Childhood trauma and its impacts
Welcome to another edition of Life as a Lunatic.
From 1995 to 1997, a study was being conducted in the United States that revealed an underlying public health crisis. Kaiser Permanente, a US health maintenance organization, and the Centre for Disease Control (CDC), investigated childhood abuse, neglect, and household challenges to determine long-term health outcomes in what was known as the Adverse Childhood Experiences Study (ACES).
The ACE study measures exposure to adverse childhood experiences and its lasting impact on overall long-term health. Adverse experiences include exposure to:
physical, emotional, or sexual abuse
physical or emotional neglect
parental mental illness, substance abuse, or incarceration
separation or divorce
domestic violence
For each adverse childhood experience you’ve been exposed to, you get a point or an ACE (you can take the ACE quiz here). Of the over 17,000 respondents surveyed, 67 per cent had one ACE and 12.6 per cent had four or more ACES.
So, what does it mean if, like me, you have a particularly high ACE score? As paediatrician Nadine Burke Harris points out in her TEDTalk, the higher the ACE score, the worse your health outcomes. Those with an ACE score of four or more are 2.5 times more likely to experience heart disease and hepatitis, four times more likely to experience depression, and 12 times more likely to try to take their own life. People with an ACE score of seven or more have three times the risk of developing lung cancer and 3.5 times the risk of developing ischemic heart disease, a leading killer in the US.
While people with high ACE scores are more likely to engage in high risk behaviours, even those that don’t can still develop numerous physical illnesses later in life because of how trauma affects the developing body. When the brain’s hypothalamic-pituitary-adrenal axis (the body’s stress response system that controls the fight/flight instinct) is confronted with danger it releases stress hormones to spur us into action. When this part of the brain is activated over and over again it becomes maladapted, which children are especially sensitive to due to their developing systems.
Informed by the ACES, Burke Harris founded the Center for Youth Wellness in San Francisco, California, to prevent and heal childhood trauma. Through routine screenings, children who have positive ACE scores are referred for multidisciplinary treatment that includes holistic healing, mental health care, educating children’s parents about the ACES, and medication if necessary. By identifying children exposed to ACES, the Center for Youth Wellness can improve prospects for long-term health outcomes through early intervention and prevention.
While the ACES and Burke Harris’ work is groundbreaking, unfortunately it’s not yet widespread. Physical health concerns, mental illness, and social needs are often considered separately by North American agencies and healthcare professionals who don’t always interact. The responsibility to coordinate a care approach can fall to the trauma sufferer, which adds to the overwhelming nature of dealing with the fallout from adverse childhood experiences.
Until mainstream health care catches up to the science behind this public health crisis, trauma sufferers can vouch for themselves by informing and educating their general practitioner (or whoever is responsible for their health care) about any adverse childhood experiences to improve their long-term health odds.
Mad History
This issue: Henry Andrews Cotton
Illustration of a mouth with teeth removed from Cotton's book The Defective Delinquent and Insane: The Relation of Focal Infections to their Causation, Treatment and Prevention.
Henry Andrews Cotton, born in 1876 in Norfolk, Virginia, was a widely regarded mental health doctor treating patients at the Trenton State Hospital, a large asylum in New Jersey, during the turn of the century. Cotton believed that mental illness was due to focal bacterial infections so routinely removed the teeth, tonsils, and colons (among other body parts which included testicles, ovaries, stomachs, spleens, and cervixes) of his mentally ill patients. Andrew Scull reveals specifics in his novel, Madhouse: A Tragic Tale of Megalomania and Modern Medicine:
An 18 year-old girl with agitated depression successively had her upper and lower molars extracted, a tonsillectomy, sinus drainage, treatment for an infected cervix, removal of intestinal adhesions—all without effecting improvement in her psychiatric condition. Then the remainder of her teeth were removed and she was sent home, pronounced cured.
Unfortunately, in a time prior to antibiotics, many of Cotton’s patients died, including the daughter of American economist Irving Fisher. Scull posits Cotton’s “treatments” had a death rate of up to 33 per cent, though Cotton himself would claim 85 per cent of his patients were cured (this was also before scientific methods such as control groups were formalized). Eventually, a report was commissioned by Aldolf Meyer at John Hopkins, a mentor of Cotton’s, to look into his practices. Conducted by psychoanalyst Phyllis Greenacre, her report was critical of both the hospital itself and the data Cotton was boasting about, which simply didn’t add up. Ultimately, Meyer would suppress Greenacre’s report to protect his protégé. A concurrent investigation by the New Jersey State Senate into waste and fraud at the hospital was also dropped.
Cotton continued his “treatments” until his retirement from the hospital in 1930. Three years later, when he died of a heart attack, he was lauded by the New York Times and local press for being a pioneer in the field of mental health.
Recommended Reading
Silence: The Power of Quiet in a World Full of Noise
By: Thich Nhat Hanh
Some books find you when you need them most. So it went with Silence, by Vietnamese Buddhist monk and peace activist Thich Nhat Hanh. I was overworked and not taking very good care of myself. I had a little time to kill between gigs and wandered into Book City on Yonge Street in Toronto, hoping a good read would distract me from the looming clouds of depression. I don’t typically find myself in the spiritual section of the bookstore, but on that day I did, and Silence shone from its place on the shelf. This powerful little book shows its readers how to cultivate calm in even the most chaotic of spaces, while encouraging us to tone down on multitasking to reconnect with the beauty of the everyday. It helped me restore my appreciation in the simple things—from a meditative walk to enjoying a good meal—instilling some much needed perspective.
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