While it's common knowledge that childhood trauma can have far-reaching and sometimes dire consequences for adult mental health, it's less obvious that abuse, neglect, parental alcoholism, severely dysfunctional family patterns, and other stresses in childhood can severely affect adult physical health, and even mortality. However, a path-breaking epidemiological survey called the Adverse Childhood Experiences (ACE) Study, initiated jointly by the Kaiser Permanente HMO in California and the Centers for Disease Control and Prevention in 1995–1997 and still continuing, demonstrates an astonishing correlation between childhood maltreatment and later-life medical illnesses and premature death.
The ACE study was based on detailed interviews with more than 17,000 Kaiser Permanente members about their childhood experiences of neglect, abuse, and family dysfunction. As the health profiles of these participants have been tracked through the years, about 70 scientific articles have been published linking childhood adversity to a host of mental and medical conditions, including among the latter autoimmune, heart, lung, and liver diseases, cancer, hepatitis or jaundice, diabetes, bone fractures, and sexually transmitted diseases.
The study came about almost by accident: it was the entirely unexpected consequence of a Kaiser Permanente weight-loss program that went strangely awry. During the mid-1980s, Vincent Felitti, founder of Kaiser Permanente's Department of Preventive Medicine, began directing a new obesity-treatment program, based on the technique of "absolute fasting"---no solid foods, only liquids supplemented by 420 calories daily derived from vitamins, essential amino and fatty acids, and electrolytes. At first, the program seemed to be a smashing success. People lost 50 pounds and up. The weight loss for some of these patients, many of whom were morbidly obese, was a staggering 300 pounds, which even exceeded what's ordinarily accomplished with bariatric surgery.
But within a year or two, Felitti reports, he and his colleagues began having "a very unusual problem." There was a high dropout rate, not among people who were eating in secret and failing to lose weight, but almost exclusively among those who were successful and losing a great deal of weight.
Jan, a young woman who entered the program in 1985 at 408 pounds, exemplifies what Felitti was encountering. Fifty-one weeks into the regime, she'd dropped down to a svelte 132 pounds. But a short time later, she suddenly began gaining again---37 pounds in three weeks, which Felitti would have thought physiologically impossible if it hadn't been documented. Asked what she thought had triggered this massive eat-a-thon, she replied that she had a history of sleep-walking and thought she was now "sleep-eating." She lived alone, and when she awoke in the morning, her kitchen was a mess of open food boxes, tins, and jars from her pantry, scattered among dirty pots, pans, and plates.
Slowly, Jan revealed the story behind the story: as a child she'd been severely molested for many years by her grandfather, and since then, her entire life had revolved around not allowing herself to ever be sexually vulnerable again. Even her job fit the bill. She worked as a nurse's aide in the night shift of a convalescent hospital---paid to stay awake, on her feet, and safe while her elderly charges were asleep in bed.
Then Jan disappeared. She returned 12 years later---once again weighing more than 400 pounds---and rejoined the weight-loss program. This time, her family had saved $20,000 for her bariatric surgery. She had the surgery, lost 96 pounds, and once again completely fell apart. She became intractably suicidal, was hospitalized five times in the next year, and given three courses of electroconvulsive therapy.
A year after this, Jan's weight had dropped to 250 pounds and she became calmer and more peaceful, but not because of any conscious attempt to lose weight: she'd developed primary pulmonary fibrosis, which causes severe weight loss, and was now dying. "At this point," says Felitti, "Jan felt more comfortable because she knew she wouldn't live much longer—she felt her life sentence was finally over." In a video made before her death, she explained what losing her protective fatty cushion had meant to her. "The weight was coming off faster than I could stand. My wall was crumbling."
As the program directors began a detailed exploration into the life histories of other patients whose very success seemed to undo them, some curious facts came to light. Virtually none of the patients were fat as children and, while most overweight people gain pounds slowly over the years, they'd gained their weight abruptly, usually in response to a difficult life event. But the shocking news was that the interviews revealed an unsettling pattern of childhood sexual abuse, trauma, family suicides, brutality, and other evidence of severely dysfunctional family relationships. In a study of 286 obese people in the program, for example, Felitti discovered that half had been sexually abused as children. For these people, overeating and obesity weren't the central problems, but attempted solutions. Food was an old, reliable friend that soothed and calmed them, while being fat protected them from a hostile world.
As a result of the ACE study, childhood adversity and its lifetime effects on health and well-being are often cited as America's most important public health issue.
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."This blog is excerpted from “As the Twig Is Bent." Want to read more articles like this? Subscribe to Psychotherapy Networker Today!