Patricia Rush, M.D., M.B.A. is an internal medicine physician whose scientific focus is complex chronic illness. Her over 40-year career has focused on working with underserved populations and promoting universal access to high-quality medical care. She spent 20 years in the Cook County (Illinois) Health System, including six years as director of their emergency department. From 2000-2008 ran a trauma-informed solo private medical practice in Chicago.
During this time, she completed in-depth interviews with more than 500 patients, which led her to identify a group of high-risk individuals with serious illnesses who also had a consistent pattern of extreme stress at a young age, including profoundly disordered sleep and emotional distress.
Until her retirement, Dr. Rush was also an Associate Professor of Medicine at the University of Chicago and now teaches neurodevelopment as a member of the Physician Workgroup of the Child Trauma Academy.
She was a co-founder and serves as a co-director of the Center for the Collaborative Study of Trauma, Health Equity, and Neurobiology, or THEN, in Chicago. The nonprofit works at the intersection of science education and social justice, exploring and communicating the links between early emotional trauma, inequality, human development, and chronic illness to a network of professionals and the public.
In this interview, she discusses a new and more integrated way to understand and treat physical and mental ailments in people of all ages that has important implications for how we raise our children.
The transcript below has been edited for length and clarity. Listen to the audio of the interview here.
Miranda Spencer: What are some of the issues and problems with conventional medical care in America that led you and your colleagues to start the Center?
Dr. Patricia Rush: Four of us health care workers from Chicago started the THEN Center in 2017. We had worked in conventional medical health care for over 40 years and saw several problems that we did not think were going to be addressed. We were interested in promoting a patient-centered approach to medical care, and also focusing on how the brain and body work together to create health, or if disrupted, to what results in disease.
But what we realized was that medical schools, and also schools of nursing, social work, and psychology, were still using a very old-fashioned approach of seeing the body as a set of disconnected parts. The old model looks at the brain as being completely separate from the body, which obviously makes no sense. And also, we were concerned that the critical role of racial trauma and health disparity was not being taught.
So the four of us decided we should start our own small nonprofit to bring a patient-centered, brain-body approach into medicine. So the conventional approach to health and to medicine, in Europe and the United States and in many other parts of the world, is to think that how we can become more advanced is to specialize by looking at individual organ systems and to assign each disease pattern to an organ system.
Therefore, when people have chest pain, the problem is thought to be maybe a heart problem or a lung problem, and they see specialists in these areas. The problem with that is that the body does not work like a set of separate parts, it works altogether. And how health is maintained as a whole, or health in any of these organ systems is really maintained, is through a regulated brain. So we decided that since there are thousands of medical articles demonstrating this connection, we would try to start our own educational program for medical schools and for the community.
Spencer: What is the THEN Center’s mission and how does it work to address these challenges, especially regarding mental health issues?
Rush: Our mission is to create a set of lessons and basic concepts that can be used in all medical specialties, including for mental health and psychiatry. So we collect and analyze research. We provide analysis of this research through our newsletter and through social media, and we use this as an opportunity to explain complex ideas, and why, when your brain becomes dysregulated, that can result in other kinds of problems.
Spencer: We hear a lot about the negative effects of Adverse Childhood Experiences and how that can lead to mental health problems in youth and adults. But a growing body of scientific research suggests that early traumas also affect a person’s physical health, and that it does so throughout their life. Can you talk about that a little bit more?
Rush: It’s only by understanding that the brain and body are one integrated, unified system that we can make sense of any kind of distress or disease, whether it’s mental or physical. And the way we do that is by looking at what helps the brain and body stay regulated, and the importance of life experience, especially starting in early childhood.
There’s thousands of articles now showing that when there is distress or disruption of the child’s attachment to their parents, particularly their mother, compounded by other traumas as time goes on, the brain gets dysregulated. It’s unable to smoothly handle the needs of day-to-day life, and that dysregulation can start inflammation, which is the basis of most chronic illnesses.
Spencer: But I also gather that the brain and the body can heal; it’s not a life sentence, necessarily.
Rush: Right. Our brain and our body are constantly changing and constantly adapting to the challenges that we see. So even people that have had very severe trauma, both physical and emotional, can definitely heal and lead a happy healthy life. But the way that healing happens is by restoring regulation through the brain.
