Monday, September 26, 2022

Comments by trail_blazer

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  • Hi Corinna,

    Thanks for the article. As someone who does research in this area, there are some things I disagree with. First, though, there are many points that I agree with. I agree there are a lot of academics who fail to involve community input and many of studies lack relevance to community level change. I have been trying to get out a paper for nearly a year on a rather basic aspect of child abuse with obvious importance to interventions (that is practically ignored in the literature), and the reviewers don’t seem to care. “Lacks innovation”, they say.

    Also, as someone who has also experienced sexual abuse firsthand, I too am concerned about the lack of discussion about risks of administering these surveys. More so in a clinical context than a research context. In research, they should have been informed before participating that these questions would be asked, and given a choice to decline participation. Your repulsion, if I understand, is linked to clinical administration, which you can’t really opt out of without making a fuss or being labeled difficult, and to giving a lecture about the effects of ACE with kids (which I’m not sure why someone would do, especially if there was no discussion about resilience, or plans about what to do if kids become upset or start disclosing abuse!). I think giving these surveys at an early appointment (especially intake) with a healthcare or service provider is a bad idea. When I was in therapy, my own abuse wasn’t something I was comfortable talking about until I had trusted my therapist (and it was my decision to bring it up)…

    As for where I disagree, I’m not sure where you are getting that the BRFSS found that suicide, substance use, mental health labels, physical health issues, and domestic violence were equally common in poor versus rich communities. Even if they had this finding, there are several other studies where all of these factors have been associated with low income communities. Also, while there are low income or otherwise disadvantage communities that have qualities that encourage resilience, this is far from universal. Likewise, there are suburban or more advantaged communities that have cohesion and other factors that would encourage resilience. This (factors both at an individual and community level that encourage resilience) really isn’t very well studied. I definitely agree this deserves more attention (especially community level), but I don’t think it helps to make sweeping generalizations.

    Also, remember the ACE survey is far from the only instrument used to measure childhood trauma. I agree, it’s not one of the best and leaves out several important traumas and aspects of trauma like timing, duration, etc. But even if there are problems with that particular measure, I disagree that measurement of childhood trauma has no value. I think combined with measures of resilience it could be quite useful.

    Finally, while the effects of trauma need to be considered, not just the experience, there are certain experiences that should matter, regardless of whether one is resilient to adverse effects (e.g., being raped by your uncle, or beaten by an alcoholic father). Even beyond health implications, these experiences in and of themselves have human rights implications.