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Most of us think of trauma as PTSD afflicting veterans of Iraq War II and consider the sexual molestation of Kolk’s patient Marilyn as a rare, tragic event. The Adverse Childhood Experiences (ACE) Study, begun in 1985 at Kaiser Permanente San Diego, discovered otherwise.
The study led by Vincent Felitti correlated current adult health status to childhood experiences decades earlier. The number of participants in the study was 17,421, with an average age of fifty-seven, almost exactly half men and half women. The racial makeup was eighty percent White, ten percent Black, ten percent Asian, and slightly less than one percent Native American. Seventy-four percent had attended college; everyone had high-end medical insurance. Clearly, a middle-class population.[1] Robert Anda, the epidemiologist for the study, observed, “It’s not just them; it’s us.”[2]
Felitti and his colleagues considered ten categories of adverse childhood experiences that generally are kept as family secrets and hidden further by shame and social taboos. The ten categories were 1) recurrent humiliation; “you are the stupidest kid I’ve ever seen;” experienced by eleven percent of the participants in the study 2) heavy-duty physical abuse; severe beatings with fists, sticks, or other objects; twenty-three percent 3) contact sexual abuse; twenty-eight percent for women and sixteen percent for men 4) major emotional neglect; fifteen percent 5) significant physical neglect; ten percent 6) growing up in a home where the mother was treated violently; eleven percent 7) someone in the home was an alcoholic or a user of street drugs; twenty-six percent 8) a family member was chronically depressed, suicidal, or in a state hospital; twelve percent; 9) not having biological parents present in the home; what was most devastating was maternal abandonment; twenty-four percent 10) one family member was imprisoned; five percent.
The researchers created an ACE score that tabulated not the number of events but the number of categories. In this obviously middle-class population, sixty-seven percent had an ACE score of one or higher; eleven percent, one in nine people, had a score of five or higher. A key finding was that a person with an ACE score of six or higher had a shortened life expectancy of almost twenty years and was 22.2 times more likely to commit suicide than an individual with an ACE score of zero. An adult with an ACE score of four or higher had 1.9 times the odds of getting cancer and 2.2 more likely of having ischemic heart disease, the number one killer in the United States.[3]
The Ace Study established beyond dispute that regardless of income, race, or access to care, adverse childhood experiences are a risk factor for the most common serious diseases in America. Yet, the medical community ignored this landmark study published in 1998 probably because the study applied to all of us, not just the marginalized, and because the study exposed the what, not the how. Felitti and his fellow researchers offered no explanation for how having an ACE score of four or more increased the chances of an individual’s fracturing a bone by 1.6 times and for developing diabetes by the same likelihood. No obvious connection exists between breaking bones and high blood sugar.
How the Body Responds to Adverse Childhood Experiences
Recall that my cat Oliver and my supposition that Marilyn, Kolk’s patient, ventured cautiously into a hostile world every morning. In such circumstances, the body produces cortisol that increases blood pressure and blood sugar levels; if an actual threat materializes, the organism will have additional energy and strength to fend off an attack.
Jacqueline Bruce and her fellow researchers suspected that adverse childhood experiences affected cortisol levels. The researchers compared the morning cortisol levels of 117 maltreated 3- to 6-year-olds residing in foster care with non-maltreated 3- to 6-year-olds living consistently with at least one biological parent. In this latter group, household income was less than $30,000, parental education was less than a 4-year college degree, and family did not have any previous involvement with child welfare services.[4]
In this study, published in 2009, severe physical neglect meant parental failure to provide adequate food, clothing, shelter, or medical care; emotional maltreatment designated parental rejection, abandonment, or failure to protect children from witnessing traumatic events. The researchers discovered that “maltreated foster children showed significant alterations in their morning cortisol production compared to non-maltreated children. . . . The foster children with low morning cortisol levels had experienced more severe physical neglect, whereas the foster children with high morning cortisol levels had experienced more severe emotional maltreatment.”
Bruce and her colleagues suggested that a physically neglected child has chronic stress that decreases cortisol production, while an emotionally maltreated child is subjected to periodic acute stress that increases cortisol levels. These patterns of stress are carried over into adult life, and that explains the correlation between ACE scores and many diseases in adulthood. For instance, high cortisol levels counteract insulin and bone formation and thus lead to diabetes and bone fractures. Low levels of cortisol are implicated in autoimmune disorders. The researchers noted that “high morning cortisol levels might be an adaptive response to the unpredictable, acute stressors experienced within emotionally maltreating environments. However, it is likely that this initially adaptive pattern of cortisol production would be less adaptive in new environments and would be detrimental to the children over time.”
