While reading the responses to a recent blog post (Screening for ACES), an uneasy feeling started to creep up from deep within me. I had sensed a similar reaction in me brewing up in other posts, and it is only by accident that this one served to begin to translate the uncomfortable sensations into some semblance of conscious thought and even words strung together.
I will see if I can articulate these here in some half-cogent way and hope that in combination with any comments that come in response, will discover whether my uneasiness has any merit or is simply another consequence of my high ACES score.
The source of my unease is this: Here on ACES Connection, there are many excellent discussions regarding ‘trauma’ and the relevant merits, efficacies of responses to it, such as EMDR, and other clinical practices. The following question, "It is safe to assume those with high Ace Scores were also traumatized as children. Yes?," posed in one of the responses to the "Screening for ACES..." blog post, seemed to infer that experiencing ACE’s, did not necessarily meet the criteria for being ‘traumatized.’ This triggered in me the response that follows, presented here as a new blog post:
Yes. I think that ACES are entirely focused on identifying, and measuring the cumulative impact of, trauma experienced by children, so it is not an assumption but an assertion. I believe it should not even be a consideration whether or not the ACE's individually or collectively meet the clinical definition of 'trauma' in the DSM-IV, -V, or even -XIV, I will even throw out the probably provocative statement that it may be ill-advised to do so.
Establishing rigid definitions or boundaries around the infinitely diverse nuances of human experience, behavior, responses, etc., may, on the one hand, serve the purpose of helping practitioners to identify the potential issue[s] that the person in front of them presents with, and therefore, help narrow the choices of tools/interventions to bring to bear in order to support that person's passage towards health [a good purpose]. On the other hand, it makes it easier to fulfill the mandates of managed care and define what's covered by insurance, for how long, and for what rate [bad purpose].
The danger also exists that some of these clinicians, armed with their "DSM"-approved diagnoses of trauma will succumb to the inclination of viewing the folks that come before them through a rigid lens, and with an 'expert's mind.'
Now before I get batches of hate mail from Therapist United Against Non-Believers International (TUANBI) or some such, let me offer in my defense that I'm pretty sure that most of the clinicians that have come here to this ACES Connection community are skilled at making astute and nuanced clinical observations and treatment choices and are aware that 'one size [or treatment modality] does not fit all,' and in general, approach their work with the 'beginner's mind.' But, there are a lot of practicing professionals out there in the world that are not as skilled or nuanced as the best of the lot, and they took the same classes, at the same august institutions, carry the same letters after their names and on their shingles, have the same number of years of practice in the field and/or logged research hours or even number of published papers, and who are simply, to the unpracticed patient's eye, indistinguishable from the best the field has to offer.
This latter group of clinicians might lazily open their treatment manuals and cut and paste the predetermined treatment decisions backed by research, or else be totally sold on EMDR or yoga or brain surgery or [fill in the blank] as THE answer, and otherwise be a complete disaster for the individual person who stands before them with all the varied individual influences and individual patterns and all the other individual yadda yadda’s ...that the general populace walk around with. All because an army of graduate student researchers cloistered in the windowless basement of a university research department somewhere at the behest of their oft-published professorial master have determined that 78.5% of females of Hungarian descent who carry an ACE score of 7 respond to the strict application of this EMDR protocol [see Appendix H] at a 94% improvement on the MENSA scale [see Figure 36.b].
Who would you like to be the first Hungarian female to walk into that therapy room?
I think that one of the beautiful things about the ACES work and maybe part of its power is that it combines acute observational science with an allowance for the nuances that make up the human condition. It began, after all, with Dr. Felitti’s initial conversations with a few individuals challenged by obesity and latter progressed to in-depth pscho-social interviews with patients in the medical setting.
One’s ACE score is not dependent on the dosage factor of any individual ACE. It makes no distinction between being physically abused and having a depressed caregiver. It does not make a value judgment between losing a parent tragically in a car accident or via an amiable divorce. It doesn't care if the person was sexually abused once in their childhood or twice every week over a seven-year period. Each one of these experiences adds up to the single and simple “Prime” number 1. There is something elegantly pure about that. Full stop.
I draw this parallel to one of the basic concepts of mathematics purposefully. From a recent (2/2/15) New Yorker profile of Yitang Zhang, a solitary, part-time calculus teacher at the University of New Hampshire who received a MacArthur award in September, for solving a problem that had been open for more than a hundred and fifty years, I quote:
“…The problem that Zhang chose, in 2010, is from number theory, a branch of pure mathematics. Pure mathematics, as opposed to applied mathematics, is done with no practical purposes in mind. It is as close to art and philosophy as it is to engineering....The British mathematician G. H. Hardy wrote in 1940 that mathematics is, of 'all the arts and sciences, the most austere and the most remote.' ....Hardy believed emphatically in the precise aesthetics of math. A mathematical proof, such as Zhang produced, 'should resemble a simple and clear-cut constellation,' he wrote, 'not a scattered cluster in the Milky Way.' Edward Frenkel, a math professor at the University of California, Berkeley, says Zhang’s proof has 'a renaissance beauty,' meaning that though it is deeply complex, its outlines are easily apprehended. The pursuit of beauty in pure mathematics is a tenet. Last year, neuroscientists in Great Britain discovered that the same part of the brain that is activated by art and music was activated in the brains of mathematicians when they looked at math they regarded as beautiful'….” [See: http://www.newyorker.com/magaz...02/02/pursuit-beauty ]
I believe that Dr. Felitti’s ACES work, like “…Zhang’s proof has a ‘renaissance beauty,’ meaning that though it is deeply complex, its outlines are easily apprehended….”
Perhaps the creeping little fear I referenced at the beginning of this post is that in growing the ‘applied’ science of ACES too quickly, too ardently, we may lose what can be gained and learned from the ‘pure’ science of ACES…the conversations, the shared stories, that connect the person with an ACE Score of 1 to the person with a score of 7. There is ‘beauty’ therein not unlike that found in pure mathematics.
The power from ACES comes from the fact that it makes such a critical, life changing, society changing, economy-affecting issue accessible to the man on the street and any person that walks into that (hopefully informed) general health practitioner's and (hopefully competent) clinician's office. And that simple one-on-one conversation, scientifically informed, would start a shared journey of inquiry on the quest for the ACES survivor’s health and happiness.
Now that would be beautiful.
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