Because 18-year-old Payton Gendron provided in his 180-page diatribe a motive for shooting 10 people in Buffalo, NY, on Saturday night, police didn’t need to search for one, as they often have other in mass shootings. But using motive to prevent mass shootings will just get you a useless answer to the wrong question.
The right question is: What happened to this person? What happened to a beautiful baby boy to turn him into an 18-year-old killer spouting racist screed?
In those questions—and looking at the answers through the lens of positive and adverse childhood experiences—lie our solutions.
The ACE Study showed a remarkable link between 10 types of childhood trauma and being violent or a victim of violence, as well as experiencing the adult onset of chronic disease and mental illness. The ten types of childhood trauma include experiencing physical and emotional abuse, neglect, living with a family member who is addicted to alcohol or who is mentally ill, and witnessing domestic violence. (For more information, see PACEs Science 101 and What ACEs/PCEs Do You Have?) Subsequent ACE surveys include experiencing bullying, racism, the foster care system, living in a dangerous community, losing a family member to deportation and being a war refugee, among other traumatic experiences.
The point is — and the science is irrefutable now — just as a bullet rips through flesh and bone, a child experiencing ongoing encounters that cause toxic stress, without positive intervention to help the child, will suffer damage to the structure and function of their brain.
TRIGGER ALERT – CONTENT REFERENCING SEXUAL ASSAULT, CHILD SEX TRAFFICKING, PHYSICAL AND EMOTIONAL ABUSE.
April is Sexual Assault Awareness Month. I don’t think it matters which month it is—when you feel called to share a portion of your story the calendar is irrelevant. In my case, the calendar serendipitously lined up with a surgery that occurred the same month. I had a full hysterectomy because of a large fibroid tumor in the wall of my uterus and multiple tumors in and on my ovaries. The tumors were located after an MRI and then a follow up CT because I was experiencing severe abdominal pain. Doctors could not verify that the pain was due to the tumors, but the tumors needed to come out regardless. My mom had passed away at age 60 from ovarian cancer. Her cancer wasn’t diagnosed until it was stage 4. Three months after her diagnosis, she passed away. I was managing a lot of emotions going into surgery.
Prior to my surgery, I had a few panic attacks about how this surgery was a culmination of the complete lack of power I’ve had over my body, most specifically, the parts of my body that men want to possess, use for their pleasure, or even damage—out of some warped psychological issue they might have.
I’m sharing this most recent turn of events in my journey to process it, or possibly reprocess it. I’ve shared parts before, and I imagine, at different times, I’ve needed to process different parts of my trauma history. I don’t know what will come of this latest information purge, but I feel deeply compelled to do it. I feel like having had this hysterectomy has been the ultimate surrender of my body for others to do as they see fit. And it’s not that I disagree with the path, but I wonder if I’d be in this situation if I could have had a safe, healthy, loving relationship with my body. I’ll never know. Instead, this surgery went wrong, and the surgeon accidentally punctured my colon. This had to be repaired in the middle of the hysterectomy. It meant I dId not have a laparoscopic surgery, that I was under anesthesia for over 5 hours, and my recovery time will be longer.
What I’m finding is that the abdominal pain, the pressure from the staples, the surprise pain when a staple breaks free from the skin it had adhered to, the physical healing, all of this is causing childhood memories to come pouring back. I’ve started waking up screaming at predators to “get out.” I’m crying in my sleep again. Earlier today, I dozed off and thought I was having a conversation with someone about the pedophile ring and how to escape, but as I started to wake up I realized that I was in my room alone with the TV on. I could have sworn the conversation was real.
At 5 years old, possibly 6, on my way to St. Helena’s Catholic School in South Minneapolis, I was wearing a green/navy plaid skirt and white button up top; my hair in long dark pony tails, and white knee high nylon socks with black patent shoes. A man came out of the parking lot, just past the corner on 34th Ave S. and 46th St. Most of the block was residential, but on that corner, there was a bar, with the word Sun in the name. I don’t recall the rest of the name. The guy asked me if I had lost my dog. He told me he had found it and he was keeping it safe on the broken down bus in the corner of the parking lot. I didn’t think my dog was lost, but I did have three dogs. So, I thought I’d better check. He also said he knew my dad and he knew the name of one of my dogs. I wasn’t supposed to talk to strangers, but it was pretty normal for me to talk to my dad’s friends.
