We know now that childhood trauma is strongly associated with chronic illness later on, including heart disease. As I wrote in a recent blog post about ACE (Adverse Childhood Experiences), researchers warn us that scoring 4 or higher on the ACE test can predict a significantly higher risk of physical or mental illness as an adult. I was stunned when I took the test and saw that my own score was 4; I was well aware of my childhood experiences, of course, but I thought that only marginalized kids from desperately poor families were at high risk – and that wasn’t me! A history of psychological childhood abuse or neglect is not what we expect our doctors to ask us about – but this research suggests that maybe they should start.
“My ACE score was seven. One example will suffice: I remember sitting in the bathtub in the only bathroom we had, and counting 33 bruises on my 10-year-old body. My mom came in to use the toilet and even she was shocked at this sight. She asked who did this to me. Well, I knew I got many bruises from her, but my half-sister, eight years older than I, had inflicted at least half of them while babysitting us (her weapon of choice, as my mom’s, was a wire coat hanger).
“So my sister then got a terrible beating, and I felt guilty that she was punished so harshly for this. She was a victim as much as I was, as much as any of us were. But my parents were only repeating what they had experienced.
“I consider myself really fortunate to have navigated my chaotic family life with fewer long-term issues than my siblings (although, come to think of it, ischemic heart disease is not exactly coming out unscathed).
“But at least I did not follow the majority of my siblings into addiction. I made choices as a very young child that were pivotal, in my opinion. For example, I did not want to ever be out-of-my-mind intoxicated, so I have never been drunk (nor ever abused drugs). I am not more ‘virtuous’, just more fortunate that I figured out that this was not how I should live my life.
“I was nine years old when I articulated this idea in my little kid mind.
“I remember clearly sitting on swings one day at a park on the military base we lived on, all alone, telling myself that I would never be drunk. Ever. Witnessing my dad out of control as an alcoholic was scary to me, and I did not want to be like that.
“I also found strength in my faith, which gave me a sense of direction, a summons to reconciliation and compassion, and a concern for social justice.
“I found a sense of purpose in serving others. I also credit taking psychology in high school, which provided insights into the cycle of abuse and how my parents were only repeating what had been done to them. I realized that they were not deliberately trying to mess us up. They had been mistreated mightily in their childhoods, and I found myself able to understand and forgive them.
“I envisioned the possibility that my parents could ‘grow up’ and change, and they did indeed become transformed, mostly after I became an adult. My father stopped drinking, my mother befriended elderly people who had no one to care for them. She taught Indian beadwork, proud of her heritage, after being scorned as a child when her teacher told her, ‘Indians massacred whites.’ They were fantastic grandparents and genuinely made positive changes. I never gave up on them.
“Yes, damage was done. Every one of my five siblings made self-destructive choices. Two of my brothers ended up as heroin addicts, and they died a few months apart.
“I know that what my parents and others did was not okay. They were the adults and were supposed to protect us, not inflict harm upon us. But they were damaged, too, by cruel treatment–even worse than what we experienced.
“The fact that I had a great relationship with them in adulthood was a blessing, and I live a happy life. I consider myself resilient and optimistic.
“I felt sad remembering the trauma we experienced as children.
“I felt sad remembering the abuse my mom experienced at the hands of cruel nuns in an Indian boarding school.
“I felt sad remembering the rage that caused my grandmother to hurl a log from the fireplace at my dad’s head when he was just a little boy, saying, ‘I brought you into this world, and I can take you out of it.’
“I felt sad remembering the homeless young woman I saw sleeping on the floor of the post office the other night, with her hospital ID band still attached to her wrist.
“Childhood trauma leaves a path of destruction in its wake. As a teacher, I know how impressionable children are, and they all deserve to be nurtured, cherished, and kept safe from harm.
“I have had a lovely life, despite the ordeal of a chaotic childhood. I witnessed many transformations. I believe fully in the power of hope. People can change for the better.