Self-Hatred
At least six categories of the ACE Study cause the child to think she is worthless and unlovable. For instance, repeated humiliation produces “unbearable feelings of loneliness, despair, and inevitable rage of helplessness. Rage that has nowhere to go is redirected against the self, in the form of depression, self-hatred, and self-destructive actions.”[5]
Consider Pam, seven years old, an only child, living with both working parents who recently bought a “nice” house in the suburbs. Every Saturday morning is devoted to a family activity, cleaning the house. Invariably, her father, in a bad mood, lines Pam up against a wall and shouts at her, “You are the stupidest kid in the world. Why can’t you ever do anything right?” Pam experiences there is something profoundly wrong with her and concludes she is not lovable.
The young girl knows that alone she is helpless and needs her father for survival, for food, shelter, and clothing, but most of all, she desires her father’s unconditional love. She suppresses her anger toward her father for his unjust treatment of her; she, instead, directs her rage against herself.
Two paths are open to Pam. One: She is so unlovable that self-hatred controls life. As a teenager and later as a young adult, she engages in self-destructive behavior — alcohol, street drugs, promiscuous sex, anything that will slowly kill her, a wretched being, anything that confirms how worthless she is.
Two: She will show her father and the world that she is worthy of love. Pam may decide to demonstrate that she is lovable by becoming physically attractive, a charming woman no one dislikes; everyone admires her beauty and grace. Or she may earn a Ph. D. in mathematics to prove that she was always the smartest kid on the block. Or she may go to graduate school at Stanford and then join the leadership team of one of the biggest firms in Silicon Valley. In our gender-fluid society, she may be the only source of income for her family since her spouse quits his job and becomes a stay-at-home dad.
But not one of these futures is satisfying. Underneath the success is the nagging fear that she is not loved for who she is. No one wants to be loved only for economic success, intellectual achievement, or physical beauty. Earned love always leaves the lingering doubt that one is not loved for oneself but for the status and pleasure that accrues to others. Earned love cannot be a substitute for unconditional love.
Despite the dissatisfaction, Pam is now addicted to the course of action she chose to earn love from others; being attractive, smart, or successful almost works; maybe the next time it will; so, Pam does Botox, writes another mathematics paper, or moves up to a better job — and on and on it goes, in an impossible, tragic quest for love.
If a child has an ACE score of zero, he may discover that he is unworthy of love when he attends a grade school based on competitive learning. Consider a typical grade school scene witnessed by anthropologist Jules Henry[6]:
“Boris had trouble reducing 12/16 to the lowest terms and could only get as far as 6/8. The teacher asked him quietly if that was as far as he could reduce it. She suggested he ‘think.’” Undoubtedly, Boris remembered hearing the teacher tell him to reduce the fraction to the lowest terms, but then he could not speak. When the teacher told him to think, his mind was probably paralyzed, and his ears buzzed. Frantic to correct Boris, other children waved their hands to get the teacher’s attention. The teacher, quiet and patient, ignored the waving hands and asked Boris, “Is there a bigger number than two you can divide into the two parts of the fraction?” After a long silence from Boris, she asked the same question again, this time more urgently, and still there was not a word from Boris. She then turned to the class and said, “Who can tell Boris what the number is?” A forest of hands appeared, and the teacher called on Peggy, thrilled to give the correct answer, four. From the smile on her face, Henry knew Peggy felt great about herself; Boris’ failure was his problem, not hers.
The next week, Boris’ class was divided into two competing teams for a spelling bee. Boris was the last person chosen and the first to go down. The following week the communal activity was show-and-tell, typically reserved for younger children. As an educational experiment, Boris’ teacher asked her students to bring to class an object beginning with the letter “b.” Boris thought of bringing himself but brought his baby blanket; though faded and frayed, it always gave him comfort. When he stood up in front of the class to give his one-minute description of his show-and-tell object, the magic of this baby blanket failed him. His palms sweated, his knees knocked, and he managed to say, “My baby blanket.” Some students snickered, others laughed, and one boy said, “Way to go, Boris.”[7]
In this fashion, Boris learned to hate the students who excelled, for they robbed him of dignity and worth. He was trapped in a situation that subjected him to repeated humiliation.
When the pain became unbearable, he would “act out,” tear pages out of his textbooks, tip over his desk, and punch one of the “winners,” usually Anton, the boy seated behind him. He was then sent to the school psychologist to diagnose Boris’ problem. Neither the psychologist nor any teacher had the insight or courage to say the problem was the system that set students against one another, not Boris.
Self-hatred is a product of the individualism of the modern West. The political organization in Modernity was established in theory by John Locke, in England, and James Madison, in America. For Locke and Madison, the smallest units of society are isolated, autonomous individuals. They argued that in a state of nature, all men are “free, equal, and independent;” yet, each isolated individual is “constantly exposed to the invasions of others;” property is “very unsafe, very insecure;” and existence is “full of fears and continual dangers.”[8] Since no individual can rely upon the goodwill of others for the protection of his goods and life, individuals contract with each other to hand over their natural power to protect themselves and their property to the State. Self-interest, weakness, and natural enmity caused isolated individuals to form political societies.