[Ed. note: This is a continuing series of articles about people who are involved and contributing in the movement to implement practices and policies based on the science of positive and adverse childhood experiences.]
Growing up as the eldest daughter in a family of three girls and three boys in Nairobi, Kenya, Becky Ndung’u and all her siblings attended school, which is mandatory for children ages six through 14. Her parents—both farmers and her father also a lifelong government accountant—were committed to providing all their children a good education.
Her education began in a public school, followed by a private high school. Our conversation was conducted in English, but Ndung’u is also fluent in her native languages, Kikuyu and Kiswahili.
After graduating from high school, the young scientist earned a “higher diploma”—equivalent to a bachelor’s degree—in analytical chemistry in 2000 at what is now the Technical University of Kenya and then went on to earn a higher diploma in soil science in 2003 at what is now the Jomo Kenyatta University of Agriculture and Technology.
Not able to find a job in her field, she opted to work in schools as a science lab assistant, organizing and teaching lessons in biology, chemistry, and physics. She also prepared students for the exams they needed to matriculate from secondary schools.
She recounted that during this time, she was often asked to teach biology and chemistry when the teacher was absent. As a result, she says, “I learned a lot about how school systems work, their challenges in terms of teachers being overworked, discipline in learners, poor academic performances, and the struggles of parents to pay school fees.”
From Science Assistant to Educational Psychologist
But she had no desire to become a teacher herself. “I wanted to help the schools but not as a teacher,” she explains. “My focus was helping learners improve their academic performance and acquiring the discipline to avoid dropping out of the school. But in Kenya, there is no provision for educational psychologists in the education system.”
After earning a diploma online in educational psychology and emotional intelligence at the University of Ireland in 2020, she started working on her own as an educational psychologist. She acquired students by word of mouth from parents. “Amazingly,” she said, “I was able to help kids with behavior problems, learning difficulties, poor academic performances, and learners with special needs.”
Before learning about the science of adverse childhood experiences (ACEs), Ndung’u’s knowledge about emotional intelligence (EQ) opened her eyes as to why children acted out and misbehaved in the classroom.
She recalls having to remove two sisters, ages six and eight, with severe dyslexia from the classroom because they couldn’t read at their grade levels. She used her EQ skills to get the sisters to open up and talk about their issues. She also involved their parents so that they could understand what their children were experiencing and to explain what needed to be done. She secured the students a special needs teacher, who home-schooled them for eight months. Later, they were both successfully integrated back into the schoolroom.
Learning About ACEs
While working with children, the trauma educator heard a talk by Dr. Angie Yonda-Maina, director of Green String Network, a nonprofit dedicated to peacebuilding through practices related to trauma, justice, spirituality, and security. Ndung’u was struck by a poster presented in the doctor’s talk that included a reference to ACEs.
As a survivor of interpersonal trauma, commitment and intimacy have never been easy, which is why I never did remarry after my first marriage fell apart. That is until last October, when my boyfriend who had been living at a comfortable distance (measured in thousands of miles) suggested I pack up my apartment and ride out the pandemic with him in Hawaii. Thus began an adventure that had me breathing into paper bags and him warranting a nomination for the Nobel Peace Prize.
I get bent out of shape easily. On days when I haven’t had enough sleep, I’m particularly vulnerable to being disgruntled and snappy, finding everything about my partner annoying, right down to his very existence. I usually seek refuge in elaborate plans of escape. (No doubt on those days my husband is similarly engaged.) I dream of a light-bathed studio giving onto a beach or a small cabin perched by a lake and surrounded by pines. The scene changes, the head count doesn’t. I am on my own.
For many trauma survivors, “avoidance”—a symptom of post-traumatic stress and driver of my escape fantasies—is the only way to make our lives feel manageable.
The latest edition of the Diagnostic and Statistical Manual of Mental Disorders describes avoidance as “efforts to avoid distressing memories, thoughts, or feelings” and “external reminders (people, places, conversations, activities, objects, situations)” associated with traumatic events. But what if the source and reminder of the trauma is other people? And what does that mean for our relationships?
