‘Those secrets… they’re literally eroding my bones’

After 34 years of sobriety, countless hours of therapy and persistent self-care, my mother can finally exhale. The emotional scars of childhood abuse are as healed as they can be. Unfortunately, this is only the beginning… there is a second chapter to her journey. The adversities my mum faced as a child are having a very real impact on her health, her immune system and her brain, today.

According to the NSPCC, one in four people experience childhood abuse or neglect in the UK. It is woven into our society. Yet with more than 85 per cent of child abuse going undetected in the UK (OCCE, 2015), and a culture of silence over uncomfortable topics, it can seem more like a rarity than a reality.

While it may seem invisible, the echoes of childhood adversity come back later in life louder and harder to ignore than ever. 'I have worked hard throughout my life to understand how my childhood affects me emotionally,' my mum says. 'I am just now at the stage where I can hear how it affects me physically.'

A wave of emotions

The striking statistics linking childhood adversity with negative health outcomes later in life are not new. In 1998, Doctors Felitti and Anda of Kaiser Permanente Hospital conducted an experiment on more than 17,400 patients in partnership with the Centre for Disease Control (CDC). They discovered that a person's risk for developing life-threatening negative health outcomes in adulthood is inextricably linked to their adverse childhood experiences, known as 'ACEs'. The 10 ACEs are physical, sexual and emotional abuse, physical and emotional neglect, growing up in a household with domestic violence, where a parent was incarcerated, substance dependent, mentally ill or divorced (Felitti et al., 1998).

After more than 30 replications of this study, the CDC repeatedly find the same chilling statistics. As a woman with an ACE score of more than 4/10, my mum is more than twice as likely to develop heart disease and cancer, and 2.5 times more likely to develop a stroke than a person with no ACEs. She is four times more likely to develop chronic lung disease and, most shockingly, her risk of developing Alzheimer's disease or dementia increases 11-fold (CDC, 2020). When I first learned this, I felt a wave of emotions.

As scientists, we pursue data that is untainted by emotion. However, we must speak vocally about these findings precisely because they are so emotionally raw. When Felitti first told his colleague, Dr Bessel Van der Kolk, of the devastating effect that childhood trauma has on adult physical health, he wept (see Van der Kolk's 2015 book The Body Keeps the Score). Emotional pain is not the downfall of modern science, but a pivotal, motivational force that drives the pursuit of knowledge.

Together, we must acknowledge the fact that childhood adversity is a very real part of our lives today. We must work together, have uncomfortable conversations, educate our loved ones and work diligently on preventative health strategies. 'Thank God I found out about this at 57,' my mum says, 'and not 67'. It is never too late to have these conversations. It is never too late to reclaim your past by making proactive, lifestyle changes.

Indirect and direct pathways

In order to understand this profound connection between trauma and health, it is important to consider numerous factors that indirectly and directly link childhood adversity to adult health.

Firstly, chronically high adversity affects a child's developing brain in critical regions involved in reward and addiction, like the nucleus accumbens, which mediates pleasure, and the orbitofrontal cortex, which is important for inhibition (Muhammad et al., 2012). A person with four or more ACEs is three times more likely to become a recurrent smoker and engage in binge drinking behaviours (Ryan-Ibarra, 2020), thus highlighting an indirect pathway linking high childhood adversity with reduced health outcomes in adulthood. Understanding the neuroscience linking ACEs, substance dependence and health is a critical piece of knowledge that can empower people to better understand their bodies and minds.

Additionally, some school systems are not built with high ACE kids in mind. Children with four or more ACEs are 32 times more likely to be diagnosed with learning or behaviour problems (Ryan-Ibarra, 2020). These behavioural problems are all too often met with detention, one-strike systems and expulsion (Mallett, 2016). This closes doors to education and the opportunity to build lasting positive relationships that typically correlate with better health outcomes. Rather than proactive care and rehabilitation, this putative system perpetuates a cycle that neglects the children most in need, deepening the grooves that link adversity and poor health.