Spencer: Can you share a case study that illustrates what you’re talking about?
Rush: Yes, let’s talk about a case of a five-year-old girl that we’ll call Bella. Bella was referred to the physician because she got in trouble in school by fighting with another five-year-old over sharing crayons. So the typical approach to this would be to think of Bella as having a conduct disorder, she doesn’t know how to play well with other children, or that she maybe isn’t paying attention, might [be] diagnosed with something like Attention Deficit Disorder. When we look deeper at Bella’s history, what we find out is just that her parents have had a very turbulent relationship. Her parents were separated several times when she was between the ages of one and three. Bella saw multiple different caregivers, and therefore was not able to sleep well.
When taking more of a history, we find out that Bella has nightmares every night, that she’s unable to calm down at home and at school. And so what we realize is that Bella’s brain is dysregulated. She has developmental trauma from not having a smooth childhood, and she just can’t take in a lot of excess stimuli. So then the question is, what is the best way to help Bella and the family and to allow Bella to be able to go back to school? And that involves a more complex evaluation to see how Bella handles input of noises and a lot of people moving around or whatever; can she make sense out of that? And then also to help the family restore some kind of smooth order and attention to Bella so that she can improve.
So in fact, when she did have this kind of evaluation, it was determined that Bella’s chief problem was she was afraid of being separated again from her parents, and when that fear was processed through family therapy and by getting occupational therapy to help her deal with her sensory questions, then Bella was able to play well and go back to regular school programming without any medication.
Spencer: So in the conventional model, Bella might have gotten some kind of psychiatric label and possibly medication at a young age, because the source of her problems was considered to be somewhat random, or from some inherent issue rather than a more environmental cause?
Rush: Right. The typical thinking is that there’s something wrong with the child, that the child is broken, or they have a personality disorder. But then if you look deeper, you can usually find out that something major happened. It may not have been any kind of violence or abuse, but just the unpredictability, the chaotic nature of her home life when she was a young child, made it impossible for her brain to be deeply regulated.
Spencer: The THEN model prescribes a more collaborative approach with the patient, in this case, Bella and her family, versus the doctor as an authority and the patient as more passive. How does the collaborative approach work with a child like this, and with any patient?
Rush: Health care has to always be a partnership. Each partner brings something to the table. The doctor, the nurse practitioner, the midwife, definitely has expertise in identifying patterns of disease or dysfunction. But the patient— and in this case, the child and the family— are the ones who really hold the most important information. Only the patient really knows how they feel, what has happened, and what they’re able to do and want to do to get better. And so part of the key of this model is to realize that the potential for change, both making different choices but also deep change within the brain and the brain networks, is what really will allow the healing.
And there’s no way that we externally can really understand what’s going on inside someone’s brain without talking to them, and the patient or the family [are] the ones that really have control over what tests are done, what treatments are tried, and what is success.
Spencer: Let’s talk about prevention and early intervention. If chronic and other illnesses can be brought on in adulthood or in later childhood by childhood trauma, how do we stop that process in its tracks? How can parents and families recognize and deal with their kids’ challenges while they’re still in childhood?
Rush: It’s always possible to heal. So when we talk about the brain or the nervous system, we’re talking about neuroplasticity, that the brain can change. Whether the child is one-year-old, or whether it’s a 16-year-old teenager, it’s never too late to get things back on track and for healing to occur. And so the most important first step after establishing trust is to reestablish regulatory processes within the body, number one being sleep.
We all take sleep for granted. And because we have electricity, we’re able to keep the lights and the TV on all night. Our sleep cycles can get very disrupted. There is excellent research that shows that sleep patterns early in childhood go on later to be associated with both physical and mental illness. So, the first thing to do is to focus on sleep, and that usually means talking to the person, even if it’s a young child, and finding out why they can’t sleep, or why they sleep only little bits and then [are] waking up, or they’re getting up in the middle of the night and wandering around. And almost 100% of the time, disrupted sleep, difficulty falling asleep, is related to fear. And that fear is usually related to not feeling safe in the house or being afraid of being separated from their parents.
