Adverse Childhood Experiences And The Truth About Everyone

2013-06-26 Dr. Felitti

In the first of three articles for the Huffington Post, Jane Ellen Stevens talks about one of the biggest public health studies you’ve never heard of.

Dr. Felitti ran an incredibly successful preventative health program, but one of the initiatives had a puzzling problem. Aimed at helping people who were significantly overweight, he found that about 50% of the population would drop out before completing the program, even though they were making good progress. His efforts to uncover this mystery led to something even bigger. In a massive study with over 17,000 participants, Dr. Felittie and others discovered that Adverse Childhood Experiences (ACEs)–things like physical or sexual abuse–created a staggering toll on adult health: “chronic disease,… mental illness, doing time in prison, and work issues, such as absenteeism.” What was really surprising, however, was the extent of the exposure to ACEs. Over 2/3rds of study participants had experienced at least one form of adverse childhood experience, and of that population, 87% have experienced two or more. Dr. Felitti, upon seeing the results for the first time, says “I wept. I saw how much people had suffered and I wept.” 

This reminds me of some comments to one of my Times And Seasons posts. One commenter, responding to accounts of how difficult even ordinary experiences like Mormon missions and early marriage could be, wrote: “It makes me wonder just what kind of people you hang around with.” He later said he was joking–and I believe him–but it just underscores how incredibly insulated people can be. I had an average middle-class upbringing, and was strictly observant to my Mormon faith. I never smoke, never drank, and avoided parties where I knew that would be going on. (I’ve only even seen a joint once or twice in my life!) Most of my Mormon friends were equally sheltered, but if I stepped even a couple of paces away from the safe zone the stories were nightmarish: drug addition, sexual assault, rape, abortion, physical abuse, sexual abuse, suicide, depression, self-mutilation (before emo made cutting yourself cool), it was incredibly how these two parallel worlds could co-exist and yet so many in the bubble could be unaffected. Most of my Mormon friends not only had no interest in knowing what was going on, but–if I spoke about the things I knew about–viewed me with suspicion and a little fear. I was tainted, it seemed, by association.

I don’t want to be too harsh, though. Part of my reaction was, naturally, to look down on the “popular kids,” but I soon learned better. The terrible toll of family tragedy, of ugly divorce, and of deadly disease is no respecter of class. We all suffer, but it seems that one of the halmarks of, for lack of a better word, the upper class is a supreme ability to manage appearances. It was, quite frankly, a lot easier to get my Goth friends to open up about their life tragedies. The kids on the Honor Role often had them, but were far more reticent to discuss or even acknowledge them.

We just all live in so much pain. It’s bewildering.

First world problems? Yeah, I’m sure there’s some of that. But when we’re talking about matters of life-and-death like dangerous stalkers, felony jail time and losing your kid for an innocent mistake because some asshole DA is boosting their numbers, or brutal rapes the tragedies are pretty damn raw. I don’t have the heart to try and start quantifying these kinds of experiences. And even the suffering that isn’t as, again for lack of a better word, impressive still has a right to our consideration, I think. The hedonic treadmill probably works in reverse, too. Happiness and misery are both calibrated to our expectations.

What else is there to say?

One thing, is that one of my deepest misgivings about “identity politics” is the way that it replaces individuals and their painful, real-world experiences with abstractions. It just seems so ugly and unhelpfully divisive to try and divvy pain and struggle up by lines of race or gender or sexual orientation. I’m not pretending that the awful weight of human misery falls with unbiased randomness, but something in me just recoils at starting the discussion with categories instead of starting with individuals. Of course minorities face particular and systematic obstacles, but all tragedies are particular, aren’t they?  Coming out with tracts about “white male privilege” just seems to miss the point. We’re people first, aren’t we? Shouldn’t we start there, and try to keep the focus on what binds us together? Can’t we start with the common feeling of standing naked before the cold jaws of bewildering pain and loss? Haven’t we all felt hated? Despised? Impotent? Vulnerable? If some have only felt these pains glancingly, shouldn’t we start with the commonality to build understanding instead of using the quantity of suffering as a wedge between people? It reminds me of how, waiting for the bus, my friends would all try to one-up each other for lack of sleep. Who the Hell wants to win that game? And on that one the stakes were so low…

Another thing: people suffer. No matter who it is in your life, no matter how much they disgust or annoy you: they have suffered. And in that suffering they, like you, are children. Might not change what you have to do in relation to them, but it will probably change how you feel about them if you remember that.

I guess there’s just one more thing I want to say. Or, rather, a quote I’d like to share. It’s by Jim Butcher, from his urban fantasy novel White Night. It’s long one, and I need to set it up. First, I don’t include this as some kind of response to those in serious grief. My faith teaches me that when someone is weeping you don’t give them an encouraging speech. You weep with them. That’s what Jesus did. So this quote isn’t addressed to those who are grieving. It’s addressed to those who–like me–have basically been lucky. My ACE score? It’s zero. And let me tell you, that is a privilege that means more the way I see the world than my race or religion or gender or sexuality. And so, for folks who have basically had it easy and yet have still found themselves from time to time wracked with a grief that seemed unbearable nonetheless, here’s something to keep in mind when we consider all the pain out there in the world.

We still hadn’t learned, though, that growing up is all about getting hurt. And then getting over it. You hurt. You recover. You move on. Odds are pretty good you’re just going to get hurt again. But each time, you learn something. Each time, you come out of it a little stronger, and at some point you realize that there are more flavors of pain than coffee. There’s the little empty pain of leaving something behind–graduating, taking the next step forward, walking out of something familiar and safe into the unknown. There’s the big, whirling pain of life upending all of your plans, and expectations. There’s the sharp little pains of failure, and the more obscure aches of successes that didn’t give you what you thought they would. There are the vicious, stabbing pains of hopes being torn up. The sweet little pains of finding others, giving them your love, and taking joy in their life as they grow and learn. There’s the steady pain of empathy that you shrug off so you can stand beside a wounded friend and help them bury their burdens.

