren't sure what to say if you said "yes" to some of these things or mental health care in general. Processing a traumatic experience is not something that has been prioritized in the U S in health care, so the resources to offer somebody who says they've experienced sexual abuse as a child or physical abuse, a lot of people don't know where they refer you to, or how to help you find an expert, because these resources are really limited. I think those might be components as to why it hasn't come up in terms of how you can bring this up. I think a lot of doctors and nurse practitioners would be happy to explore this subject with you if you initiated it. And I think a great way to start would be to say that you were doing some learning about adverse childhood experiences, you identified with a number of them, and you're wondering where they would recommend you go from here to explore how this relates with your physical health.
And some people will be receptive to that and want to explore that more with you. Other people are going to possibly, I guess, be less curious about that. And so if this is something that's important to you, then I would encourage you to try to find a provider who aligns with, wanting to look into this with you. And that is not going to be all doctors. There's, certainly no guarantee that any doctor you have will want to dive into this for you. As you might guess, complicated childhood experiences, we do not have a pill that can be prescribed to fix them for you.
Joseph: Unfortunately.
Well, thanks for that answer really helps me a lot because I know going in now, there are certain conversations I need to have with my physician and be like, "The reason I'm struggling with this thing is not because I'm not trying it's because there's something that I have not identified as part of the problem. And from what I've learned, you know, counsel me." So I love that answer. You mentioned something that you referred to earlier as toxic stress. I'm a little bit interested in that. And I don't know if you could shed a little bit more light on that and how someone can recognize the manifestation of that, maybe as a physical condition in their body or as a mental manifestation in some way. If you can, show a little bit of light on that, that'll be great.
Athalie: Yeah, so I can go into it briefly. Now I am planning to have a whole episode at some point, dedicated to really digging in depth to this.
The idea of stress, which we view as a really negative thing in general is actually a very useful, human adaptation.
If you think about, if your life is in danger, people always use the example of the lion on the Serengeti, going back to our human roots. you see a lion. You don't need to have like a long thought-out logical response. You need to get the hell out of there, right? Or pretend to be dead or do something to preserve your life.
So when you are confronted with this really stressful situation, a different part of your brain takes over. It sends hormones like adrenaline, which makes your heart pump faster, which is gonna help you run faster. Steroids are released from your adrenal glands. This is to again, give you the muscle power that you wouldn't have otherwise, to help you get through that situation. The expectation is that the threat is going to go away at some point. What has become an issue with the way most of the world operates in the 21st century is we very rarely have like immediate threats to our life. The threats to our life are much more gradual and they are potential future things that might happen. There may be a new nuclear war, or there may be a hurricane that takes out my town, or there might be a school shooting at my kid's school. All these are things that, they don't really end cause they're always potential future things. And the result is that our bodies stay in the state of stress when you stay in that state of stress. And there's never a resolution to the stressor. So the lion never gets killed or you narrowly avoid being hit by a car, but now that it's no longer an immediate threat in front of you. The buildup of all of those hormones- a lot of people are familiar with the fact that there's bad health effects to using steroids. So having a long-term exposure to that steroids created by your body is a problem. The increased blood pressure from having that burst of adrenaline, if you just continue to have it, that causes damage to all of your organs. So these things over time start to become basically a poison in our bodies.
The way toxic stress relates back to the adverse childhood experiences is we're kind of setting up the way your body is going to function. And if you're constantly in that state of fear for your life as a child, that literally changes how your brain develops, how your body develops in the way that your hormone systems are prepared to interact with the world for the rest of your life.
Joseph: That was, that was brilliant. Thank you. I think you have some solutions for us too. Right?