The essential dilemma for survivors of interpersonal trauma is that, as Judith Herman has written, “recovery can take place only within the context of relationships; it cannot occur in isolation.” It makes sense that for those of us who have suffered abusive relationships, safe, stable relationships would be the cure, in the same way someone who has been poisoned might flush out toxins with pure water. However, as survivors of interpersonal trauma, getting close to people also feels inherently unsafe. In many cases, our trauma stems from the fact that the people who were supposed to love and protect us instead hurt us. We learned—sometimes at a young age—to distrust and fear the very thing we need as humans to survive. In The Boy Who Was Raised as a Dog, Bruce Perry writes:
“Being harmed by the people who are supposed to love you, being abandoned by them, being robbed of the one-on-one relationships that allow you to feel safe and valued and to become humane—these are profoundly destructive experiences. Because humans are inescapably social beings, the worst catastrophes that can befall us inevitably involve relational loss.”
Even more worrying, the inability to tolerate close relationships not only impedes trauma recovery but may even shorten our lifespan. A 2015 Brigham Young study reported that isolation is as bad as smoking 15 cigarettes a day in terms of the impact on our mental and physical health—and ultimately our longevity. The daily pain of social isolation is very real; it actually registers in the same region of the brain as physical pain. For some trauma survivors, isolation can be “iatrogenic”—meaning, the remedy is worse than the disease.
Some people get around the need for emotional connection with other humans by befriending other large mammals: dogs or horses are regularly used in trauma therapy. For those of us who dare to dip a toe into the potentially tumultuous waters of relationships with other humans, the experience is probably best approached as a kind of exposure therapy, where you face the thing you most dread in small increments until your brain is rewired and you no longer sense a threat. The problem is that marriage—to go back to my own situation—does not work like that. You can’t be married for say, one day a week, until you build up a tolerance. And, quite apart from your own ability to tolerate this unaccustomed state of being close to another person, unless your partner understands trauma well—and, like my husband (thus far), has enduring patience—there is a serious risk that the relationship will end up imploding.
Three relatively recent studies from different parts of the U.S. show that only a tiny percentage of physicians, medical school faculty and other healthcare providers are integrating practices and policies based on the science of positive and adverse childhood experiences (PACEs).
Why it matters: For people in the PACEs community, the following is news that’s 20 years old: Adverse childhood experiences are common, preventable and linked to six out of the top ten leading causes of death in the United States.
As one of the studies noted: “Positive and negative experiences in childhood shape our trajectory of health or illness for our entire lives, and this impact can be attributed to the brain-body physiology that results from our experiences during childhood.”
The science is well established. Thousands of research papers have been published about the long- and short-term health effects. Every U.S. state has done an ACE survey, many more than one. Legislation addressing childhood trauma and PACEs science has been passed in 39 states. Dozens of books have been written about the topic, including two bestsellers; one of those—Bessel van der Kolk’s The Body Keeps the Score—has been on the New York Times paperback bestseller list for 178 weeks. Physicians who have been early adopters for more than a decade say they would never go back to not integrating it into their practices.
Who did the studies and why? In Muskegon County, MI, Resilience Muskegon, a community organization created by mental health agency HealthWest, did a survey of county residents that showed a huge disconnect between the healthcare system, which is highly rated, and the health of people in the county. A local ACE survey showed that 31.4 percent of adults have experienced 4 or more ACEs, nearly three times the number in the original CDC-Kaiser Permanente Adverse Childhood Experiences Study, which showed 12.5 percent had an ACE score of 4 or higher. This prompted researchers to recruit 226 physicians from Mercy Health, a hospital and healthcare system that serves 85% of the county, to participate. They asked if they knew about ACEs science, if they used it in their practice, and if they had a personal history of ACEs.
In Texas, researchers from the University of Texas and the University at Albany, NY, recruited 85 healthcare providers from Central Texas that included physicians, nurses, social workers and other staff who were at least 18 years old and providing care in a medical setting to women or children in Central Texas. Going into the study they thought that most healthcare workers would know about ACEs. They thought that most screened for traditional ACEs such as substance use or mental health issues, more often than ACEs such as bullying or community violence, and they thought that most patients would self-disclose common ACEs. They also thought that healthcare providers familiar with ACEs would implement ACE-informed strategies for patients, such as providing resources for patients or creating an ACE-informed culture in their practice. They were remarkably off target.
