Children from unhappy, dysfunctional families who experience chronic adversity undergo changes in brain architecture that create lasting physical scars, that look pretty similar no matter who you are, where you lived, or what happened to make you unhappy when you were growing up.
Happy families may succeed not because of what they do right, but because of everything they don’t do wrong.
The stress of Adverse Childhood Experiences causes toxicity to the neurons and neural pathways that integrate different areas of the brain. These brain changes have a profound effect on our decision making abilities, self regulatory processes, attention, emotional regulation, thoughts, and behavior.
Cutting her mother out of her life was the only conceivable way she could survive.
Janet Camilleri reveals why she cut ties with her mother.
What do you do when a close family relationship, such as a parent or sibling, becomes so dysfunctional it’s toxic?
For some, completely cutting off from that person can be the only solution for them to heal and move forward but it‘s by no means ever an easy one.
Blogger and mother of two Janet Camilleri, 51, is a survivor of a childhood overshadowed by violence and psychological abuse so profound that cutting her mother out of her life was the only conceivable way she could survive.
“My mother was violent, irrational her mood could change at the drop of a hat,” she recalls. “I call it the Dr Jekyll and Mr Hyde personality because she was a very outgoing, extroverted, life of the party type person in the company of others but at home she was like the devil and you just never knew what would trigger her.
I would have ended up a basket case if I’d kept her in my life as just a phone call with her would reduce me to a quivering lump of jelly, that was the effect she had on me. For the sake of my own marriage and children, I had to cut her off to look after my own mental health.”
My Mum, the narcissist
Janet describes her mother regularly sabotaging her school work, throwing things around the room in a rage, embarrassing her at school and in front of friends, playing favourites with her siblings, using her as a gobetween to pitch venom at her father and regularly inflicting physical violence in the home.
In hindsight, Janet says she recognises that her mother had many severe narcissistic traits exacerbated by other personality disorders, and underlined by a clinical diagnosis of bipolar disorder.
Helen Gibbons, Director and Principal Psychologist of Australia’s Autogenic Therapy and Training Institute, says that toxic behaviour in families can be identified by dysfunctional dynamics.
“Most commonly you see in any dysfunctional set up narcissistic traits in one or more family members that, in its most severe form, can result in premeditated abusive, manipulative and controlling behaviours,” she says.
Narcissism is a condition that presents a set of personality traits such as arrogance, selfcentredness, manipulation, a lack of empathy and remorse, dishonesty, dominance, a strong sense of entitlement, an inability to handle criticism and a grandiose sense of self.
When children grow up in the shadow of a severe narcissist, Ms Gibbons says their emotional needs are seldom met.
“These children are having their brains shaped based on a lack of positive stimulation, love and validation, which does seem to impact heavily on the formation of their limbic system and, in particular, the amygdala, the centre of emotional control in the brain,” she says.
Janet describes her mother’s behaviour becoming increasingly worse after her parents separated and, as her mother’s mental health continued to deteriorate, at the age of just 10 years old, Janet was thrust into the role of ‘carer’ for her younger siblings.
“For a lot of it I protected the younger ones; I was like a mother figure to them because Mum just wasn’t capable of it,” she explains. “It was a lot of responsibility Mum dumped a lot of stuff on me that a kid that age should never be exposed to.”
One Christmas, things came to a head and Janet says she stood up to her mother for the first time and told her she was leaving, to which her mother replied, ‘If you leave, you will never be able to come back’.
“I was nearly 20 years old and I was like, ‘I just can’t do this anymore’. I cut off from her then and we didn’t talk after that for about eight months,” she says. “I had no money, no job and very little support; I just had to survive.”
Janet tried to reinstate contact with her mum at least three times after that. “I tried really hard but it was always awkward and strained,” she says. ”She always upset me whenever we spoke on the phone.”
Janet continued to walk on eggshells, as she had always done, and accommodated poor behaviour to keep the peace, even forgiving her mother for not attending her wedding. But just prior to the birth of her first child, after yet another argument, Janet decided enough was enough and cut off from her mother for the last time.
Cutting off communication
Ms Gibbons says that for people like Janet, any attempt to communicate and rectify problems in a rational way with the narcissistic family member would most likely result in even more abusive behaviour.
“Malignant narcissists are experts at blaming others and the family scapegoat is always the easiest target so cutting off contact may be the only option available to them for a peaceful life,” she says. “No contact literally means no contact ..You don’t explain yourself, you disappear, block them on Facebook and don’t return phone calls.”
Once you’ve gone ‘no contact’, however, you can go into shock and potentially suffer from acute stress symptoms.
“It can be a very lonely and confusing time going no contact because you may find that you are not getting the understanding, support and validation you so desperately need from those around you,” Ms Gibbons says. “When you tell your friends, a lot of people, even though they’re well meaning, believe that all mothers love their children.
