The practice of ACEs science in the time of Trump


As with any remarkable change, the 2016 presidential election, a swirl of intense acrimony that foreshadowed current events, actually produced a couple of major opportunities. It stripped away the ragged bandage covering a deep, festering wound of classism, racism, and economic inequality. This wound burst painfully, but it’s now open to the air and sunlight, the first step toward real healing. The second opportunity is how the election and its aftermath are engaging more Americans from many different walks of life. The election brought out people who hadn’t voted in years; its aftermath has engaged people who’d counted on someone else to do their citizenship work for them. All these people — all of us — now have an opportunity to work together to solve our most intractable problems. That knowledge is embodied in the science of adverse childhood experiences (ACEs).

In a nutshell, this ACEs science clearly shows that childhood trauma results in the adult onset of chronic physical and mental illness, violence, and being a victim of violence. It shows that most of us have experienced childhood trauma. And it shows that the systems we’ve created to change human behavior — whether criminal, unhealthy or unwanted — will actually work if we change them from blaming, shaming and punishing people to understanding, nurturing and and healing them.

The divide we start from is stark: an Electoral College that chose Donald Trump to be president by a vote of 306 to 232, and the voters who chose Hillary Clinton by a nearly three-million vote margin (65,844,610 to 62,979,636).

So, here we are with an administration, whether you agree with its policies or not, that often uses bullying to try to get its way instead of respectful negotiation, responds to decisions it doesn’t like with threats instead of respectful disagreement, describes events it doesn’t like by saying they didn’t happen, and is enacting some policies that harm children and families.

Those actions are not just a matter of being merely “politically incorrect”. ACEs science is clear: bullying, losing a parent (to divorce, separation or deportation), emotional abuse, racist or religious discrimination, physical abuse and witnessing others being hurt — along with several other types of adversity — harm children and adults.

In the case of children, these experiences damage the structure and function of their brains, which can lead to them becoming unhealthy adults who may harm themselves or other people. If their adverse experiences are unrelenting, children live much of their lives in survival mode, responding to their world by fighting, by being frozen into inaction by fear, or by fleeing. They can’t learn as well as those who haven’t been traumatized and they don’t form healthy relationships because they have trouble trusting.

Besides the damage to their brains, children’s health suffers in two other ways: The over-production of the stress hormone cortisol damages their immune response system, leading to illness and chronic diseases that can affect them immediately and/or emerge when they’re adults. These diseases include asthma, obesity, cancer, heart disease, autoimmune diseases, etc. And to cope with the anxiety, depression, frustration, anger, etc. caused by toxic stress from ACEs, children grow into adults who drink too much alcohol or become addicted to other drugs or activities such as shopping, or who overeat, rage, engage in thrill sports, and even overachieve (workaholism), all of which can also contribute to poor health.

These same behaviors — bullying, emotional abuse, racist or religious discrimination, physical abuse and/or witnessing others being hurt — can harm adults, too. Depending on the number of the ACEs they experienced, the duration and when they occurred, the nurturing they received when they were growing up, or the healing that they experienced, adults can be triggered into reliving those same experiences virtually, with the same fight, flight or freeze responses, and, in absence of healthy behaviors, the same harmful coping behaviors. Adults carry these behaviors with them to shape how they interact with their co-workers, their children, and people in their community.

And so the cycle continues.

As we progress through these next few years, this knowledge about ACEs science helps us in two ways:

First, it helps us understand that our responses of fight, flight, or fear to current bullying, threats, and/or humiliation are normal and expected if we’ve had those experiences in our childhood. And one part of ACEs science — the CDC-Kaiser Permanente Adverse Childhood Experiences Study — as well as the dozens of subsequent ACE surveys completed by 32 U.S. states and several countries — show that most of us have had those experiences. It helps us recognize that anger, though useful to motivate, will harm us if we don’t move through it to constructive – not destructive — action. Anger comes from survival brain, and we need to be in thinking brain (our prefrontal cortex), if we’re to make good decisions.

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The most important thing I didn’t learn about in medical school: Adverse childhood experiences


Dr. Nancy Hardt


The most important thing I didn’t learn in medical school is about adverse childhood experiences, also known as ACEs.

To be sure, if I had understood them then the way I do now, I would have been a better and more compassionate physician. Importantly, I would have avoided lots of mistakes.

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Just one year of child abuse costs San Francisco, CA, $300 million….but it doesn’t have to


In 2015, 5,545 children in San Francisco, CA, were reported to have experienced abuse. Of those, the reports of 753 children were substantiated. The expense to San Francisco for not preventing that abuse will cost $400,533 per child over his or her lifetime. That adds up to $301.6 million for just that one year, according to “The Economics of Child Abuse: A Study of San Francisco.”

And, because child abuse is profoundly underreported, the costs are likely to be as much as $5.6 billion for one year of children experiencing trauma, the report found.

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Dear doctor: A letter from a survivor of sexual trauma to all medical professionals


Dear Doctor,

As a medical professional you have taken an oath to do no harm, but there are ways in which you can hurt your patients without even recognizing you are doing so. What seems to you as a simple exam may cause injury to those who have been victimized by someone’s touch. This is a subject that we, survivors of sexual violence, have been meaning to discuss with you for some time now, but your authority can be more intimidating than you may know. I am also unsure if you are aware just how much power you, as a physician, hold and to the extent that you affect the lives of all of your patients. Your interactions with us travel much deeper than the physical core.

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Artists in the ACEs and resilience movement: Creative avenues to change


From "Airings...Voices of our Youth", created by staff from the Bellingham and Mount Baker School Districts (WA), the Whatcom Family and Community Network, faculty at Western Washington University’s Psychology Department and, more than 20 teenagers from the community who have shared their stories (Photo: Angela Kiser and Nolan McNally).

From “Airings…Voices of our Youth”, created by staff from the Bellingham and Mount Baker School Districts (WA), the Whatcom Family and Community Network, faculty at Western Washington University’s Psychology Department and, more than 20 teenagers from the community who have shared their stories (Photo: Angela Kiser and Nolan McNally).


At a June summit in Whatcom County, WA, titled “Our Resilient Community: A Community Conversation on Resilience and Equity,” the arts played a starring role.

Kristi Slette, executive director of the Whatcom Family and Community Network, one of two Washington sites participating in the Mobilizing Action for Resilient Communities (MARC) project, says the arts—music, dance, sculpture, storytelling—can help audiences understand trauma, resilience and hope in a visceral way.

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We have to partner with law enforcement around trauma

jjie_kathy-mcnamara-2-16-12-13Is there a need for trauma-informed training for police officers? Let me share an example of a situation where the outcome could have been very different if the responding officer had been trauma-informed.

I was working with a young man on probation who was a trauma survivor. He was being tested for drugs, and, unfortunately, the environment triggered a traumatic response. He came running out of the bathroom and I followed him as he wandered around in a highly agitated state. I was able to talk with him and was working on helping him reconnect with his environment.

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Building human resilience for climate change addressed at Washington, DC, conference


The missing piece in the response to climate disruption—preparing humans to cope with the trauma and toxic stress it causes—was the focus of a recent Conference on Building Human Resilience for Climate Change sponsored by the International Transformational Resilience Coalition (ITRC). About a hundred mental health professionals, emergency response and disaster management officials, and others from education and faith communities gathered in Washington, DC. Continue reading

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