And if you’re very, very lucky, there are a very few blazing hot little pains you feel when you realize that you are standing in a movement of utter perfection, an instant of triumph, or happiness, or mirth which at the same time cannot possibly last–and yet will remain with you for life.

Everyone is down on pain, because they forget something important about it: Pain is for the living. Only the dead don’t feel it.

Pain is a part of life. Sometimes it’s a big part, and sometimes it isn’t, but either way, it’s a part of the big puzzle, the deep music, the great game. Pain does two things: It teaches you, tells you that you’re alive. Then it passes away and leaves you changed. It leaves you wiser, sometimes. Sometimes it leaves you stronger. Either way, pain leaves its mark, and everything important that will ever happen to you in life is going to involve it in one degree or another.

Again: I don’t intend this as consolation to those currently grieving. It’s meant as encouragement to those who aren’t now, but who have in the past, may again in the future, and who know so many others are right now. It’s just my way of saying that, despite the costs, I really do think it’s worth it. Or at least, in the end, it can be.

In the meantime? Let’s go to work trying to make it all suck a little bit less.

4 thoughts on “Adverse Childhood Experiences And The Truth About Everyone”

  1. I just had a conversation yesterday with someone about the problem of evil, and he was saying that you really start to see God differently when you become a parent. You see how your children suffer for their own choices, and sometimes for other peoples’ choices, even though you care about them. I responded that if you could, you would protect them from the suffering of other peoples’ choices, and he insisted he would not. He was talking about pain leads to growth and strength.

    But he was thinking of pain like the pain of having to figure out how to pay for college–pain i will refer to as “growth pain.” I countered that there are other kinds of pain, what I’ll call “destructive pain”, such as sexual abuse and the like. I’m not sure if I wholly understood him, but his position seemed to be that all kinds of pain–growth or destructive–can lead to improvements. He said we can never really know how something is going to play out, it’s impossible to say, and I think he was working toward the idea that, since we can’t know how it will play out, we can’t know if there could be a better system than this for reality. Plus, he said, it’s moot because this is the only system we have and there’s no alternative.

    I tried to explain that the point isn’t to imagine some better version of reality so much as to wonder whether this reality is the result of the divine or chance. But the conversation devolved from there, unfortunately.

    On another note, my forensics program includes many grisly stories, actions that I don’t just consider stupid but actually evil, and I feel myself getting more cynical. The idea that so many people experience ASEs is terrible but not as surprising as it would have been 6-9 months ago, for me, I mean. For lack of a more eloquent phrase–it’s kind of fucked up.

  2. You’re welcome. It’s just something I’ve thought about / struggled with a lot throughout my life. Based on replies, it seems that might not be as common as I thought. But I guess that when it resonates with someone at all, it resonates a lot.

  3. So here’s the thing: I don’t like to research true crime stories because I think it’s kind of sick. But knowing about some of what goes on is unavoidable if you read as much as I do, or if you do forensic science like you do. So, without any desire to find them, I’ve come across enough stories (involving kids, some criminal some just tragic) to really kind of mess me up a little bit.

    Add to that my real-life experience with friends who have had pretty traumatic things, and I can be frustrated sometimes with people who don’t seem to realize how much pain is involved in living.

    One of the thing that frustrates me in particular is when people seem so surprised when tragedy strikes. This is delicate, so I want to be careful, but I guess what I’m saying is that if you don’t get angry that God let someone else’s little baby die what grounds for outrage do you have if your own little baby dies? I realize that emotionally these are black and white, but intellectually it seems that if you haven’t at least tried to reconcile yourself (before anything happens) with the fact that your own children are as likely to die as anyone else’s then there’s something wrong with you.

    This is especially true if you consider how un-freaking-believably privileged we are as 21st century Americans compared to the rest of the world now or going back through history. We have it good. They have it bad. If that’s not bothersome, really and truly bothersome, then there’s something wrong with you.

    Last thing, however, is that there’s a really useful scripture for this question of how much to shelter your kids:

    Woe unto the world because of offences! for it must needs be that offences come; but woe to that man by whom the offence cometh!

    That’s Matthew 18:7, KJV. The verses before it put it in even greater context:

    1 At the same time came the disciples unto Jesus, saying, Who is the greatest in the kingdom of heaven?

    2 And Jesus called a little child unto him, and set him in the midst of them,

    3 And said, Verily I say unto you, Except ye be converted, and become as little children, ye shall not enter into the kingdom of heaven.

    4 Whosoever therefore shall humble himself as this little child, the same is greatest in the kingdom of heaven.

    5 And whoso shall receive one such little child in my name receiveth me.

    6 But whoso shall offend one of these little ones which believe in me, it were better for him that a millstone were hanged about his neck, and that he were drowned in the depth of the sea.

    So yeah: suffering happens. And I believe that all suffering can–in time–be made for a person’s good. But that never justifies causing unnecessary suffering. Not by harming others “for their own good” nor by allowing harm to come to our children ’cause it will “toughen ’em up”.

    It’s not really possible to be overprotective. It’s possible to be enabling, or suffocating, or to deprive your children of freedom and healthy risk, but those aren’t really the same thing. You’re not protecting them in those cases. You’re harming them.

    So practically it’s hard to figure out where to draw the line, but theoretically it’s pretty black-and-white: don’t cause suffering if you can avoid it.

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