In Illinois, a team comprising three medical students and four medical school faculty noticed that “very, very few of our colleagues knew anything about childhood trauma,” says Dr. Audrey Stillerman, one of the authors who is clinical assistant professor in the Department of Family and Community Medicine at the University of Illinois at Chicago. They were also interested in why this science that has existed for decades hasn’t been integrated into medical education so that it could become a part of clinical practice. What’s the rub? they wondered. Why isn’t medical education just different now? The team developed a survey to explore these questions; 81 faculty members from the University of Illinois College of Medicine and Rush Medical College in Illinois responded.
Examine Vladimir Putin’s childhood and you will see an eerie parallel to the atrocities playing out in Ukraine today. His life is a stark example of how childhood adversity is the root cause of most social, economic and mental health issues, as well as violence and chronic disease, as the science of positive and adverse childhood experiences demonstrates.
And while we can’t change the Russian president, we can encourage and educate people not to create more Putins by recognizing how childhood adversity impacts us throughout our lives and by integrating solutions into our healthcare, education, justice and economic systems.
Born in 1952 Leningrad, Putin was a street kid in a city devastated by a horrific, three-year siege by the Nazis during WWII, a genocide described as the world’s most destructive siege of a city. Most of the population of three million people died, one million starving to death. Putin’s father was badly injured in the war, his mother nearly died of starvation. Living in a rat-infested apartment with two other families, the family had no hot water, no bathtub, a broken-down toilet, little or no heat. His father worked in a factory; his mother did odd jobs she could find. A small child, whose two older siblings are believed to have been lost to war and disease, Putin was left to fend for himself, severely bullied by other children.
From his parents he inherited their wartime trauma personified by Nazi forces threatening their existence, ravaging their city and killing their friends and family. With his parents struggling to survive, they were absent or too traumatized to be attentive to their son. There’s no mention of other family members: no grandparents, aunts, uncles, cousins. Kindness and affection didn’t seem to have been part of the child Putin’s world.
While the experiences of childhood adversity piled up, two positive experiences changed his trajectory: After years of being labeled a troublemaker in school, a sixth-grade teacher helped him realize his potential. He excelled in high school, learned judo to defend himself, got a law degree and was selected to join the KGB. But the damage that led to his current behavior was done. It produced a machismo man, distrustful and unpredictable, and who cultivates disinformation to advance his own agenda at any cost.
In her essay,“The Ignorance or How We Produce the Evil,” psychologist Alice Miller wrote: “Children who are given love, respect, understanding, kindness and warmth will naturally develop different characteristics from those who experience neglect, contempt, violence or abuse and never have anyone they can turn to for kindness and affection. Such absence of trust and love is a common denominator….All the childhood histories of serial killers and dictators I have examined showed them without exception to have been the victims of extreme cruelty, although they themselves steadfastly denied this.”
Research shows that early abuse and neglect damages an infant’s developing brain. If a child suffers abuse and neglect for years without intervention, the consequences can be dire. As Dr. Bruce Perry, co-author with Oprah Winfrey of What Happened to You? Conversations on Trauma, Resilience and Healing, says, the more healthy relationships a child has, the more likely they will be to recover from trauma and thrive. Relationships are the agents of change and the most powerful therapy is human love.”
But without that love in their childhoods, abused people in power can do serious damage. Hitler, Stalin and Mao Zedung all suffered years of merciless beatings and other unconscionable abuse in childhood and went on to be responsible for the deaths of millions of people. In Mao’s case, 35 million people. Of course, dictators can’t become dictators absent an environment that supports their ability to accumulate power. In The Real War, Richard Nixon pointed out that the “Darwinian forces of the Soviet system produce not only ruthless leaders, but clever ones.” Stalin killed nearly a million people each year he was in power; in 1938 he sent Khrushchev to Ukraine where he proved his ruthless ways by eliminating 163 out of 166 members of that country’s Central Committee. Of course, not everyone who has an abusive childhood grows up to abuse others; but it’s safe to say that all abusive dictators and autocrats had a childhood filled with abuse and/or neglect, and not enough love.
