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October 20, 2018

Why we are what we are

Reuel S. Amdur

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It's not what's wrong with you: it's what happened to you. That is the message of the ACE findings. ACE: adverse childhood experiences. ACE findings are accredited to the research of Dr. Vincent Felitti, head of Kaiser Permanente's Department of Preventive Medicine, in San Diego, and Robert Anda, of the U.S. Centers for Disease Control and Prevention.

Things began with Permanente’s weight control program.  Half the patients left the program in spite of losing weight.  Why did they go back to past habits?  Felitti found that, for example, one woman had been sexually abused.  She needed to be fat in order to be unattractive as a sexual object.  This was his clue.

In developing the formula for determining who is affected by ACE, the researchers list ten factors:  physical abuse, sexual abuse, emotional abuse, physical neglect, emotional neglect, witnessing domestic violence, substance abuse in the family, family member suffering mental illness, parental separation or divorce, and substance abuse in the home.  The number of factors listed which a person reported has been found to be positively correlated with social and medical problems: the greater the number of factors, the greater the likelihood of negative outcomes.

While the likelihood of a negative outcome might be predicted, which negative outcome less so.  We are left instead with postdiction.  As well, there are many people who experience ACE’s who nevertheless thrive.  They thrive perhaps because of one or more strong individuals in their lives with whom they can identify or who can support or mentor them.  The strength of a supporting milieu may also be a factor.  As well, just as we are not all the same height or weight, so we are not all the same in our innate ego strength.

This discussion arises from a presentation by Crime Prevention Ottawa on September 12.  The program consisted in the showing of the film “Resilience” and a panel of local experts.  The underlying theme is that ACE’s affect the very structure of the developing brain as well as how it functions.  The brain also interacts with its milieu.  “The body remembers.”  Telling someone to “just suck it up” because of childhood traumas makes no more sense than saying that to someone with cancer.  

Among the phenomena associated with elevated ACE’s are smoking, promiscuity, obesity, cancer, heart disease, high blood pressure, diabetes, mental illness, criminality, and early death.  Dr. Tracie Afifi of the University of Manitoba and her colleagues identified spanking as a factor in the development of mental illness.  From this example and from phenomena such as family violence and substance abuse, it can be seen that in order to help children we need to change adults.

Studies not directly related to ACE research nevertheless support the principles.  For example, in a study by Kirsty Lee and Tracy Vaillancourt in the journal “Developmental Science,” the authors found that “peer victimization and body dissatisfaction” were related.  Obesity and negative body image were consequences of bullying. 

One finding from the ACE research that may surprise is the very high rate of sexual abuse of children in the US studies, in the range of 20% to 30%.  Another food for thought is that in spite of this and of all the other ACE’s that many suffer, most of us function reasonably well. 

Then we come to the matter of prevention and treatment.  Preventive measures include opening up channels of communication with children and giving them support in facing ACE’s.  Treatment would be both more of the same for children and adults and also social measures—tackling poverty, enacting sound programs for dealing with addiction, providing favorable education and recreation, and early identification and treatment of emotional problems and other psychological difficulties.

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