First Do No Harm


In 1980, Dr. Vincent Felitti, head of Kaiser-Permanente’s Department of Preventative Medicine in San Diego started an obesity clinic. Over the next five years, he noticed that despite his patients’ considerable weight losses, about half of them dropped out of the program each year. Confused, he decided to interview some of those who had left to determine their reasons. His questions ranged from how much they weighed at various times in their lives to how old they were when they achieved certain milestones. In one interview, however, instead of asking how old the woman was when she became sexually active, he mistakenly asked how much she weighed when she did. And when she answered 40 pounds, he was given the first clue as to why many of his patients were leaving.


In the 23 years of his practice prior to this, Dr. Felitti reported that he had only ever come across one other incident of incest. But once he started asking the right questions, he discovered a pervasive pattern of sexual abuse amongst his patients. Most of them had been of average weight when they were born and remained so until the sexual abuse occurred, at which point their weight skyrocketed. He not only learned reasons for his patients’ obesity (eating soothed them, losing weight increased their anxiety), but also their desires to maintain it as a way to keep them safe from those who would abuse them. As one patient observed, “Overweight is overlooked, and that’s the way I need to be.”


Between 1995-1997, Dr. Felitti, together with medical epidemiologist, Dr. Robert Anda, and a team of researchers from the Centre for Disease Control and Prevention expanded the study to look at childhood experiences in a general population. They interviewed more than 17,000 members of Kaiser Permanente’s San Diego Care Program (largely white, middle class, middle-aged, educated and employed) and began to make significant connections between adverse childhood experiences and later mental, physical and social problems in life. This became known as the ACE study. Participants were asked to respond to questions related to two types of neglect (emotional and physical) three types of abuse (sexual, verbal and physical) and five types of family dysfunction (mental illness, alcoholism, incarceration, witnessing domestic violence, loss of a parent through divorce or abandonment), adding up to ten types of adverse childhood experiences. The study assigned one point for each adverse experience, and not surprisingly, the higher the ACE score, the higher the incidence of physical, mental and social problems in later life.


The results of the ACE study are wonderfully illustrated in the 2021 moving and impactful documentary by Zaya and Maurizio Benazzo, called “The Wisdom of Trauma.” The film includes interviews with survivors of childhood trauma and finds them homeless, in prisons and in poor physical and mental health. In one particularly poignant scene, Compassion Prison Project’s Founder and Executive Director Fritzi Horstman asks a very large circle of prisoners standing in a prison yard to step forward into the circle each time that they answer yes to any of the questions related to Adverse Childhood Experiences. With each question, the circle grows smaller and smaller as prisoners confirm the neglect, the abuse and dysfunction in their homes.


The film also features Dr. Gabor Mate, physician, author, speaker and expert in the treatment of addiction and trauma. He suggests that when children are left alone with their trauma, they often figure out a way to survive by shutting down their feelings and disconnecting from themselves, so that they do not have to experience the intense fear, sadness, anxiety, or anger that they feel in response to whatever is happening in their lives. The longer they live with the secrecy and shame, the more they seek alternative methods of soothing themselves through alcohol, drugs, food, sex, self-harm, violence, etc. to continue to escape their emotions.


To add insult to injury (literally), aside from the traumas that these individuals endured in early life, they continue throughout their lives to be judged as lacking willpower, having character flaws and being moral failures, instead of as people who have learned, in whatever way they could, to survive their abuse, neglect and dysfunctional families.


Without intervention, the fallout is devastating and sets in motion a domino effect of negative consequences, The neurological development of children is disrupted, leading to impairments in social, emotional and cognitive development, which in turn leads to adoption of maladaptive behaviours, which brings about disease, social problems and early death. In the field of epigenetics, they have linked childhood trauma to 10 of the most common diseases today.


However, with social, medical, educational and community interventions, such as supporting parents in need, providing mentorship programs, teaching healthy coping behaviours as an alternative to unhealthy ones, there are ways to heal the hurt and give hope to the harmed.


For more information about the ACE study, please go to:

https://www.cdc.gov/violenceprevention/aces/index.html


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