By Mathijs Koenraadt

"Never apologise for showing feeling, my friend. Remember that when you do so you apologise for truth." - Benjamin Disraeli, Contarini Fleming[1]

Victims of child maltreatment repress their memories out of shame, because of a social taboo, or out of respect for parents, but as long as we keep denying the link between adverse childhood experiences and problems later in life, no therapy or medication will help us solve those problems. By being emotionally honest to ourselves, we can break through the societal taboo on speaking out about the effects of child maltreatment. That starts by daring to ask what kind of effect traumatizing experiences have had on our lives.[2]

Turning Gold into Lead

What is the cause of death of someone who commits suicide by jumping off a balcony, the fall or the depression?[3] While psychotherapy can direct patients traumatized as children towards forgiveness of once maltreating parents, doctors and other medical staff must consider different courses of action. The symptoms of a maltreated childhood namely don't disappear by simply reconciling oneself with once maltreating caretakers.

On a daily basis, medical staff has to deal with the damage a maltreated childhood does to our health, such as for example the effects of an alcohol or drug addiction, obesity, depressions and failed suicide attempts. In such acts of self-destruction, traumatized people find a false solution that anesthetizes the pain of their pasts. However, by only looking at the symptoms of underlying traumata, society wastes a lot of its potential on preventable medical costs and unnecessary employee absenteeism.

During a study on obesity, researcher Vincent Felitti and his colleagues accidentally discovered the true cause of a great deal of self-destructive behavior among adults. In the eighties, Felitti set up a broad program to help people lose weight. What struck him was that participants that had lost most weight had the highest chance of prematurely discontinuing the study.

During a follow-up research, he asked the dropped-out participants for the reason why and discovered that "for many people, obesity was not their problem, [but] it was their protective solution to problems that previously had never been acknowledged to anyone."[4] Obesity was but a symptom of an underlying, unsolved problem.

The Hidden Trauma

The drop-outs declared that the weight loss had made them feel insecure. An obese woman in her sixties, suffering cardiovascular disease, explained for example that she, as a young woman in her early twenties, had been raped. The excess weight she had put on in the year after her rape protected her against sexual attention from men.[5]

Her overweight insulated the pain of an unprocessed sexual trauma, but doctors only saw the overweight, not the prior trauma. It hit Felitti and his colleagues that adverse childhood experiences might very well be the cause of many problems later in life, an apparently simple link medical scientists had not yet demonstrated before:

"Many of our most intractable public health problems are the result of attempted personal solutions to problems caused by traumatic childhood experiences, which are lost in time and concealed by shame, secrecy, and social taboo against the exploration of certain topics."[6]

The ACE Study

In co-operation with an American public health organization (the Center for Disease Control and Prevention), the researchers decided to design a large-scale study of the effect of adverse childhood experiences on psychological and physical complaints in adulthood. The so-called Adverse Childhood Experiences (ACE) study lead to over fifty scientific publications that, taken together, proved the destructive medical effects of early childhood traumata.

The ACE study looked at the number of qualitative categories of maltreatment people had been exposed to as a child. They performed their research using a questionnaire. The researchers discovered that the combination of multiple categories of maltreatment accumulates the risk of later complaints.[7] Felitti asks himself where things went wrong:

"How does this happen, this reverse alchemy, turning the gold of a newborn infant into the lead of a depressed, diseased adult? The Study makes it clear that time does not heal some of the adverse experiences […]. One does not 'just get over' some things, not even fifty years later."[8]

Return to a Bio-Psycho-Social Model

The outcome of the ACE study discomforted many in the medical world, because they had little to no experience with the sometimes shocking stories of people maltreated as children.[9] Doctors don't like to be traumatized themselves by the horrible events their patients once had to endure.[10]

Because of this, a lot of early suffering remains invisible, because professional providers don't ask about it. Although general practitioners see the cuts and bruises of children's bodies, they don't see how badly children have suffered psychologically, for example as a result of humiliations by or fights between their parents. Later in life, it is precisely those emotional blows that cause the biggest problems.

While a debate is going on in the medical world about the influence of the pharmaceutical industry, more and more medical doctors embrace a bio-psycho-social model of man.[11] That model means that psychological complaints aren't just the exclusive result of genes or viruses, but also partly, or in great part, the effects of the patient's inner psychological state, for example the sum of his adverse childhood experiences.

The results of the ACE study support this vision. Doctors who don't look at their patient's social history risk treating third-degree symptoms that are rather the psychosomatic effect of a maltreated childhood than of intermediate symptoms.[12]

Effects of Adverse Childhood Experiences

The ACE study questionnaire studied ten categories of adverse experiences to which people had been exposed as a child, namely physical, emotional and sexual maltreatment; physical and emotional neglect; and various types of dysfunctional households, such as divorced or depressed parents. Every category counts as one point. What exactly are the effects of childhood traumata?