Athalie: I think an important thing to touch on is what we can do about this. 2020 has shown us how dysfunctional a lot of our support systems are. We've had a lot of nationwide conversations about race and what that looks like in the U S and around the world. How these experiences of racism are affecting people individually and our society as a whole. Also the pandemic has shown the fragility of the systems that we have in place for employment and supporting people who are not employed, health insurance, health care. All of these things have been stressed and a lot of problems have become more obvious in the last year. I think there's two ways that this can be addressed. So one is on the individual level. We can do our own personal healing from these things that we've experienced through self work, but also partnering with professionals, therapists, doctors, as we talked about and do that work on ourselves. There's also systems that make it really difficult for us to make progress in our personal life. And so I think just doing individual work is not enough. We need to strengthen the supports we have on the institutional level. Change the way we look at supporting parents and the way even that we view the role of parenting, to go from a kind of punishment-training model to partnering with our kids, to build adults that will be running the future. Education is a key component of this. But as we saw in that initial study, even highly educated people often still have experienced these things. And then a lot of this stuff starts at a really young age, so focusing on early childhood development coaching for parents. Identifying early problems, situations or potential problems and providing a lot of support to families, I think is a way we can address these things as a community and on the more institutional level. And neither the individual or the systems approach to this is going to be enough on its own.
I think we need them both together.
In future episodes. We're going to look into this more in depth- both some of the individual things that happen and individual adverse childhood experiences, as well as solutions to those individual problems that we can put, put into practice starting now with ourselves. And then also to inform how we vote and how we interact with the people around us, in the systems that we participate in.
Joseph: That's it. Everybody's just not. You will kind of summarize it. However, I'm curious about the lion. I'm the Serengeti guy and how acting dead actually worked out for that person. It's like, I'm not going to do that, but yeah,
Athalie: I don't know. It's pretty hard for humans to out run the lion. Even with steroids, adrenaline.
Joseph: Absolutely. Oh, the other thing that came to mind, but I feel like that that doesn't have to be caught on here is the self healing. I can have conversations with my siblings. Well, part of that conversation also has to include, and I use this word very loosely, the abuser, so to speak, right? The person that inflicted that harm, is there a part of the conversation where they have to be pulled in and be like, this has to be some acknowledgement?
Or is that not necessary?
Athalie: Well, I don't think it's necessary for your personal healing. I think that depends on what type of relationship you want to have with that person going forward. And some people will be able to hear this okay and have a response. I think a lot of people are unaware. A lot of parents are just repeating the way they were parented. Right? They're not necessarily trying to harm their children. Right? and so having a conversation that involves them, where they learn about how these things have affected you could be really beneficial to your relationship. There are also people that your healing may mean that you stop interacting with them altogether, or at least on the plane where you have these type of meaningful conversations.
And so that's, I think a really individual thing, but it's not necessary for healing. That's more just looking at what you want to do with that relationship going forward.
I think like all of these conversations. There is work in research that you could do on your own, but it's really helpful to have someone, a therapist or somebody who's trained to help people walk through these situations, who's not emotionally invested in what's happening to help you work out what the best thing is for you to do your exact situation going forward.
Joseph: Absolutely. Well, I did learn a lot. Thanks for having me on your show today. I will follow up this conversation by going to the resources and learning as much as I can and having this conversations, like I said, with my siblings. And with my healthcare professional, the people I have in my corner to look out for me, my physician, whatever that I have going on there. But this really was an eye opener.
Hopefully we can have more of these conversations moving forward. I look forward to talking to you more.
Athalie: Thank you for being here and asking really interesting questions. One of the reasons that I wanted you to be part of this conversation is because I work in healthcare and I work in a lot of these institutions.
I have learned to speak a certain language and talk about these things with some assumptions of a shared understanding, so it's really very helpful to me to have someone who doesn't have that same background helped me have this conversation in a way that's approachable to people from all kinds of backgrounds. So thank you.
Joseph: You're welcome.
Song Credits
Many thanks to these artists for licensing their music under Creative Commons. Tracks featured in this episode, in order of first appearance, are:
I dunno by grapes (c) copyright 2008 Licensed under a Creative Commons Attribution (3.0) license. http://dig.ccmixter.org/files/grapes/16626 Ft: J Lang, Morusque
Between Worlds (Instrumental) by Aussens@iter (c) copyright 2017 Licensed under a Creative Commons Attribution (3.0) license. http://dig.ccmixter.org/files/tobias_weber/56664 Ft: (Smiling Cynic)
Silence Await by Analog By Nature (c) copyright 2008 Licensed under a Creative Commons Attribution (3.0) license. http://dig.ccmixter.org/files/cdk/17432 Ft: oldDog
nightRain by airtone (c) copyright 2017 Licensed under a Creative Commons Attribution license. http://dig.ccmixter.org/files/airtone/55887
