In the late 1990s, the Adverse Childhood Experiences (ACE) Study revealed a powerful relationship between childhood trauma and later adult emotional difficulties and physical health problems (previously reported here by Joshua Kendall). Two decades after the ACE Study was published, it has finally become politically correct for U.S. politicians to acknowledge its significance, and for Congress to respond with legislation (previously reported here by Leah Harris). However, U.S. history tells us that even when politicians finally acknowledge an ignored truth, given their allegiance to the U.S. societal status quo, their reactions routinely neglect the most embarrassing implications of that truth.
ACE findings produced two areas of unexpected results for its researchers Vincent Felitti and Robert Anda. The first area was the prevalence of adverse childhood experiences in a relatively well-off population in the United States. The second area was the strength of the relationship between adverse childhood experiences with adult emotional problems and physical health issues—while unsurprising for many ACE victims, this has been groundbreaking for medical authorities.
With respect to prevalence, more than a quarter of subjects grew up in a household with an alcoholic or a drug user; 23% had experienced severe physical abuse; and 28% of women had been sexually abused as children (16% of men). More than half of the subjects reported at least one adverse childhood experience of abuse, neglect, or other household traumatizing exposure; and one-quarter reported two or more such adverse childhood experiences.
It is important to keep in mind that the ACE Study examined middle-to-upper-middle-class subjects (74% had attended college, and all had higher-end medical insurance), and we know from other research that abuse and neglect is far higher for children from financially impoverished households (see the National Incidence Study of Abuse and Neglect).
Marginalizing and Ignoring U.S. Childhood Trauma
The finding that abuse and neglect are so common in well-off U.S. households—where, for example, 28% of girls are sexually abused—is so unpleasant that some defenders of the U.S. societal status quo have attempted to marginalize the ACE study by arguing that it is unreliable because it relies on the memory and credibility of respondents. The reality, Felitti and Anda have responded, is that underreporting of trauma is more likely than overreporting. Common sense tells us that Felitti and Anda are correct as, for example, a woman would be reluctant to discuss her childhood sexual abuse, and that underreporting is far more likely than overreporting.
While ACE findings of the prevalence of household dysfunction in well-off American households is embarrassing for apologists of the U.S. societal status quo, even more taboo—and uncounted in the ACE Study—are adverse childhood experiences outside the household. Such adverse experiences outside the household and uncounted in the ACE Study include childhood trauma created by U.S. societal authorities and institutions with regard to: (1) schooling; (2) psychiatric treatment; and (3) state coercions.
In their schooling, my experience is that what has driven adolescents to feel stressed, hopeless, and suicidal even more often than peer bullying are school authorities’ coercions and threats of dire consequences for academic noncompliance and failure.
Oppressive psychiatric treatment (e.g., the use of drugs to control bothersome behaviors instead of receiving caring for the emotional pain fueling such behaviors) is also a major adverse childhood experience, as Mad in America readers are well aware of.
The adverse childhood experience that dominated my adolescence was the U.S. state terrorism of the Vietnam War and the draft, which filled me with a chronic fear that I was going to get maimed or killed in Vietnam unless I became a fugitive. Today, many adolescents are overwhelmed with anxiety owing to a range of societally generated terrors—e.g., they are all pressured to go to college but well aware that a college degree may result only in a low-paying job, crippling student-loan debt, and failure to avoid becoming one of life’s “losers.”
For a sane society, the most obvious implication of the ACE Study would be prioritizing the prevention of preventable adverse childhood experiences. A sane society would be asking questions about the very nature of a society and culture that creates so much trauma for children.
However, we do not live in a sane society. We live in a society that prioritizes profits for large corporations and power for large institutions. We live in a society in which, for example, the cause of depression and suicide has been, for decades, falsely attributed by psychiatry and Big Pharma to a chemical imbalance theory long known to be untrue—an untruth that has made billions of dollars for drug companies and increased power for psychiatry through increased use of antidepressants which are known to actually increase suicide. This is just one of many examples that we do not live in a sane society.
U.S. Politicians’ Response vs. A Sane Society’s Response
Owing to the great efforts of Felitti, Anda, and others (including those in the Mad in America orbit) getting the word out on the ACE Study, twenty years after its publication, it is no longer possible for politicians to simply ignore its finding of the powerful relationship between childhood trauma and later adult emotional difficulties and physical health problems.
In June of 2019, the RISE From Trauma Act was introduced with bipartisan support in the U.S. Senate, its stated purpose: “To improve the identification and support of children and families who experience trauma.” It allocates $50 million in grants, spread over 2020 to 2023, for institutions such as child welfare agencies, hospitals, and schools for research, building awareness, and to assess, prevent, and treat youth and their families who have experienced trauma or at risk of experiencing it.
In her Mad in America report about the RISE From Trauma Act, Leah Harris provides examples of how states have created initiatives in schools to be more “trauma sensitive.” In response to the idea of creating more trauma sensitive schools, one young man I know with an extremely high ACE score (8 of a possible 10)—but who feels as traumatized by his school experience as by his household ones—was cynical, rhetorically asking me: “Are schools going to include ACE screening day with lice screening day? Are they going to report ACE scores to parents—parents who will then abuse the kid even more for talking to authorities about their shit parents?”
In response to Harris’s Mad in America report, there were many comments by MIA readers who had negatively experienced psychiatric treatment and were concerned that the legislation would result in more such treatment that would be re-traumatizing. Felliti himself has concerns about typical mental health services that primarily treat traumatized patients with drugs, noting, “Back when I was at Kaiser Permanente, I was afraid to send patients to psychiatrists.”
In a sane society, treatment for traumatized young people would be quite different than the treatment routinely provided. A sane society would not equate treatment with drugging the symptoms of trauma; and it would not be self-satisfied with quick-and-easy behavioral “trauma informed focused treatments” (such as “cognitive processing therapy” and “prolonged exposure”). A sane society would recognize that real healing involves providing safe, caring, and loving relationships, which may or may not be possible within a paid therapeutic relationship; and so all efforts would be made to re-make society so that safe, caring, and loving relationships could be found in daily life.
A sane society would also be asking: What is it about U.S. society that creates so many abusive and neglectful adults? A sane society would acknowledge that such adults have themselves likely not only been traumatized as children but continue to be traumatized in their adult lives—e.g., alienated and humiliated in their jobs; and given the general message that they are simply objects and tools, and to the extent that they cannot be used to make some rich asshole even richer or some powerful institution more powerful, they will be discarded. A sane society would not be surprised that such adults often have little patience for normal but sometimes frustrating behaviors of children, and react with abuse and neglect.
It is good that the general public is finally hearing about the ACE Study, but should we be hopeful now that U.S. politicians are “trauma informed”? I’m not.
U.S. politicians, for the most part, create and enable insanity—from insane psychiatric treatments to insane wars. When, for example, U.S. politicians finally acknowledged that the U.S. lost the Vietnam War and that Americans were reluctant fight another war, their “diagnosis” was that Americans suffered from “Vietnam Syndrome,” a reluctance to support wars —the “treatment” for which has obviously not been the end of senseless wars but rather multiple senseless wars with weaker opposition.
So I do not count on U.S. politicians to address the core implications of the ACE findings—the need to re-make U.S. society so as to (1) prevent preventable adverse childhood experiences, and (2) create a society in which healing from trauma can more easily occur—where safe, caring, and loving relationships could be more readily found in daily life. Rather than count on self-serving politicians to challenge the status quo and re-make society, we can only count on ourselves.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.