So, Putin’s statements on and after Feb. 23, are chilling and revealing: “The purpose of this operation is to protect people who, for eight years now, have been facing humiliation and genocide perpetrated by
As I post this, the U.S. Senate is in the middle of the second trial of former President Donald Trump, after the U.S. House of Representatives impeached him for the second time.
Several people have asked me why I had not written about the events of Wednesday, January 6, 2021, sooner — a traumatizing day that will be seared in our long history of trauma in this country. Basically, I was waiting for the other shoe to drop, because this isn’t over.
I was also listening to what people in the ACEs movement were saying about the insurrection on January 6. We were all pretty much saying the same things that most people in the nation and the world were saying. First, about the violence, which was horrendous, terrifying, unreal. And then further disbelief, as well as rage, about why a mob of mostly White rioters was let loose on the U.S. Capitol, the people’s house, for six hours without consequences when just months before Black Lives Matter protestors who were practicing their First Amendment rights and were not violent, were tear-gassed, beaten, and arrested.
Below, I’m re-posting an article published last July about how former President Trump’s childhood adversity shaped his life, based on an amazing book by his niece, Mary Trump. The insurrection of January 6 demonstrated how much he has shaped ours in his run-away four-year screeching, careening metaphorical train wreck. Many people warned of this; Mary Trump could see it coming. At the root of all his actions over the last decades, and especially during his presidency, is his childhood trauma.
Adverse childhood experiences are also at the root of the behavior of people in the mob that stormed the U.S. Capitol. People who are happy and healthy, who have a promising future for themselves and their children — i.e., those that have had enough positive childhood experiences to counter the inevitable adverse childhood experiences — those people don’t storm buildings, don’t erect posts with a noose, don’t threaten the Vice-President of the United States and the U.S. Speaker of the House of Representatives with a guillotine or hanging.
But we’re stuck in a generational escalation of ACEs.Idaho just did an ACE studyand found that an astonishing 23 percent of adults, who are overwhelmingly White, have an ACE score of 4 or more. The original ACE Study showed 12 percent of adults with ACEs. Too many ACEs lead to substantial violence, being a victim of violence, chronic disease and mental illness (more information in the article below). People who have an overabundance of ACEs live out their lives in a number of predictable ways: They endure lives of depression, over-achieving, extreme anger, and/or anxiety. People who use anger to cope with their ACEs will latch onto anything that satisfies the craving for hate, including racism, hate groups, misogyny, etc., just as opiates satisfy the craving for relief from depression and anxiety. Fueling their hate is the belief that the world is a dangerous place, based on the traumatic experiences seared into their tiny bodies and brains when they were babies.
On January 6, 2021, most White people had yet another awakening (after George Floyd last year). Most Blacks and Native Americans did not, because they already knew that this country was not a safe place. They have already experienced this violence, for centuries. Those of us who didn’t understand what Donald Trump represented now realize that we have a very long way to go to create a nation of communities that are self-healing.
At ACEs Connection, and in the ACEs movement, we’re in this for the long haul. We know it will take a long time for the country as a whole to heal. I hope we’ve made a strong start. I hope our efforts come in time…to ameliorate the hurt in this country, to have enough individual and community resilience to survive, and perhaps even thrive, during these next decades of climate change.
Trump’s story is a cautionary tale for all of us. For many people, the January 6 insurrection put the last four years into a different and dangerous light. Ahhh, hindsight. But the basic rule is: Hurt people hurt people, no matter how much or little money or prestige they have. Without significant intervention and healing, people who have significant childhood adversity — and little of the necessary nurturing required as babies and toddlers to grow into healthy adults — are incapable of change. That’s why Mary Trump kept saying her uncle would remain on his destructive path. I hope we put the knowledge to good use in future elections.
About two years ago, a team from LifeLong Medical Clinics jumped at the opportunity to integrate practices based on adverse childhood experiences when it joined a two-year learning collaborative known as the Resilient Beginnings Collaborative (RBC). RBC began in 2018 and includes seven safety-net organizations in the San Francisco Bay Area. (Here’s a link to a report about the RBC.)
