Nadine Burke Harris, MD, a San Francisco based physician, made a presentation that captured both my attention and my concern, and I’d like to share some of the information from that presentation. Let’s be clear, these are her words, not mine, but if you take a deep dive into her work, it may be a little like the kid who saw his reflection in the water because many of us grew up in an era when several of the “conditions” mentioned in this description were considered normal.
In the mid-1990’s, a discovery was made that exposure to one thing contributed to the cause of seven of the ten most likely causes of death in the United States. This discovery was known to impact Brain Function, the Immune System, the Hormonal System, and even DNA function. People who were exposed to it had a 20-year difference in life-expectancy with triple the amount of heart disease and lung cancer. Now, that was a blockbuster discovery, but physicians are still not trained in even the most routine screening for this diagnosis let alone for its treatment.
What was this amazing discovery? It was Childhood Trauma. The short list of things that fall into this category are abuse, neglect, and dealing with a parent who struggles with Drug and Alcohol Abuse or Mental Illness.
The discovery came from a paper written by Dr. Vince Felitti of Kaiser and Dr. Bob Onda from the Center for Disease Control. It was titled “Adverse Childhood Experience Study,” and over 17,500 adults who were exposed to these adverse experiences were interviewed for this study. It became known as the ACE study. This study included people who had been exposed to emotional or sexual abuse, physical or emotional neglect, parental mental illness, substance abuse or dependence, incarceration, separation, or divorce, or domestic violence. That’s a list that many people can absolutely relate to on many levels.
For every YES checked off on that list, the participants got one point on the ACE score, and then the physicians compared them to health outcomes. Of those interviewed, 67% of the population had at least one on the ACE score, 12.6% had four or more ACES.
Here’s the discovery. There was a direct response relationship between ACE (Adverse Childhood Experiences) and health outcomes. The higher the score, the greater the risk and the worse the health outcomes. Depression was 4.5 times more likely to be present, 3.5 higher risk for lung cancer, and a 3.5 times more likelihood of getting heart disease, but the most dramatic prediction was the incidence of suicidality, this suicide or attempted suicide statistic was 12 times higher.
There are real neurologic reasons why folks who were exposed to childhood diversity were more likely to engage in high-risk behavior, but even if they weren’t engaged in that behavior, they were still more likely to get heart disease or cancer. You see, when you’re exposed to stress, the body’s stress response system that governs your flight or fight response mechanism ignites, and if that stress is coming at you every day, it evolves from being adaptive and life-saving to maladaptive and health damaging.
The most likely reason this “discovery” hasn’t become more highly promoted within the medical community may be because of something that is not directly evident. The information generated from these 17,500 people may have been marginalized because, as Dr. Harris points out, people may have just thought, “It’s those kids from those neighborhoods.” The reality, however, is that the participants in the study were 70% Caucasian and 70% college educated. Maybe the study hasn’t been more widely embraced because it truly is “too close to home.”
This is an issue that touches many of us, and it’s easy to look away. The very real courage must come from our ability to acknowledge this is a real problem and then in taking the steps necessary to deal with it through a multi-disciplinary treatment team that works to reduce impact of adversity through care coordination, counseling, attention to nutrition, holistic interventions, and, when needed, medicine.
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