Can childhood trauma be the central issue affecting health? Could chemical changes that started in the brain years earlier make people sick not just today but in the future? If a high Adverse Child Experience score is as likely to predict heart disease as a high cholesterol reading, what does this mean for how primary care should be provided? How can communities heal themselves?
“The memory of our experiences is stored in our bodies,” Robert Anda, the epidemiologist at the Centers for Disease Control in Atlanta who co-authored the landmark Adverse Childhood Experience. study told a State of Reform audience on Wednesday. His study of 17,000 patients enrolled in the Kaiser organization in San Diego from 1994-1998 had a 70 percent response to a questionnaire asking sensitive questions about childhood experiences of parental divorce, physical and sexual abuse, emotional neglect, and growing up with family members suffering from mental illness or drug and alcohol problems.
Even educated, white, middle class group of respondents showed that “ACES are common,” Anda said. About a quarter of the respondents had “doses” of childhood stress frequent enough to cumulate into a “pathway to preventable diseases” such as liver or heart disease.
“People with ACE scores of six or more die 20 years earlier on average,” Anda said, in part because “behaviors are, in their own way, adaptive.” Smokers smoke in part because nicotine reduces anxiety. “It’s a partial solution, an adaptive behavior.”
“I didn’t learn this in medical school,” Anda said. “Providers tend to be afraid of this information.” He advocates providing scripts so that healthcare workers can ask, listen, educate and affirm.
“And not all the burden is on the healthcare provider,” Anda said. Schools, the criminal justice system and “an informed public” need to embed these concepts.
“Can positive relationships reverse this? I believe yes,” Anda said. “People affected by trauma can teach others how to do it.”
His remarks were echoed on a panel on mental health. “The benefits I’ve seen through the use of a peer support specialist… are almost miraculous. They allowed the client to take steps toward recovery by saying ‘I understand, I know what it’s like’,” said Marcia Hille, executive director of Sequoia Mental Health Services in Washington County.
Anda also said those with high ACE scores are costly in terms of high use of pharmaceuticals from anti-depressants to topical skin creams, unexplained symptoms and doctor visits.
Joe Hromco, vice president of Western Psychological Associates described one of his patients: “He had 35 emergency room visits and was seeing primary care weekly yet there was nothing wrong with him. Over four months (of mental health treatment) he’s had zero emergency room visits. He’s just a very anxious guy.”
Anda would like to see more pilots begin testing what he called “self-healing communities,” and called Spokane a “trauma-informed community” that looked at high ACE scores among students to predict students’ likelihood to fail a grade, be suspended, suffer language difficulties and be in poor health.
“Seventy percent of prison populations have substance abuse disorders,” Anda said. “There’s a progressive nature of adversity in life with early trauma and stress leading to slow language, poor decision-making or social isolation, poor understanding of social cues leading to conflict, school expulsion to the prison pipeline.”
But Anda also said “ACEs are not destiny,” and can empower people to change the frames of their lives and realize they are not alone. “They can say ‘that’s what I don’t want to pass on to my kids… or the systems or policies I create’.”
Jan can be reached at [email protected].