Fifteen years ago, a groundbreaking study was published in the American Journal of Preventive Medicine that had (and still has) the potential to revolutionize the practice of medicine. Yet, practitioners and hospitals all over the world largely ignored it and went on the way they always had: dividing our emotional experiences from our physical health. The conventional medical approach segments body parts by specialty in the first place, so how could we make room for the idea that our life stories, specifically what may have happened to us as children, could make us sick or keep us well?
The 1998 study known as the ACE (Adverse Childhood Experiences) study clearly shows with a gigantic amount of evidence that our life stories matter a great deal to our health. Funded by the Centers for Disease Control and Prevention and Kaiser Permanente in San Diego, the ACE study is one of largest studies ever completed to investigate the effects of emotional and physical trauma in childhood on our physical (and psychological) health later in life. With over 17,000 individuals participating, the research is more than clear that childhood abuse and family dysfunction can influence our chances of developing heart disease, cancer, diabetes, obesity, depression and more.
ACE In Practice
I recently listened to an interview with the doctor who lead the ACE study, Dr. Vincent Felitti. He is still publishing articles related to the ACE study and putting what he learned into action with absolutely amazing results. He found that simply acknowledging the past trauma, and asking about and listening to a patient's story, had profound implications on their health and need for medical treatment.
Just by asking the question, "Can you tell me how this adverse childhood experience has affected you later in your life?" and letting the patient talk about it, Felitti saw a 35 percent reduction in doctor visits and an 11 percent reduction in emergency room visits among participants during the year following his interaction with them. Even more astounding, when he had a staff psychiatrist conduct hour-long therapy sessions, doctor visits went down by 51 percent. I firmly believe that if a medication were producing these kinds of positive results, the drug would be mandated.
The Physiology Of Trauma
How is it medically possible that an emotional or physical trauma can affect the body years later? Felitti explains that chronic, unrelieved stress has enormous affects on the body and brain. Hyperstimulation of a network known as the HPA (Hypothalamus-Pituitary-Adrenal) axis has profound effects on the rest of the body, particularly the immune and endocrine (hormonal) systems. Emotional stress generally begins in the brain, stimulating the hypothalamus and pituitary gland, then affecting the glands that manage stress, the adrenals. Adrenal hormone imbalance can have all kinds of health implications, which I write about in my book Is It Me Or My Adrenal Glands? and in the adrenal section of Women to Women's website.
Dr. Felitti also mentions epigenetics as a factor in how childhood trauma can influence the adult body. If you've read my blogs before, epigenetics may sound familiar. This fairly new genetic concept explains that our genes are controlled by an "on-off" switch that can be influenced by our environment, meaning that just because we have a gene for cancer doesn't mean it will get turned on, per se. The choices we make and the way we live -- diet, chemical exposure, hormonal balance, emotional health, and more -- can affect this switch. This is the good news to me: We have more control than we think.
Resistance To Putting ACE Into Practice
In the 15 years since its publication, the ACE study has received recognition all over the world, yet very few practitioners are putting its lessons into practice. Why is this? Dr. Felitti believes that, despite the numbers, many practitioners find it hard to get over the hump that psychology is connected to physiology.
He admitted that even he would have been resistant to this subject when he went into medicine. He explained:
When I was first in practice, I wouldn't have wanted to go near any of this with a pole because I would have felt incompetent. What am I going to do? There's no prescription for this, there's no operation, there's no injection for this, etc. And it took so long to realize that one didn't always need to do something. Indeed that asking and listening ... was itself a very powerful form of doing.
The bottom line is that our life stories have deep connections to our physical health. I've seen this in my practice for years, and it's been validated by Dr. Felitti's careful research. We have a great responsibility as practitioners to talk about what's lying below the surface of disease. Not all practitioners can ask these difficult questions, nor do they have, or take, the time to listen to the answers. But we know definitively that acknowledging the past -- even if there is no concrete solution to a problem we find there -- can have profound effects on our health. If your practitioner won't ask or listen, find someone who will -- a friend, a family member, a therapist, or another practitioner. Just by telling your story (or even writing it), you begin to release its negative effects on your body.
References:
1. Centers for Disease Control and Prevention. 2013. Adverse Childhood Experiences (ACE) Study. URL: http://www.cdc.gov/ace/.
2. Felitti, VJ, et al. 1998. Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults. American Journal of Preventive Medicine, 14(4), 245-258. URL: http://www.ajpm-online.net/article/PIIS0749379798000178/abstract.
3. Safe Space Radio. 2013. Child Abuse and Physical Health 25 Years Later. URL: http://safespaceradio.com/2013/04/child-abuse-and-physical-health-25-years-later/
For more by Marcelle Pick, OB-GYN, NP, click here.
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