12. Are the wounds of the child the seeds of the monster?
Exactly 40 years ago, one of the great advances in understanding our health happened when a doctor screwed up. Dr. Felitti was running an obesity clinic in San Diego for a large health maintenance organization (HMO) and he was very frustrated.[i] Morbidly obese people would participate in his clinic, and they would lose weight. They had great success, the scales showing that they dropped 100 pounds or more. But abruptly, half of the people would drop out of the program. They vanished. This was puzzling, why on earth would people leave when they were doing so well? Wouldn't they want to keep on losing weight and being healthier? Were they not getting enough positive feedback? Dr. Felitti dug deeper and was interviewing a woman to better understand her history. He asked how much she weighed at birth, how much she weighed in first grade, and at graduation. Then, he fumbled. He messed up. He asked “How much did you weigh when you first became sexually active?” She blurted out “Forty pounds.” Confused, he repeated the question, and she burst into tears, and said “Forty pounds. I was 4 years old when my father raped me.”
This stunned Dr. Felitti. He had been taught that incest was extremely rare and had only one other case in 23 years of practice. The Comprehensive Textbook of Psychiatry at the time asserted that incest happened to one girl in a million[ii] and that they often initiated it, and “the girls do not act as though they were injured.” [iii]
Dr. Felitti was different, though. He did not believe that people were not injured by childhood sexual abuse. He had seen the tears surge up when the stories came out. He and his colleagues started interviewing the other people in the clinic who were 300 pounds or more, and found that the majority of them had been sexually abused. In 1985, that was a shocking finding, as it completely contradicted the dominant belief.
The 10 Adverse Childhood Experiences
Old beliefs die hard, and other doctors poked holes in Dr. Felitti's finding that sexual abuse was strongly associated with morbid obesity. The sample size was small, and the group was very selective, as it was an obesity clinic. It also was just one study, and could be a fluke. He needed to study a huge group of people who were more representative of the general population. So, he teamed up with Dr. Anda of the Centers of Disease Control, and asked over 17,000 members of the Kaiser Permamente Health Maintenance Organization about 10 types of trauma in their childhood. They asked people if they had been abused physically, sexually, or emotionally before the age of 18. Or if they had been neglected physically or emotionally. They also asked about 5 types of dysfunction in the household, whether they had a parent with a serious mental disorder, a substance abuse problem, whether there was violence between the parents, if they were separated from a parent before age 18, or if someone in the household had gone to jail. They labeled these 10 events as Adverse Childhood Experiences or ACE’s.
Initially, Drs. Felitti and Anda did not expect much. 3/4 of the sample had been to college, and they had good jobs, and good healthcare. They also lived in San Diego, which is one of the most beautiful and affluent cities in the US. These people had it good. They were living the American dream, and expensive cars crawled through the streets of their city. But reality shattered this image, like a nail through a TV screen. When the results came back, Dr. Anda logged into his computer and was so shocked that he cried. There was much more pain than he thought. Two-thirds of the sample had experienced some form of abuse or parental dysfunction.
Two-thirds. Consider that number for a moment. The majority of people have experienced one or more very painful events or relationships before age 18. It is guaranteed that you, or your spouse, or best friend have either been abused, neglected, or had a parent with serious problems. The pain is even more widespread than that. The ACE scores asked about 10 adverse experiences, but did not ask about others. Being bullied by other kids, or feeling consistently lonely or rejected by your peers has a major impact as well.[iv] So does growing up in a neighborhood with a lot of violence, or being very poor. Adding everything up, the number of people who had an emotionally healthy childhood are in the minority. They are the aberration, they are the unusual ones. The norm is to carry around a lot of pain from growing up. It is very likely that you do. I have an ACE.
And it is not just emotional wounds from one event. The data from Dr. Felitti's sample showed that many people had multiple adverse experiences as a kid. The dysfunction in the family showed up several ways at once. If Dad was an alcoholic, then Mom was severely depressed. In other homes, kids were emotionally abused by Mom and Dad was out of the picture. These kids were starving for attention. They were noticed by a Boy Scout leader, who treated them well to gain their trust. Once the leader had enough influence over them, they used it to sexually abuse the child and keep them silent.
