Addressing ACEs as a Social Transformation Initiative: An Invitation to Nova Scotia and Canada
Originally published March 14, 2018.
Revised and updated Feb. 14, 2019, July 5, 2019.
In 1998, the ACE Study was published, outlining extensive lifelong effects of Adverse Childhood Experiences.
I had been accessing mental health support for 12 years before I heard about this study. After reading Bessel van der Kolk’s book The Body Keeps the Score in 2014,[i] I started talking with other people about this research, trying to muster excitement and engagement with addressing this prevalent social issue.
The resistance I met was explained after watching Dr. Nadine Burke Harris’s Ted Talk explaining ACEs. She belied not being able to get people excited about addressing the issue as well, and concluded that it isn’t because it doesn’t apply to many of us. We’re resistant because it’s all too familiar. [ii]
The study was done in the US and the minimum effect of ACEs was identified to affect 64% of the primarily white, middle class respondents. [iii] Data on ACEs in Canada is scant,[iv] but an adapted study conducted in Alberta in 2015 found 56% of respondents reported at least one experience of abuse or household dysfunction, although physical and emotional neglect were not measured. [v]
When I talk about trauma in Nova Scotia, I get the response of nodding knowing heads, or redirected eye contact, bowed heads, and avoidance. The head nodders tell me they know all about trauma – that the ACE research has provided the basis for the increasingly popular trauma informed practice talked about among human services providers. The avoiders don’t want to talk about it – it’s too raw, too socially brash, too taboo - too personal. The mainstream health care and social services professionals don't want me talking about it because we don't have free services available for people to access if they realize they are affected. I say, they already know! They just don't know why and deserve to have access to this essential knowledge. I also believe if we inform the community, they will develop their own solutions.
When I hear the data and I observe the predominant nature of our society as well as recall my own upbringing and adult challenges, I am compelled to conclude that as long as we continue to avoid addressing the effects of ACEs in the adult population, we will never make the necessary changes we need to make in our society to reduce their incidence in our descendant children.
There is a strong movement in the US to address ACEs. Scotland has made phenomenal inroads across multiple sectors in less than 2 years. The movement has not yet gained traction in Canada. Although a webinar held in January 2019 cautioned about universal screening. Mostly the emphasis here has been to use the more subtle terminology of Trauma Informed and even that is severely limited.
Trauma Informed Practice is an essential lens for those of us working in the field, but in the general public, the terminology creates distance from the personal connection to the topic. Also the over use of the word trauma provides a false sense of awareness. I’ve heard people try to shut me up by saying, “Everyone has experienced trauma.” Another person optimistically informed me, “The greater the trauma the greater the opportunity for growth.” I have heard many people say in reference to daily experiences, “I’ve been traumatized.”
The significance of ACEs is trivialized by these perceptions of trauma. ACEs describe experiences of childhood that undermine the holistic healthy development of the human organism for the lifetime if intervention is not provided.
What I’m talking about here is how we as a society have raised our children throughout the generations. This continues to inform our worldview as affected adults influencing how we make decisions in our own lives and in the lives of all those we are associated with.
Until we are willing to acknowledge that we collectively have not fulfilled the needs of developing humans throughout our evolution, and therefore as adults we are not operating at our optimal capacity as human organisms, we will continue to perpetuate the social conditions that hinder optimal development, all the while pretending that we adults are unaffected and traumatic childhoods are normal.
Increasing emphasis in our health care and education fields is being placed on building resilience in children. There are also a handful of programs being introduced in schools to teach social and emotional literacy. Although all this is beneficial, we are still not addressing the causes of ACEs directly – the affected adults in society. Additionally, resilience training has its own underbelly – it can create the precedent for victim blaming if people are still affected by their experiences even though they’ve been trained not to be because the overwhelming causes persist.
As long as we continue to make decisions as adults that undermine the long term habitability of our environment, disadvantage others disproportionately to fill our own greed, discredit the legitimacy of others’ perspectives and needs because they seem different from our own, and fortify our perceptions of self-righteousness and superiority – perpetuate inaccessibility to SDOH - we’re never going to make the substantive changes necessary to build a just, equitable and healthy society.