So then we get into complicated family issues, because oftentimes the parent themselves has fear or stress and is not able to calm themselves down. Therefore, the parent-child pair, or the group of children, all become kind of dysregulated and keep each other dysregulated. So, the most important thing is getting the parent calm and reconnecting the parent and the child and establishing routines that everybody goes to bed early and try to do what we can to make the child and the parent feel comfortable and safe.
Spencer: How can adults recognize and address the role of their own early-life or ongoing trauma and their physical and mental health issues, not only for their own sake, but to be better parents?
Rush: Again, I want to say it is never too late to get things in your own life or your family’s, back on track, regulated, and calm. Oftentimes with adults, if you’re a parent, you’re old enough that some of your early trauma seems like ““Well, that was a long time ago, I’m not going to let it worry me.” But the problem is when we have unprocessed trauma, it does worry us, or we have messages about ourselves that we should be more perfect or we should do things differently, or have a better job, etc.
So without processing that old trauma, it’s often hard for us to feel safe. When we have the extra burden, even if it’s a joyful burden, of taking care of other people, particularly young children that are very dependent, oftentimes the parents’ stress level just overwhelms them, and they may develop a new chronic disease.
Spencer: Let’s look at the bigger picture. Can you talk a bit more about the Health Equity part of your name, and the idea that [health] reflects more than genetics and personal choice?
Rush: The goal of health equity is that everyone should have all the essential supports and services to live a healthy without mental or physical illness. The reality is that people who are the target of discrimination, whether based on race or religion or sexual orientation, when we have the extra stress of feeling like we don’t belong or it’s harder to get essential services or a job, that extra stress on top of all of life’s other problems leads to a huge burden of cumulative stress.
Black and brown people in America on average live 15 years less than white people. So, as you know, there’s many studies showing that you can have an impoverished community two miles from an affluent community and the life span is dramatically different between the struggling communities and the affluent communities. So, what we want to bring to the community’s attention and to medical science is that this is not an accident and really has nothing to do with genetics. It has to do with life experience.
So, by understanding the concept of cumulative stress, that racial trauma or discrimination of any type adds to the total burden of stress —and therefore is more likely to interfere with sleep and with brain-body regulation— results in this huge disparity of disease prevalence and lifespan.
Spencer: What can health care professionals, the government, and ordinary people do to ensure health equity?
Rush: I think it’s important, especially since we’re talking about families and parenting, that we all remember that our health really begins in early childhood. So an important step that the United States has taken this year is to add financial support for young families, and there’s also discussion now of improving the quality and availability of childcare. So the first thing is to support young families, and to make sure that those young parents are not struggling just to have a safe place to live, to have enough food to eat, etc.
Second thing is to ensure that education is conducted in a way that all children are treated with respect and affirmation. A lot of attention has come to the issue of bullying over the past decade or so, but we really haven’t made much progress. School, especially for young children, is where they spend the second-greatest amount of time. So if the school does not feel friendly and safe and fun and a place of friends, then this is going to add to the distress that the child feels, which then again ripples back to the family.
Spencer: What kind of resources do you have on the website that parents and families might find useful?
Rush: We have a lot of resources, including a book and videos section [with] scientific texts but also general text explaining trauma, the brain, and a different brain-body approach to understanding health. We also offer a free newsletter, and we have weekly posts on Twitter and Instagram showing how brain-body regulation can heal, and how dysregulation results in disease.
Spencer: Is there anything else that we haven’t touched on?
Rush: I would recommend the new book on childhood trauma by Dr. Bruce Perry and Oprah Winfrey, What Happened to You? In that book, Oprah describes various experiences and memories she has from her early life and how that shaped her. Dr. Perry describes how to understand her experiences through looking at the brain and gives a lot of good examples of how to improve brain regulation through regulatory exercises, including sleep and sports and family connection.
Dr. Perry is a neuroscientist and child psychiatrist and serves on our advisory board. Dr. Stillerman and I, both from THEN, have been studying with Dr. Perry for the last four years.
Spencer: I understand that the THEN Center collaborates with other organizations. What are some examples of what you all are working on?
Rush: One of the things we’re trying to do is create a free public database on the impact of discrimination and racial trauma, and so we are gathering experts and putting more videos together that are available on YouTube.