Emotional wounds as seeds of cancer
Since Dr. Felitti worked for a HMO, he and Dr. Anda gathered so much data from the surveys, medical charts, and 15 years of follow up that they published over 60 papers. They appeared in top journals, such as the Journal of the American Medical Association. One finding emerged over and over. The more ACE’s a person had, the higher their risk of having a deadly disease. For example, people who had 4 or more ACE's were 220% more likely to develop heart disease as those with none.[v] This is a massive impact. Researchers at Harvard analyzed all the genetic factors for heart disease and found that those with the highest risk were 65% more likely to develop this dread condition than those with the lowest genetic risk. [vi] Here, psychological injuries are more powerful than genetics. They are so influential that seven of the 10 leading causes of death (stroke, emphysema diabetes, etc) are strongly influenced by how many ACE’s a person has experienced. I did a TEDx talk on this subject, which you can watch here.
The science of human health was flipped over by this finding. No one suspected that being emotionally neglected or physically abused in childhood had a major impact on physical health later in life. Furthermore, no one dreamed that the influence of psychological injuries in childhood was more powerful than that of genes. Yet, the data rolled in. People with 4 or more emotional wounds were 190%[vii] to 230%[viii] more likely to develop cancer than those with none. It is estimated that 10 to 11% of cancers in Europe and North America are directly due to ACE's, with a cost of over 210 bn dollars to these regions.[ix] This is substantially more than the number of hereditary cancers.[x] Once again, neglect and abuse in childhood are more powerful in determining your risk of cancer than the genetic material you inherit from your parents.
Although you now understand more about the origins of cancer, you may fear more. The fact that your Mom was an alcoholic who ignored you, or you suffered evil from the hands of a swimming coach, are events in the past. You cannot reverse them. Are they now your doom? Stay tuned for the next several posts by subscribing. We will unpack the pathways by which they increase or decrease your risk of cancer. We will look at how these Adverse Childhood Experiences can be healed. You will understand the changes you can make, to rewrite the story of your past and greatly improve your health. Leave comments below or share this information with someone else who might be interested.
[i] https://acestoohigh.com/2012/10/03/the-adverse-childhood-experiences-study-the-largest-most-important-public-health-study-you-never-heard-of-began-in-an-obesity-clinic/
[ii] Quoted in Kolk MD, Bessel van der. The Body Keeps the Score (p. 20). Penguin Publishing Group. Kindle Edition.
[iii] Olafson E, Corwin DL, Summit RC. (1993) Modern history of child sexual abuse awareness: Cycles of discovery and suppression. Child Abuse Negl. Jan-Feb;17(1): 7-24. doi: 10.1016/0145-2134(93)90004-o.
[iv] Finkelhor D, Shattuck A, Turner H, Hamby S. (2015). A revised inventory of Adverse Childhood Experiences. Child Abuse Negl. Oct; 48:13-21.
[v] Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS. (1998) Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med. May;14(4): 245-58.
[vi] https://www.health.harvard.edu/heart-health/the-genetics-of-heart-disease-an-update
[vii] Felitti, Anda et al. (1998).
[viii] Hughes K, Bellis MA, Hardcastle KA, Sethi D, Butchart A, Mikton C, Jones L, Dunne MP. (2017) The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. Lancet Public Health. Aug;2(8):e356-e366.
[ix] Bellis MA, Hughes K, Ford K, Ramos Rodriguez G, Sethi D, Passmore J. (2019) Life course health consequences and associated annual costs of adverse childhood experiences across Europe and North America: a systematic review and meta-analysis. Lancet Public Health. Oct;4(10): e517-e528.
[x] Soto, A.M., Sonnenschein, C., (2011). The tissue organization field theory of cancer: A testable replacement for the somatic mutation theory. Bioessays 33, 332e340.