However, according to Paediatrician Nadine Burke Harris (2018), even a person with educational advantages who does not engage in high-risk behaviours is still statistically more likely to develop heart disease and cancer if they have a high ACE score. How can this be? Burke Harris explains that repeated exposure to prolonged stress in childhood affects the brain developmentally. Imagine you run into a bear. Your amygdala fires up, activating the hypothalamic-pituitary-adrenal axis, the stress response system. Cortisol floods the body. Blood is shunted to your major skeletal muscles. You are in fight or flight mode. Your immune response becomes hyperactive, just in case. These complex systems, all working in concert, are highly adaptive and can save your life if you run into a bear in the woods.

But, as Burke Harris puts it, what happens when the bear comes home every night? This was the case for my mum. Prolonged, repeated exposure to ACEs chronically hyper activates the stress response system and the immune response system, which becomes maladaptive and toxic to the body. The neurophysiological mechanisms behind this may seem complex, but the simple analogy of a bear in the woods is replicable and easy to understand. Conversations about mental and physical health do not need to be overly complex.

A re-education

A meta-analysis examined the nuanced relationship between sexual abuse and autoimmune diseases including rheumatoid arthritis and fibromyalgia (Häuser, 2011). Prolonged toxic stress is one of many factors that can contribute to the increased circulation of proinflammatory cytokines throughout the blood to harmful levels (Purewal et al., 2017). As a woman with an ACE score of 8 out of 10, it is sadly unsurprising that my mother lives with rheumatoid arthritis. When my mum found out about this link, she was furious. 'I've worked so hard to distance myself from my past, so the fact that it is still affecting my whole body in a systemic, visceral way is infuriating.'

This highlights an important facet of family conversations. Acknowledging childhood trauma itself is not easy, let alone the fact that it may still have effects on health today. These conversations are not about reliving, or retraumatising, but about re-education. Talk with your loved one at their pace. Listen, be patient, and be empathetic.

At this point, it is easy to shy away from these distressing statistics and reassure ourselves that 'this does not apply to me'. However, of Felitti's original 17,400 participants, two out of three people had at least one ACE and one in eight people had four or more ACEs. This is a crisis that affects people on all ends of the socioeconomic spectrum. 70 per cent of these original participants were Caucasian, and 70 per cent were university educated (Felitti et al., 1998). More pressing is the fact that this crisis disproportionately affects people of colour in certain communities that are forced into low socioeconomic status by systemic racism (Burke Harris, 2018). In some areas, up to 92 per cent of children have at least one ACE (Purewal et al., 2017).

This problem is further exacerbated when acknowledging that ACEs themselves are highly correlated with other community-specific adversities and other general health risk factors (Purewal et al., 2017). Underlying shared risk factors that promote ACEs can simultaneously increase the likelihood of poorer health outcomes generally. What makes ACEs so fascinating, however, is their statistical stubbornness. A strong dose-response relationship exists where the more ACEs a person has, the worse their health outcomes, even in communities of poverty with these confounding negative health risk factors (Boparai et al., 2018).

Whether or not this link is due to causal pathways or robust correlations, the fact is that there is a link. This is not a question of 'how can this be', but a conversation about what's next.

Preventative health care

So, what can you and your loved ones do? For the rest of my life, I will ask mum 'how did you sleep' when she picks up the phone, and she knows this is lovingly synonymous with 'how are you?'. Every night of acute sleeplessness contributes to the build-up of beta-amyloid proteins in the brain (Shokri-Kojori et al., 2019), which, over time, stick together to form plaques. These plaques are one of many factors that can increase the likelihood of Alzheimer's disease. Too many of us pride ourselves on how little sleep we need to 'survive'. With one out of six people over 80 living with some form of dementia (Alzheimer's Society), sleep can no longer be taken lightly.