To join the RBC, LifeLong Clinics — which has 14 primary care clinics in Alameda, Contra Costa and Marin Counties — and the other collaborative teams had to agree to introduce all staff members to the science of childhood adversity and trauma-informed practices. LifeLong went full steam ahead with a 2.5-hour introductory training for more than 100 employees who work at its clinics that serve pediatric patients. Trauma Transformed, a program of the East Bay Agency for Children in Oakland, CA, did the training in October and November 2018.
LifeLong Clinics’ decision to move forward on integrating ACEs science and trauma-informed practices into its clinics is important particularly in California where a state policy has made childhood adversity a front and center issue. On Jan. 1, 2020, as an incentive to doctors who serve Californians in the state’s Medicaid program, the state began offering supplemental payments of $29 to doctors for screening the estimated 12 million pediatric and adult patients for adverse childhood experiences (ACEs).
ACEs comes from the groundbreaking Adverse Childhood Experience Study (ACE Study), first published in 1998 and comprising more than 70 research papers published over the following 15 years. The research is based on a survey of more than 17,000 adults and was led by Drs. Robert Anda and Vincent Felitti. The study linked 10 types of childhood adversity — such as living with a parent who is mentally ill, has abused alcohol or is emotionally abusive — to the adult onset of chronic disease, mental illness, violence and being a victim of violence. Many other types of ACEs — including racism, bullying, a father being abused, and community violence — have been added to subsequent ACE surveys. (ACEs Science 101; Got Your ACE/Resilience Score?)
The ACE surveys — the epidemiology of childhood adversity — is one of five parts of ACEs science, which also includes how toxic stress from ACEs affects children’s brains, the short- and long-term health effects of toxic stress, the epigenetics of toxic stress (how it’s passed on from generation to generation), and research on resilience, which includes how individuals, organizations, systems and communities can integrate ACEs science to solve our most intractable problems.
After it trained employees in 2018, brainstorming around workflow was provided for staff at the LifeLong Howard Daniel Health Center in Oakland, CA, in February 2019, where LifeLong plans to pilot ACEs screening in newborns to five-year-olds, said Dr. Omoniyi Omotoso, the pediatric lead at LifeLong Clinics, who led the brainstorming about workflow and additional training.
Four months into that training, in June, Omotoso showed staff the ACEs questionnaire and asked them how they thought patients would feel about it.
And that’s when Omotoso realized that they had to put on the brakes. “A lot of the staff were uncomfortable because they themselves had similar instances that they personally were triggered by as they read the [ACE] questions themselves,” said Omotoso, who splits his clinical time between LifeLong Howard Daniel Health Center and LifeLong William Jenkins Health Center. He said that LifeLong will be using the de-identified PEARLS ACE screener for its pediatric population, which asks those surveyed to write on the form the number of ACEs that apply to them. (Here’s a link to ACEs Aware, where you’ll find out more information about PEARLS, the only pediatric ACEs screener for which California providers can be reimbursed.)
When you’re working with people who’ve had a lot of childhood and adult adversity, it’s hard for you to believe that anyone else can have a bad day, says Laura van Dernoot Lipsky. “Your neighbor or your best friend says: ‘I’ve had a bad day.’ And you think, ‘Oh, I’m sorry you had a bad day; were you sex trafficked today? No, you were not!’”
Dr. Ken Epstein has been in the social services sector for nearly four decades and has witnessed firsthand the long-term effects of trauma. As both the son and father of fellow social workers, the work runs in his blood. He has been frontline staff at a residential facility for youth with severe mental and emotional challenges, a therapist, a family and couples therapy professor and director of the Child, Youth and Family System of Care for the City of San Francisco’s Department of Public Health. Now, he’s helping Bay Area health clinics screen for and address childhood trauma through the Resilient Beginnings Collaborative (RBC), led by Center for Care Innovations (CCI) and made possible by Genentech.
Trauma is pervasive. Studies show that one in seven children in California experience trauma by age five (Children Now, 2018), and research links adverse childhood experiences (ACEs) – incidences of abuse or neglect, household dysfunction, and community violence – to an increased likelihood of negative health outcomes. In youth, trauma can cause behavioral issues, asthma, and infections; as adults, those same individuals are at greater risk of heart, lung, and autoimmune disease, obesity, mood disorders, and substance use disorders. This is magnified when you include income disparities and the impact of systemic and structural inequities.