“One of my brothers, who spent many years as a heroin addict, said as he was being transported to the hospital for the last time due to liver cancer (brought on by hepatitis C from dirty needles):
‘My life has been golden.’
“Wow. What an incredible attitude. He died a week later, after a horrific ordeal. But he carried a sense of gratitude because the final 12 years of his life were lived without the constant struggle to find heroin. He was able to get on a program to receive methadone. The stability provided by methadone allowed him to become an integral part of his grandkids’ lives, and he truly was devoted beyond imagining to them, often helping his daughter care for them as she finished her college degree.
“He found redemption in his relationships with his children and grandsons. He lived with our parents and cared for them with devotion. He became active in church, playing music for the teen mass. Two weeks before his death, he insisted on washing our dad’s car, even though he had difficulty walking and needed a cane.
“I still marvel at the wonders I have seen amidst the rubble of a wretched childhood. Yes, my brother’s life was cut way too short. My other heroin addict brother, a Vietnam vet, had died three months before him. We all carried wounds, and sadly, most suffered from the desperate quest to find escape in very self-destructive ways.
“But love also found its way, and despite everything, I am grateful for the insights that led me to my path in life.
“I wish so very much that no one would ever have to endure abuse of any kind. Have you seen the poem by Gabriela Mistral, the Nobel Prize winning Chilean poet?
“We are guilty of many errors and many faults,
But our worst crime is abandoning the children,
Neglecting the fountain of life.
Many of the things we need can wait.
Right now is the time his bones are being formed,
His blood is being made,
And his senses are being developed.
To him we cannot answer ‘tomorrow’
His name is Today.”
“If childhood trauma set me on this course, I can at least now try to get on a better track in terms of caring for myself, body, mind, and soul. It actually gives me more impetus to give myself permission to treat myself with more kindness. I tend to put myself last.”
“Thank you for shining a light on this little known risk factor of childhood trauma’s effect on our heart health. May it summon all of us to not look away when we see children vulnerable to abuse.
“And may we take time to nurture ourselves, even now, as adults, worthy of love and respect.”
About Marie: “I’m a teacher, mother and wife. I live on the west coast of the U.S. My heritage is Native American. (In Canada, you are all more familiar with the term, Metis). My background is Chippewa and French. My father’s side is part Seminole. I’m participating in women’s cardiac research called the WISE study at Cedars Sinai Hospital in Los Angeles; it specifically explores why patients with coronary microvascular disease tend to develop heart failure with preserved ejection fraction.”
NOTE FROM CAROLYN: Marie demonstrates that it’s possible for siblings suffering the same “ordeal of a chaotic childhood” to experience very different adult outcomes. As Harvard pediatrician Dr. Jack Shonkoff, director of the Center on the Developing Child at Harvard, explained:
“There are people with high ACE scores who do remarkably well. ACE scores don’t tally the positive experiences in early life that can help build resilience and protect a child from the effects of trauma.
“Having a grandparent who loves you, or a teacher who understands and believes in you, or a trusted friend you can confide in may mitigate the long-term effects of early trauma.”
Q: Can you recall a moment in your own childhood when, like Marie, you made a decision about the rest of your life?
- Oh, great. Another cardiac risk factor to worry about… my original blog post that inspired Marie’s response
- More about ACE, take the ACE test, and learn more about how to help prevent the poor outcomes associated with ACE
- More about ACE from the ACES Too High website.
- Resilience: it’s hard to feel like a victim when you’re laughing
- Do you think you’re a “somebody”?
- When an illness narrative isn’t just about illness
- The bumpy road between diagnosis and getting better
- Almost anything written by Dr. Jonathon Tomlinson, a GP in East London who writes eloquently about ACE issues and social determinants of health in his highly recommended blog.
- Dr. Victor Montori works on a unique concept focused on reducing a patient’s “burden of treatment”, which he and his Mayo Clinic-based team call “Minimally Disruptive Medicine”. His book Why We Revolt calls on his medical colleagues to provide care that is careful and kind.