“A very common experience is that the friends that you want to believe and validate you will immediately try and support the mother in some way, by saying, ‘Oh yes, but she loves you’ or, ‘Being a parent is difficult’, so it can be very lonely and confusing.”
Janet says the pressure she felt from her family, friends and colleagues to reconcile with her mother was significant. “I was part of a church and the pressure I felt was huge,” she says. “In church, nobody could understand because it’s like, ‘Honour thy father and thy mother’ and all that and I felt like the lowest of the low for not being able to do that.
“I remember talking to somebody at work once, an older fellow, I was pretty bitter and upset at the time, and I mentioned something about my mum that was probably not very nice and he turned to me and said, ‘I think it’s disgusting the way you talk about your mother’. I was just gobsmacked.”
The toxic devastation
Janet went on to survive her childhood but says by the time she managed to escape it, the damage had already been done. “I just tried to be a good kid and to stay out of trouble … I didn’t want to attract her attention because she’d thump me if I did,” she says. “Growing up in a household like mine leads to a few issues so I’ve been and seen a psychologist to help me out at different times.”
Ms Gibbons can’t stress enough the importance of therapy for people who have experienced this kind of trauma.
“Therapy is really important for someone who has suffered abuse from narcissistic family members,” she says. ”it’s so important to speak with a psychologist who is experienced in psychological abuse and to work through the impact that those relationships have had on you so that you can start to make better, healthier choices.”
Janet suffered from Post Traumatic Stress Disorder (PTSD) after leaving home, which later developed into postnatal depression after the birth of both her children.
“I remember going shopping with my kids and seeing other young women with their babies and their mums by their side and just bursting into tears,” she says. “I was like, ‘Why don’t I have a mum like that?‘ I have a wonderful, supportive husband but it very much felt like I was on my own at that time.”
The final blow
It was five years after her mother’s death that Janet first learnt of her passing by accident. And despite having been estranged from her mother for almost 20 years, her grief sent her into a spiral of total despair.
“I was just devastated, I always thought I’d done my mourning when the kids were little because that was a really tough time and I’d grieved the loss of the relationship then, but I think deep down I always hoped that one day a miracle would happen and we’d work it out,” she says. “Even though we were estranged, I never wished ill for her and I sincerely wanted Mum to be happy, despite everything.”
To add insult to injury, Janet learned that she hadn’t been told of her mother’s death at the time because her mum had specifically requested she and her siblings not be. “To learn that she had been so bitter, so twisted and angry, right up until the moment of her death makes me very sad,” she says.
Hope and healing
Despite the devastation she felt over her mother’s passing, Janet says she has no regrets about cutting off communication.
“I didn’t feel guilty when I found out because I knew I’d done everything I humanly could to try and have a relationship with my mother and that no matter what I did, I would never, ever have pleased her so it was never going to work,” she says.
“It helped that I had my wonderful husband beside me saying, ‘You need to get rid of this influence in your life’ and he helped me to be strong and to realise that other people might not approve but that it was something I had to do.”
Some years ago, while driving her young children to school, Janet recalls pulling up beside a bus that had an advertisement about child abuse. “A little voice from the back seat asked, ‘That’s what happened to you, didn’t it, Mummy?‘ and I said, ‘Yes, it was, she says.
“And they’d replied, ‘It’s OK, Mummy, we love you now’.”
Different Adversities Lead to Similar Health Problems
Donna Jackson Nakazawa
The opening line of Tolstoy’s Anna Karenina, “Happy families are all alike; every unhappy family is unhappy in its own way.”, has inspired a philosophical dictum called “The Anna Karenina Principle.” The idea is this: it’s possible to fail at something in many ways; it’s far harder to succeed at something, because success requires not failing in any of those ways.
Happy families may succeed not because of what they do right, but because of everything they don’t do wrong.
And according to ACE research, 64 percent of us grew up in families in which at least one thing went wrong: we’ve had at least one Adverse Childhood Experience. Every one of these unhappy families may be unhappy in its own, unique way. But there is one way in which unhappy families are alike, according to neurobiologists who study childhood adversity:
Children from unhappy, dysfunctional families who experience chronic adversity undergo changes in brain architecture that create lasting physical scars that look pretty similar no matter who you are, where you lived, or what happened to make you unhappy when you were growing up.
How Your Biography Becomes Your Biology
To better understand how toxic childhood stress changes our brain, let’s first review how our stress response is supposed to work when it’s functioning optimally.
Let’s say you’re lying in bed and everyone else in the house is asleep. It’s one am. You hear a creak on the steps. Then another creak. Now it sounds as if someone is in the hallway. You feel a sudden rush of alertness, even before your conscious mind weighs the possibilities of what might be going on. A small region in your brain known as the hypothalamus releases hormones that stimulate two little glands, the pituitary and adrenal glands, to pump chemicals throughout your body. Adrenaline and cortisol trigger immune cells to secrete powerful messenger molecules that whip up your body’s immune response.