For example, later in life, people with an ACE score of four, i.e. people who as a child had suffered four different categories of maltreatment, have a higher chance of depression and suicide attempts than people with an ACE score of zero. The researchers also found that, later in life, adverse childhood experiences can lead to a higher chance of smoking, lung disease, drug use, alcoholism, personality disorders, heart disease, diabetes, obesity, psychoses, schizophrenia and unwanted pregnancies.[13]

Humiliated Children

The effects of such traumata continue to negatively influence lives even over a half a century after the maltreatment took place, which means that parents who traumatize their children condemn them to a life-long prison sentence. Psychoanalyst Alice Miller understood that a beaten child naturally wants to respond to its maltreatment with anger, but she wonders what happens to a child that has to hide its true feelings before maltreating caretakers "and also accept this treatment as beneficial."[14]

Felitti and his ACE-study colleagues confirm this insight, "[We] came to recognize that the earliest years of infancy and childhood are not lost but, like a child's footprints in wet cement, are often life-long."[15]

It isn't the case that the damage childhood maltreatment does only surfaces in adulthood. From an early age, beaten and humiliated children show disturbed behavior. Teachers and other educators often believe that the problematic behavior is part of the child, that they were born that way, or that they are 'crazy', but only because they don't know the true causes. A researcher outlines the traumatizing effects that surface even with babies and toddlers:

"It has been long believed that very young children do not understand violence or forget about violence. That is not the case… The way children express their problems with witnessing aggression varies with age, but even babies under one year of age respond to violence with excessive crying, failure to gain weight, difficulty being soothed, exaggerated startle responses, frozen posture, stiffness, sad and withdrawn facial expression and lack of interest in exploration…

Toddlers and preschoolers […] have night terrors, difficulty going to sleep, intense separation anxiety, hyper-vigilance, multiple fears, emotional withdrawal, and on and on. School children and adolescents show all the same behaviors, but also early and excessive experimentation with sexuality and with illegal substances, anger at authorities, school failure and criminal behavior.."[16]

During teenage years, our brains form the important nerves that eventually become our adult personality. It is during these years that a great deal of early abuse thus manifests itself as a personality disorder.[17] That makes it so difficult for care providers to uncover the true causes of behaviorally disturbed teenagers, because the early traumata that cause this disturbed behavior remain completely hidden to the outside world.

• [1]Benjamin Disraeli, Contarini Fleming: An Autobiography (New York: D. Appleton and Company, 1870), 17.
• [2]Valerie J. Edwards et al., "It's OK to Ask About Past Abuse," American Psychologist May-June (2007): 327.
• [3]Robert F. Anda et al., "Building a Framework for Global Surveillance of the Public Health Implications of Adverse Childhood Experiences," American Journal of Preventive Medicine 39, no. 1 (2010): 94.
• [4]Vincent J. Felitti, "The Relationship of Adverse Childhood Experiences to Adult Health: Turning Gold into Lead," 2002, 2.
• [5]Ibid.
• [6]Vincent J. Felitti and Robert F. Anda, "The Relationship of Adverse Childhood Experiences to Adult Health, Well-Being, Social Function, and Healthcare," in The Impact of Early Life Trauma on Health and Disease: The Hidden Epidemic, ed. Ruth A. Lanius, Eric Vermetten, and Claire Pain (Cambridge: University Press, 2008), 14.
• [7]Anda et al., "Building a Framework for Global Surveillance of the Public Health Implications of Adverse Childhood Experiences," 95.
• [8]Felitti, "The Relationship of Adverse Childhood Experiences to Adult Health: Turning Gold into Lead," 2.
• [9]Felitti and Anda, "The Relationship of Adverse Childhood Experiences to Adult Health, Well-Being, Social Function, and Healthcare," 14.
• [10]John Read et al., "Child Maltreatment and Psychosis: A Return to a Genuinely Integrated Bio-Psycho-Social Model," Clinical Schizophrenia & Related Psychoses 2, no. 3 (2008): 236.
• [11]Ibid.
• [12]Robert F. Anda et al., "The Enduring Effects of Abuse and Related Adverse Experiences in Childhood: A Convergence of Evidence from Neurobiology and Epidemiology," European Archives of Psychiatry and Clinical Neuroscience 256 (2006): 182.
• [13]Felitti, "The Relationship of Adverse Childhood Experiences to Adult Health: Turning Gold into Lead," 6.
• [14]Alice Miller, Evas Erwachen: Über Die Auflösung Emotionaler Blindheit (Frankfurt am Main: Suhrkamp Verlag, 2001), 62.
• [15]Felitti and Anda, "The Relationship of Adverse Childhood Experiences to Adult Health, Well-Being, Social Function, and Healthcare," 1–2.
• [16]Robert M. Reece et al., "Children: The Hidden Victims of Domestic Violence," Health Alert 8, no. 1 (2001): 7.
• [17]Steven J. Phillipson, "When the Going Gets Tough… The Perfectionist Takes Control?: Early Recognition of Perfectionism amongst Adolescents from Ages 12–21," 2013, http://www.ocdonline.com/#!going-gets-tough/c1sbr.