But, once Kaiser doctors began administering the ACE questionnaire, after getting some basic coaching on how to broach sensitive issues, they found the interview process to be quick (a few minutes per patient), surprisingly painless, and astonishingly positive. Considering that no actual therapy was involved, the process was even therapeutic for patients. Only a small minority were referred to a psychiatrist or a weight-loss or smoking-cessation program. Not only were the patients willing to talk to their physician about the most fraught issues of their childhoods, they clearly felt relieved and gratified by even this small acknowledgement of their past suffering. Furthermore, they apparently derived benefits that seemed disproportionate to the amount of face-to-face attention they received. A data-mining firm compared ACE participants with other Kaiser members—120,000 people altogether—and found that one year after the survey, the former showed a 35-percent drop in doctor's visits, an 11-percent drop in emergency room visits, and a 3-percent drop in hospital visits. If the ACE program had been in place for all Kaiser members, Felitti estimates it might potentially have saved outpatient services $4 billion.
Two years later, however, in the absence of any follow-up whatsoever, the percentage of medical outpatient utilization had reverted to normal. Reviewing the ACE participants' charts, Felitti found that, "Almost never did anybody try to integrate this knowledge into a patient's ongoing care. The information might as well have been printed in invisible ink."
In fact, notwithstanding all the bean counters obsessing about cost containment, the vast implications of this study—medical, social, political—seem to trigger a kind of cognitive dissonance in the world of healthcare. The medical profession isn't designed, organized, or financed, much less philosophically ready, to grapple with these facts. Rather than exploring amorphous, hard-to-measure psychosocial and emotional factors lost in the mists of time and patients' unverifiable memories, both medical researchers and clinicians focus on what's directly in front of them—current physical symptoms and directly preceding causes. So the traumatic "insults" in childhood to complex neurobiological systems remain "silent" until the middle-aged or elderly patient brings her obesity and diabetes, his high blood pressure and clogged arteries, to a physician half a century or more later.
"If you believe information, then you realize that this calls for a paradigm shift," says Felitti. "The truth is right there, just under the surface—you just have to ask the right question." But as he's fond of saying, "Most people spend their whole lives not asking the basic questions."
Mary Sykes Wylie, Ph.D., is the senior editor of the Psychotherapy Networker. Tell us what you think about this article by e-mail at firstname.lastname@example.org, or at www.psychotherapynetworker.org. Log in and you'll find the comment section on every page of the online Magazine section.