When it comes to sleep, it is not simply about how many hours you log at the pillow, but instead how many complete 70-90-minute sleep cycles you achieve in one night. An adult should be getting five or six sleep cycles a night, which amounts to between 7.5-9 hours of slumber, but most of us only achieve four sleep cycles a night (according to Matthew Walker's Why We Sleep). Once you understand the mechanism of sleep, the correlation between sleep quality and emotional stability (Saghir et al., 2019) becomes refreshingly clear in your own life. Occasionally, when my mum is crying and having a bad day, I tentatively ask 'are we working with a three sleep cycle night?', to which she responds with a few chuckles in amongst the tears. Humour is so important, especially when things are intense. My mum has reinforced to me throughout my life that 'you have to be able to laugh at yourself'.

The Centre for Youth Wellness, a pioneering organisation for ACE awareness, highlights six main categories for preventive health care for those with high ACEs. First, there are the classics we are all too familiar with; sleep, diet and exercise. Secondly, we must also consider mental health, mindfulness and maintaining positive relationships. On a wider scale, broad governmental intervention programmes that protect children are essential. Early intervention for at-risk children leads to measurably improved brain function, as well as decreases in inflammation markers and stress hormones (Lee Oh et al., 2018). We have the power to strive for lasting, policy changes that protect our children, but this cannot be done before we start having practical conversations with those closest to us.

'This conversation is more important than ever'

Finally, it is important to note that I am fortunate to have a relationship with my mum where we can discuss these topics in a safe way. This is not the case for everyone. These conversations can be had with your friends, the people you love, and any support system in your life that means family to you. 'This conversation is more important than ever,' my mum says, 'the shame is keeping it secret, and those secrets are eroding our health. In my case they're literally eroding my bones'. Coming together to have these types of conversations is, of course, inherently uncomfortable. It is an oxymoron where science and emotion must mix.

My mother is the bravest, strongest and most inspiring person I know. She has battled traumas I will never be able to fully understand, and she has become more resilient and loving. It is an honour to work alongside her, improving our health together with a newfound sense of urgency. Conversations about our pasts must become the norm to better our futures. Yes, it is uncomfortable. No, it does not come naturally to us, but the reward is so immense. 'It allowed me to empower the abused child within me, to fully recover her body and her mind.'

- Kyle Kelleher is a student at Durham University
[email protected]

Illustration: Karine Creemers

References

Adverse Childhood Experiences (ACEs). (2020, April 03). Retrieved from https://www.cdc.gov/violenceprevention/childabuseandneglect/acestudy/index.html

Alzheimer's Society. (n.d.). Retrieved from https://www.alzheimers.org.uk/

Boparai, S.K., Au, V., Koita, K. et al. (2018). Ameliorating the biological impacts of childhood adversity: A review of intervention programs. Child Abuse & Neglect, 81, 82-105.

Burke Harris, N. (2018). The deepest well: Healing the long-term effects of childhood adversity. Boston: Houghton Mifflin Harcourt.

Häuser, W., Kosseva, M., Üceyler, N., Klose, P., & Sommer, C. (2011). Emotional, physical, and sexual abuse in fibromyalgia syndrome: A systematic review with meta-analysis. Arthritis Care & Research, 63(6), 808-820.

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Ryan-Ibarra, S. (2020). A Hidden Crisis: Findings on Adverse Childhood Experiences in California. Centre For Youth Wellness. Retrieved from https://centerforyouthwellness.org/wp-content/uploads/2020/02/hidden-crisis-errataversion.pdf.

Saghir, Z., Syeda, J. N., Muhammad, A.S. & Abdalla, T.H. (2018). The Amygdala, Sleep Debt, Sleep Deprivation, and the Emotion of Anger: A Possible Connection? Cureus.

Shokri-Kojori, E., Wang, G., Wiers, C.E. et al. (2018). β-Amyloid accumulation in the human brain after one night of sleep deprivation. Proceedings of the National Academy of Sciences, 115(17), 4483-4488.

Van der Kolk, B. (2015). The body keeps the score: Brain, mind, and body in the healing of trauma. New York: Penguin Books.

Walker, M. (2018). Why we sleep: The new science of sleep and dreams. London: Penguin Books.