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But many of us do recognize that when someone experiences childhood trauma, there may be an emotional and psychological impact.
stories about people who have experienced early hardships and have either overcome or, better yet, been made stronger by them. These tales are embedded in Americans’ cultural DNA. At best, they paint an incomplete picture of what childhood adversity means
Twenty years of medical research has shown that childhood adversity literally gets under our skin, changing people in ways that can endure in their bodies for decades. It can tip a child’s developmental trajectory and affect physiology. It can trigger chronic inflammation and hormonal changes that can last a lifetime. It can alter the way DNA is read and how cells replicate, and it can dramatically increase the risk for heart disease, stroke, cancer, diabetes—even Alzheimer’s.
Despite rough childhoods, plenty of folks got good grades and went to college and had families. They did what they were supposed to do. They overcame adversity and went on to build successful lives—and then they got sick. They had strokes. Or got lung cancer, or developed heart disease, or sank into depression.
They certainly didn’t connect them to the past, because they’d left the past behind. Right?
will learn the tools for healing that begins with one person or one community but has the power to transform the health of nations.
My newest patient was at the 50th percentile for height for a four-year-old. Which would have been fine, except that Diego was seven years old.
She spent the next ten minutes telling me about an incident of sexual abuse that had happened to Diego when he was four years old.
was a family friend, someone her husband knew from his work in construction.
Diego started having trouble in preschool, and as he moved up, he lagged further and further behind academically.
Rosa’s husband blamed himself and seemed angry all the time.
She recognized the tension and drinking weren’t good for the family but didn’t know w...
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strongly suspected she was suffering fr...
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As with Diego’s, most of my patients’ ADHD symptoms didn’t just come out of the blue.
highest rates in patients who were struggling with some type of life disruption or trauma,
What if the cause of these symptoms—the
the poor impulse control, inability to focus, difficulty sitting
Despite the checked boxes, despite the great care, and despite more health-care access than the community had seen in a generation—the needle in Bayview only bounced.
The trauma had happened at age four and he had gained very little vertical height since then.
But by all accounts, Diego wasn’t malnourished and didn’t have any evidence of a hormonal disorder. There didn’t seem to be a readily available medical explanation for Diego’s stature.
One immediate problem with getting to the bottom of this larger connection between adversity and ill health was that at times, there was an overwhelming number of factors to consider—my patients’ different upbringings, their genetic histories, their environmental exposures, and, of course, their individual traumas.
examining newborns.
These babies came into the world no different than the ones born in Laurel Heights,
yet as I did newborn exams in Bayview, I knew that these human beings’ lives would, according to the statistics, be twelve years shorter than the lives of the children in Laurel Heights.
At the beginning, they are equal, these beautiful bundles of potential, and knowing that they won’t always be is enough to break your heart.
Everything I’d learned in my training told me that adversity was a social determinant of poor health outcomes, but what was never examined was how it affected physiology or biological mechanisms.
there is a molecular mechanism behind every natural phenomenon—you just have to look for it.
hormonal imbalance can have direct and indirect effects. For instance, an increase in corticosteroids can directly affect blood pressure, but it can also indirectly affect growth and development by altering how other hormones do their jobs. How hormones affect one another and, as a result, the human body can be complicated, but it’s hugely important.
When times were tough, the body would detect a lack of nutrients and begin the chain reaction that is the stress response.
One of the biggest parts of this process is the increased production of cortisol, and a major effect of cortisol is an increase in blood sugar.
In the case of the hunter, the process was adaptive (good for survival) because it happened in adulthood; in the case of the tadpole, the process was maladaptive (bad for survival) because it happened in childhood (or tadpole-hood), too early in development.
six-year-old girl who woke up one morning paralyzed from the waist down.
ADEM, acute disseminated encephalomyelitis. ADEM is a rare autoimmune disease in which the body’s immune system attacks myelin, the insulating sheaths that surround nerve fibers and allow nerve impulses to travel quickly through the body.
The treatment for ADEM is high doses of the steroid prednisone, which is essentially a syn...
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Medical protocols are put in place when the side effects of a certain medication are so predictable that it’s worth setting up a system for addressing them.
When hypothyroidism occurs in infancy, though, it’s a whole different ball game. The condition, once cruelly called cretinism, can result in significantly impaired physical and mental growth.
great example of just how critical timing is: a lack of thyroid hormone in the body has wildly different effects depending on when it happens. In adulthood, it’s minor and treatable. In childhood, it’s profound.
Wait a minute, forty pounds?
“It was when I was four years old, with my father,” she said.
But the strange part was that the dropout rate was highest among the most successful patients—the
There didn’t seem to be any physical signs of a metabolic problem.
“I think I’m sleep-eating,” she said sheepishly.
“When I was a kid, I used to be a sleepwalker. I haven’t done that for years, but I live alone and when I go to bed at night everything is clean and put away in the kitchen. Now, when I wake up in the morning, the pots and dishes are dirty, the boxes and cans are open. Somebody has obviously been cooking and eating, but I can’t remember any of it. Since I’m the only person there and I’m putting on weight, I guess it’s the only explanation.”
There was usually a trigger event.
“Well, I don’t know if it’s related, but there’s this man at work,” she said, looking down again.
new patient who kept hitting on her.
Patty had a lengthy history of incest at the hands of her grandfather, starting when she was ten years old. This was also when she had begun to struggle with her weight.
he couldn’t ignore the similarities between her and Donna.
Both patients had begun to gain weight as children immediately subsequent...
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Felitti wondered if she might be subconsciously protecting herself from what must have seemed like a recurring trauma by gaining weight.