So why do we make these self-destructive decisions?
The answer comes from trauma research.
Trauma impairs brain development as a result of overwhelming stress that is not recovered from.
In a society that has normalized war, poverty, oppression, misrepresentation of the facts and consequent betrayal, and pathological posturing and denial and rejection of reality as perpetual elements exhibited and educated into our young, it’s no wonder few of us see clearly our role as one species among many in ecology.
The human organism is not built to withstand such constant and repeated threats to its survival.
The quote is from Stephen Porges; the artwork is by Christine Cissy White; the photo is by Margaret Bellafiore. This artistic piece is from an interactive community exhibit at Mobius.
For generations we’ve exponentially piled on overwhelming experiences to the point where our current generation has the highest incidence ever recorded of anxiety, depression, obesity, suicidality, and bullying. [vi]
Advances in understanding pediatric mental illness are valuable. What concerns me is the fact that we are celebrating being able to diagnose mental illness in young people, but we’re not publicly talking about why our children are developing mental illness. In fact in January 2019 the lead child psychiatrist at the local children's hospital denied knowing why our children are developing mental illness. This is alarming and evidence of a continued denial of the extant research that explains cause as ACEs and Toxic Stress.
I think this is the real question of our time that we are still too politically challenged to address.
We’re not supposed to ask why our children are experiencing mental health crises because to answer that question we have to look at our adult selves, and we refuse to look at ourselves and the society we’ve brought our children into because we would have to admit that we are affected too and our society is a reflection of that.
In fact, lead trauma and ACEs researchers lobbied the American Psychiatric Association to include a diagnosis for developmental impairment as a result of childhood trauma and in spite of significant clinical research corroborating the legitimacy of such a diagnosis, in the 2013 DSV – 5 (Diagnostic and Statistical Manual of Mental Disorders) the psychiatric authority refused to endorse a diagnosis. The condition is too pervasive in society. To endorse a diagnosis would be to admit that what we have deemed normal in our society is actually illness. [vii] Dis-ease outside of our natural state.
Many professionals in the field talk about Complex Post Traumatic Stress Disorder and Developmental Trauma Disorder and serve their clients through the lens of these informal diagnoses. They operate from a trauma informed practice, acknowledging in their work, even though it’s not endorsed by their leadership, that childhood abuse, neglect, and household and systemic dysfunction adversely impact the optimal healthy development of human offspring.
The developing human organism has certain requirements for healthy optimal development.
Most of us have known forever that we weren’t getting our needs met. As children, our default setting is to think we’re the problem. To avoid being the problem forever we adopt facades of functionality and protect those vehemently throughout our adulthood to prevent the truth of our inadequacy from being revealed.
Some of us have been fortunate enough to land on our butts and be motivated to figure out the truth of ourselves. Many of us still diligently block out the early life subconscious messages that we don’t want to be true but that we can’t seem to shake and they’re too scary to face.
But we’re running out of runway. We’re destroying the habitability of the planet. We’re increasingly unable to convince others we’ve got everything under control. Our society is unsustainable. We don’t have enough money to provide for everyone what they’re calling for. We can’t afford to provide everyone with necessary health care. People are going hungry and without shelter while a few continue to siphon off wealth and resources and sock them away – isolated from collective access, for no measurable benefit. The 2019 Oxfam report reveals that 26 people possess the same wealth as the poorest half of the world's population.
It’s time for all adults, including those with wealth, power, and privilege, to face our fears, to proactively take charge of our situations, to face our demons, to heal our psyches, to own our own pain and stop passing it on to and causing it for others.
It’s time to build a society where everyone’s basic needs are met, starting with safety and security – food, shelter – where we and our children experience genuine belonging and our families get assistance when they need it to provide healthy psychological environments where we develop our autonomy and experience opportunity to achieve our potential.
If we address ACEs head on, identify them in our own pasts, recover proactively from them, offer compassion to each other in light of their likely existence, we can stop them from continuing to influence ourselves negatively. We can stop ourselves from passing them on to our children. We can adapt our social systems to eradicate them from our society.