We Americans, of course, do not learn that existence is “full of fears and continual dangers” by reading Locke or Madison’s contributions to the Federalist Papers. In preparation for the workplace in a capitalist economy, where “the isolated individual has to fight with other individuals of the same group, has to surpass them and, frequently, thrust them aside,”[9] students experience that everyone is a real or potential competitor of everyone else. “Competitiveness, and the potential hostility that accompanies it, pervades all human relationships,” psychiatrist Karen Horney concludes from her years of psychoanalytic practice.[10] Psychotherapist Rollo May agrees: “Individual competitive success is . . . the dominant goal in our culture.”[11]
In a recent conversation over Johnny Walker Black, my friend Alex confided that he became a theoretical physicist because of his obsessive-compulsive personality disorder. In contrast to the messy “real world,” where imperfections and uncertainties make him anxious, rigid mathematical rules and lists of unchanging numbers comfort him. His best days are spent poring over computer printouts and going over again and again the computational procedures he has control over.
The worst day of his life occurred when he was a counselor in a church camp for teenagers. (What an atheist like him was doing in a church camp he did not tell me, nor did I ask.) The unpredictable behavior of the teenagers drove him crazy. In the middle of the night, he yelled, “You little bastards can do whatever you like. I’m leaving.”
Being a physicist and wedded to materialism, Alex insisted that his personality disorder was caused by his malfunctioning brain. When I suggested the possibility that his obsessive-compulsive behavior had its origins in his chaotic family life; I knew from prior conversations that nothing was stable in his childhood for both his parents were alcoholics, lost jobs, were always broke, and moved up and down the east coast of Florida every six months. Alex scoffed at my suggestion, shook a forefinger at me, and said, “All human behavior is caused by body chemistry and genes.”
My friend revealed to me an aspect of intellectual life I had never understood before — physics, philosophy, or educational outlook for that matter may be driven by hidden fear, anger, or self-hatred.
In private conversation, His Holiness the Dalai Lama asked several well-known American teachers of Buddhism, “What kinds of challenges are you facing?” Sharon Salzberg replied that one challenge we face is that so many of the people who come to us to learn how to practice meditation hate themselves. His Holiness said, “No, they don’t; impossible.” In traditional Tibetan and ancient Indian cultures, there is no notion of self-hatred, and the main spiritual obstacle is self-centeredness, or inordinate self-love. To say self-hatred in the Tibetan language is difficult, but when His Holiness understood what was said, he was shocked.[12]
[Next episode: The Treatment of Mind/Body Diseases.]
Main image courtesy of Anderson Rian on Unsplash.
Endnotes
[1] See Vincent J. Felitti et al., Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults, 1998; Vincent J. Felitti, The Relation Between Adverse Childhood Experiences and Adult Health: Turning Gold into Lead, Winter, 2002; and Vincent Felitti: Reflections on the Adverse Childhood Experiences (ACE) Study, June 21, 2016.
[2] Robert Anda, quoted by Jane Ellen Stevens, The Adverse Childhood Experiences Study — the largest, most important public health study you never heard of — began in an obesity clinic, October 3, 2012.
[3] Since the original ACE Study was published, thirty-nine states and the District of Columbia have collected ACE data. The data shows that between 55 and 62 percent of their populations had experienced at least one ACE category, and between 13 and 17 percent of their populations had an ACE score of four or more. See K. Gilbert et al., “Childhood Adversity and Adult Chronic Disease: An Update from Ten States and the District of Columbia, 2010. American Journal of Preventative Medicine 48, no. 3 2015): 345-49.
[4] Jacqueline Bruce et al., “Morning Cortisol Levels in Preschool–Aged Foster Children: Differential Effects of Maltreatment Type,” Developmental Psychobiology 51, no. 1 (2009): 14-23.
[5] Kolk, The Body Keeps the Score, p. 136.
[6] Jules Henry, Culture Against Man (New York: Random House, 1963), pp. 295-296.
[7] Henry does not report on Boris’ subsequent life. The rest of his story given here is a possibility envisaged by me.
[8] John Locke, Second Treatise of Government, ed. C. B. Macpherson (New York: Hafner, 1980 [1690]), pp. 52, 66.
[9]Karen Horney, The Neurotic Personality of Our Time (New York: Norton, 1937), p. 284.
[10] Ibid.
[11] Rollo May, The Meaning of Anxiety, rev. ed. (New York: Norton, 1977), p. 173.
[12] See John Dunne, Self-Compassion & Going Forth, a Dharma Talk given at the Upaya Institute and Zen Center, Santa Fe, New Mexico, November 15, 2021.
One Response
I was amazed at learning that despite the clear evidence that abusive treatment of children deeply affects their mental and physical health, it is continually ignored by most health professionals. I asked my husband, “How can they do this to children and deny them the help they need?” He responded that it is because our culture believes that we are mere machines without souls, so what they think they need to treat is a chemical imbalance – very disconnected from the human person and his or her needs.
Dr Stanciu, this world needs to read your book, The Great Transformation. This world needs to relearn what it means to be human!
Laura