Lumpers and Splitters: Who doesn’t believe in ACEs?

Aforest

Here’s the problem. Since you are reading this on ACEsTooHigh, you are likely not the type of person who questions ACEs — the adverse childhood experiences research that shows how childhood trauma is linked to the adult onset of chronic disease, mental illness, violence and being a victim of violence, among other consequences. Like me, when you first heard about ACEs, you shouted “Eureka!” or felt the heavens open up or maybe simply thought “Well, that makes sense.” Writing this, I’m preaching to the choir.  After all, there is so much scientific evidence to support ACEs, doesn’t everyone believe it?

Well, working in public health communications, I have learned that science only goes so far. There are people who question the science of vaccinations, or fluoridation, climate change, evolution, the disease model of addiction and/or social determinants of health. So why not those who question the science of adverse childhood experiences?

Of course, few people will come right out and say they do not believe the science. “But what about personal choice or responsibility?” or “I faced lots of problems in childhood and I didn’t need any help” are the type of arguments we are more likely to hear.

These are the folks who often believe that individuals simply need to “make better choices” or should try harder to “pull themselves up by their bootstraps.” They might be the parents of the child we are trying to help or the program director we are trying to persuade. They might be the elected official who is opposed to trauma-informed legislation. They are not people we can write off or ignore.

Linguist George Lakoff explains these different ways of thinking in terms of the different metaphors people use to frame the world: There is the “strict father” types on the conservative side and the “nurturing parent” types on the more liberal end.

While accurate, these terms may tend to polarize an already politically sensitive populace. A different explanatory model that comes to my mind comes from my high school biology teacher, who divided the world into “Lumpers” and “Splitters.”

If given two things, do you tend to see their commonalities (a Lumper) or are the differences (a Splitter) what stand out for you? For my biology teacher, “Splitters” tended to see new species everywhere, while “Lumpers” tended to create super species groups. But in a broader sense, “Lumpers” looked for large patterns, while “Splitters” saw most things as sui generis (in a class by itself). Some of us see the forest, while others see the trees.

Now if you think about it, ACEs science plays solidly to the “Lumper” mentality. Childhood trauma somehow correlated with chronic illness decades later? Check. Divorce, bullying and sexual abuse (three admittedly very different types of problems) similar in terms of their long-term outcomes? Check. Addiction, illness and poverty the direct result of personal character flaws? Not so much.

But while I am a “Lumper” on the concept of ACEs, I become a “Splitter” when it comes to services and treatment. There, I become a “rugged individualist” with a deep and abiding suspicion of “one size fits all” treatment plans. I value personal narrative. I want to root for the hero, precisely because they face great challenges. And here is where I see hope for bringing the two approaches together.

Government agencies typically concentrate on non-narrative communications, that is, arguments focusing on logic, science and research and avoiding the personal story. This is a mistake on many levels. First, facts in the abstract tend to be hard to grasp. Few of us truly know what a billion dollars or fifty parts per milliliter represents. You need a human-sized context. We severely limit our ability to persuade all groups when we leave out the personal story. Second, we have found that some people simply choose to ignore the facts that don’t fit their worldview.

For example, the more we cite research about vaccine safety, the more entrenched many anti-vaccinators become. Adding a personal experience of a parent whose child has a compromised immune system or whose child died from a preventable disease supports our vaccine argument in different ways. It focuses on the consequences of our choices and actions. It helps break down the fear of imagined “big government” action into reasonable personal steps. We need to communicate in a way that reaches all people, including those with a different mental framework, or motivated by different things.

In one of her poems, Muriel Rukeyser wrote: “The universe is made of stories, not of atoms.” The physical universe may be explained through physics, but we understand our social universe through the impact on people. Adding a personal narrative allows us to appeal to people on multiple levels. It gives us a chance to show how the desire to take personal responsibility can be frustrated by the lack of reasonable access and opportunity. You can emphasize the disparities faced by a particular group, while sharing common outrage over an unfair system. It allows us to offer a view of the universe we can all understand.

We need to explain ACEs to a larger audience, and to more than just the “Lumpers” who would have gotten it anyway. Narrative alone is not the answer, but it costs us nothing to try. We know the choir will like it and it might help to expand the congregation.

For a more detailed discussion about framing and writing to appeal to diverse audiences, I recommend the Robert Wood Johnson report, “A New Way to Talk About THE SOCIAL DETERMINANTS OF HEALTH.

Alan Nishikawa is a public health analyst in the Sonoma County, CA, Department of Public Health.

2 responses

  1. Pingback: Lumpers and Splitters: Who doesn’t believe in ACEs? • SJS

  2. I think the first step in this direction would be to define for the public what trauma really is, for instance, the way Robert Scaer describes it in The Trauma Spectrum. One does not have to have a high ACE score to be riddled with the effects of trauma. We need to make this concept relevant to all, not just a few “unfortunates”, who, for the most part, no one is really interested in helping.

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