Unresolved ACEs are serious risk factors for developing addiction, depression, suicidality, obesity, chronic heart, lung and liver disease. ACEs have also been identified as significant factors in violence, criminality and unstable economic conditions creating poverty and homelessness.
The negative effects of ACEs can be reduced throughout childhood by the presence of protective factors including a strong social context and support, secure attachment relationships, reliable sources of food, shelter and comfort, as well as opportunities to learn and contribute.
They can be reduced in adulthood by understanding the context, assigning accurate accountability, intentional processing emotionally, physically and cognitively, in order to fully integrate the hurtful childhood experiences into the shame free stories of our lives. And all of this must happen in a context of equitable access to service, support, and healthy relationships.
Avoidance of the pain and confusion we experience is our default approach as children in order to enable us to survive with those we rely on who are the causes of our pain. As adults, avoidance becomes a dysfunctional coping strategy, because by adulthood we have developed enough intellectually to now be able to understand our situations and access resources for ourselves.
Unfortunately as a society we have belittled the value of mental health support for many generations. Although we talk about mental health more frequently in our society, it is still stigmatized.
I still hear comments such as “Get over it. The past is in the past – leave it there. Stop whining. You’re an adult now. You have choice. Choose your destiny. Don’t be such a negative Nelly. Stop being a Debbie Downer. I got over it. Look at me. I’m living in a million dollar house. I don’t have any issues, except that I can’t seem to help my son get over his addiction.”
On Twitter in Feb. 2018 I saw a post where someone was suggesting that rather than studying people who don’t do well in adulthood we should study the people who do manage to be successful in spite of their early beginnings. Of course many of the commenters agreed and made claims of being unaffected. But the question arises in me: How do we define success?
If we define success by creating social systems that create and serve only cream at the top and subjugate and starve the masses beneath, then I think that proves my point. The accumulation of wealth and resources for no substantive benefit to oneself while causing existential threat to all others does not sound like a healthy consciousness to me. People who hoard do so to fill perceived needs that they fear were not or will not be met. They avoid the origins of their fear of not having enough by over accumulating at the expense of others. As a society we have normalized this behavior economically.
Justin Trudeau, Prime Minister of Canada, in a town hall meeting in Hamilton in early 2018 said we have to find the balance between protecting the environment and having a healthy economy. We could do this much easier if we didn’t enable wealth hoarding and in fact encouraged addressing underlying misperceptions of our identity, worth and true value in the world by addressing the pervasive effects of intergenerational adverse child rearing.
We’re at a crisis in our society and evolution. We are running out of runway. We are not addressing the root causes of the dysfunction in our society. We are perpetuating them and allowing ourselves to dig ourselves deeper into self-destruction.
As children, denial is an effective coping mechanism. As adults utilizing denial forever has created the conditions where the long term existence of our species is questionable.
I could conclude that humans are simply stupid. I prefer to conclude that humans haven’t known better, and now that we do, we will change our priorities and start dealing with our issues and stop enabling disconnection from ourselves, others, and nature.
Children are naturally resilient, because they find a way to survive.
We shouldn’t perpetuate a society where as adults we must also simply find a way to survive, instead of taking full command of our circumstances and creating conditions where we can all thrive – nature and humans in harmony.
That’s my vision. That’s my hope. It's time for adult children to fully recover from the lies they were programmed to believe about themselves and others when they were developing, and to adjust the norms in our society to ensure the healthy development of our descendants and the recovery of the adult affected. It's time for the adults with power to look in the mirror and do the right thing.
I’ve been working to inspire this vision all my life. Adults must take responsibility for being healthy themselves so they don’t pass that on to their children and others. As a society we must prioritize this to stop our devolution to self-destruction.
[i] van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. New York: Viking.
[iii] Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults Felitti, Vincent J et al. American Journal of Preventive Medicine , Volume 14 , Issue 4 , 245 - 258
[vii] van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. New York: Viking.
Elizabeth Perry is an educator who is passionate about being a responsible cosmic citizen. She has an academic background in child and human development, early childhood and adult education, and linguistics. She is a survivor of ACEs, ACoA, and adult spiritual abuse. She is a mental health and self-help advocate.