LEARNED IN CHILDHOOD

If fire departments attacked just the smoke coming from a burning house instead of the underlying fire, they would use fans instead of hoses. “And the house would burn down faster,” Dr. Vincent Felitti said the other day in Maine’s introduction to his work on the underlying reasons for poor adult health and well-being. The fire, in this case, may have been ignited in childhood.

Dr. Felitti, the chief of preventive medicine at the Kaiser Permanente managed care organization in San Diego, is a primary researcher for the ongoing Adverse Childhood Experiences (ACE) survey, which has gathered data from 17,421 middle-class patients for Kaiser’s Department of Preventive Medicine. His work, presented around the state last week, makes the connection between children’s emotional experiences and the physical and mental health of adults.

In a traditional view, mental-health issues based on childhood beatings, loss of a parent, rape, verbal abuse, a mother treated violently or neglect might not be so surprising, but Dr. Felitti offers another reason for removing the definitional barrier between mental and physical illness.

His work suggests issues such as obesity, smoking, drug and alcohol addictions can be protective responses to childhood trauma. That is, these physical responses are reasonable (to the patient) ways to defend against the harmful memories of negative experiences, and that as adults are treated for, say, obesity or smoking, the possibility of those early experiences – 51 percent of the population studied had a least one adverse experience as defined by the research – demands that they be considered.

More, the ACE study showed that ill health was more likely, sometimes many times more likely, with the higher number of adverse experiences an adult experienced as a child. The reaction to the negative experiences persisted decades later. Even some seemingly successful pursuits may be responses to trauma.

“Certainly some people sublimate their stresses into work, as the term ‘workaholic’ hints,” Dr. Felitti said, “while others choose high levels of exercise. An insight into the latter can be gained from those anorexics who maintain low weight by constant exercise. While superficially successful, these approaches nevertheless leave core problems well concealed from public recognition… Thus, these approaches are protective, but not curative.”

The personal and societal costs of higher intravenous drug use, smoking, alcohol abuse, higher rates of chronic obstructive pulmonary disease and attempted suicide and their connection to the childhood experiences raise the question of what might be done. Dr. Felitti proposes that more medical providers ask their patients specifically about traumatic events in their past though a questionnaire. Some doctors do this already in Maine; in related work, Dr. Felitti found that the number of patient visits declined substantially simply by care providers showing interest in a patient’s history.

Clearly, however, prevention in the home will be the primary means for addressing this problem. That means that parents will first have to be aware of the effects of the early experiences and work to reduce them in their own homes. It means that men must connect the dots between the Colorado high school case in which a 53-year-old man forced the boys to leave the class before terrorizing the girls or the case in the Amish schoolhouse in Pennsylvania with an even more deadly outcome and the acceptance of violence against girls and women. And yes, of course, women are sometimes violent toward men and toward children, but not in the same numbers as men and not usually to the same severity.

Dr. Felitti’s work invites Maine to respond, on both a broad scale and in the home. The costs are apparent if it does not.