By David Asia
Where does a person’s mental health or mental illness come from? Why does the voice inside your head tell you that its time to get up and go to work, while the voice inside of mine demands that I stay home and rage at my children?
Maybe you can turn yours off. But what if the strategy that helps quiet mine is killing me?
Vincent Felitti, a physician with Kaiser Permanente, one of the largest health maintenance organizations in the country, knows a lot about this. In 1997, he and his colleagues were working with obese patients, some weighing as much as 400 pounds. They were puzzled when several of their most successful patients dropped out of the program.
Think about this.
Why would the patients who had lost the most weight, improving their overall health in the process, quit the program which was saving their lives? Did they lack will power? Were they incurable? We often think these things about those who fail in treatment — it’s easy to overlook the psychological realities of people whose struggles are different than our own.
What Felitti learned when he interviewed these patients transformed medicine at Kaiser Permanente and led to one of the largest public health research projects in history (which I’ll wager very few of you have heard of).
For Felitti and his colleagues, obesity was the problem. For their patients, obesity was the solution.
He discovered that the problems these patients believed they were trying to solve came from abusive or traumatic events often from deep in their childhoods. Compulsive behavior, be it eating, smoking, drinking or drug use, gambling and other habits, initially feels protective, and, as Felitti writes, “it’s hard to get enough of something that almost works.” In the long run, though, this behavior can sicken us and shorten our lives. The researchers called these traumatic incidents themselves Adverse Childhood Experiences (ACEs).
Childhood trauma
This research became known as the ACE Study (ACES), and it went on to include over 17,000 predominantly middle-class people. They found that 10 categories of trauma before the age of 18 predicted an increased probability of mental illness, drug abuse, alcoholism and addictions, obesity, suicide, and (remarkably) lung disease, ischemic heart disease and other auto immune diseases.
Here’s a sample of the 10 categories with their prevalence (visit www.cdc.gov/violenceprevention/acestudy/index.html) for more information):
• 27 percent reported alcoholism or drug use in the home.
• 13 percent reported their mothers were treated violently.
• 22 percent reported being sexually abused.
It turns out that ACEs are surprisingly common. Regarding sexual abuse, for example, 22 percent of 17,000 equals 3,740 people — imagine that prevalence in a population of several millions. And the ways in which we choose to deal with these traumas earlier in our lives more than probably shorten our lives as we age.
The coping strategies we choose and the ongoing stress from unresolved childhood trauma can, as we age, depress our immune response making us susceptible to a variety of biomedical diseases. To quote the researchers, “We found a strong graded relationship between the breadth of exposure to abuse or household dysfunction during childhood and multiple risk factors for several of the leading causes of death in adults.”
We like to believe that “children bounce back.” Filetti’s research and follow-up studies through the Centers for Disease Control suggest that appearances are deceiving. We pay the piper as we age, and the price is steep.
Tyranny of shame
It’s not just the traumatic events themselves that make us sick, but also the accusations and taboos with which we attempt to snuff them out:
How can you say such a thing about your uncle (don’t trust your feelings). How could you even think such a thing (you must be the bad person).
You kids go to you room (pretend not to see, hear, or know). Your father (mother) will calm down by morning (flowers, toys, or apologies will excuse violence). If you tell anyone about this, the police will take you away from us (bad things will happen to you and your family if you tell anyone).
Don’t think, don’t feel, don’t trust. Above all, don’t speak.
Where does this leave us?
Violence against children, whether perpetrated by families, gangs or governments, is a global phenomenon. In 2015, there were 74,382,502 children in the United States, and there were an estimated 3,957,000 referrals for child abuse or neglect (U.S. Department of Health and Human Services, “Child Maltreatment 2015”). In Washington state, there were 40,607 confirmed cases of abuse in 2016 (KidsCount Data Center). UNICEF estimates that there are now approximately 50 million refugees under the age of 18, 28 million of whom have fled their homes because of armed conflict. How should these numbers inform our conversations about mental illness in a time of madness? Are we choosing to incubate disease among children?
Donald Winnocut, a psychoanalyst and pediatrician who worked with children evacuated from war zones framed it this way: after thousands of years of civilization, what should we be striving for as parents, grandparents, and as a nation, if we want our children to finally become capable of generosity and happiness?
David Asia, PhD, lives in Twisp.