Your pulse drums under your skin as you lie there, listening. The hair on the surface of your arms stands up. Muscles tighten. Your body gets charged up to do battle in order to protect life and limb.
Then you recognize those footsteps as those of your teenager coming up the steps after finishing his midnight bowl of cereal. Your body relaxes. Your muscles loosen. The hair on your arms flattens back down. Your hypothalamus, as well as your pituitary and adrenal glands, the “HPA stress axis”, calm down. And, whew, so do you.
When you have a healthy stress response, you respond quickly and appropriately to stress. After the stressful event, your body dampens down the fight-or-flight response. Your system recovers and returns to a baseline state of rest and recovery. In other words, you pass through both the first and the second half of the human stress cycle, coming full circle.
Even so, emotions affect our body in real and significant ways. Emotions are physical. We feel a “knot in our stomach,” or get “all choked up,” or see a relative or coworker as a “big pain in the neck.”
There is a powerful relationship between mental stress and physical inflammation. When we experience stressful emotions, anger, fear, worry, anxiety, rumination, grief, loss, the HPA axis releases stress hormones, including cortisol and inflammatory cytokines, that promote inflammation.
Let’s say your immune system has to fight a viral or bacterial infection. Lots of white blood cells charge to the site of the infection. Those white blood cells secrete inflammatory cytokines to help destroy the infiltrating pathogens and repair damaged tissues. However, when those cytokines aren’t well regulated, or become too great in number, rather than repair tissue, they cause tissue damage. Toxic shock syndrome is an extreme example of how this can happen in the body very quickly.
More subtle types of tissue damage can happen slowly, over time, in response to chronic stress. When your system is repeatedly overstimulated, it begins to downshift its response to stress. On the face of it, that might sound like it’s a good thing, as if a downshifted stress response should translate into less inflammation, right?
But remember, this stress response is supposed to react to a big stressor, pump into defensive action, then quickly recover and return to a state of quiet homeostasis, relaxing into rest and recovery.
The problem is, when you are facing a lot of chronic stress, the stress response never shuts off. You’re caught, perpetually, in the first half of the stress cycle. There is no state of recovery. Instead, the stress response is always mildly on, pumping out a chronic low dose of inflammatory chemicals.
The stress glands, the hypothalamus, the HPA axis, secrete low levels of stress hormones all the time, leading to chronic cytokine activity and inflammation.
In simplest terms: chronic stress leads to a dysregulation of our stress hormones, which leads to unregulated inflammation. And inflammation translates into symptoms and disease.
This is the basic science on how stress hormones play a part in orchestrating our immune function and the inflammatory process. And it explains why we see such a significant link between individuals who experience chronic stress and significantly higher levels of inflammation and disease.
As Stanford professor Robert Sapolsky, PhD, a MacArthur Fellowship recipient for his research on the neurobiological impact of emotional stress on the immune system, has said:
“The stress response does more damage than the stressor itself as we wallow in stress hormones.”
Research bears out the relationship between stress and physical inflammation. For example, adults under the stress of taking care of spouses with dementia display increased levels of a cytokine that increases inflammation. Likewise, if an adult sibling dies, your risk of having a heart attack rises greatly. If you’re pregnant and face a big, stressful event, your chance of miscarrying doubles. Encountering serious financial problems raises a man’s risk of falling down and being injured in the months that follow. A child’s death triples a parent’s chance of developing multiple sclerosis. States of intense emotional fear or loss can precipitate a type of cardiomyopathy known as “broken heart syndrome,” a severe physical weakening of the heart muscle that presents almost exactly like, and is often misdiagnosed as, a full-blown heart attack.
Why Stress Is More Damaging to a Child
Emotional stress in adult life affects us on a physical level in quantifiable, life-altering ways.
But when children or teens meet up with emotional stressors and adversity, they leave even deeper scars.
These potential stressors include chronic put-downs, emotional neglect, parental divorce, a parent’s death, the mood shifts of a depressed or addicted parent, sexual abuse, medical trauma, the loss of a sibling, and physical or community violence. In each case, the HPA (hypothalamus-pituitary-adrenal) stress response can become reprogrammed so that it revs up one’s inflammatory stress hormone response for the rest of one’s life.
In young and growing children, the HPA stress axis is developing, and healthy maturation is heavily influenced by the safety or lack of safety we encounter in the day-to-day environment. When a young brain is repeatedly thrust into a state of hyperarousal or anxiety because of what’s happening at a child’s home, community, or school, the stress axis gets tipped into reaction over and over again, and the body becomes routinely flooded with inflammatory stress neurochemicals. This can lead to deep physiological changes that lead to long lasting inflammation and disease.
More than half of women suffering from irritable bowel syndrome report childhood trauma. Children whose parents divorce are far more likely to have strokes as adults. ACE Scores are linked to a far greater likelihood of diseases including cancer, lung disease, diabetes, asthma, headaches, ulcers, multiple sclerosis, lupus, irritable bowel syndrome, and chronic fatigue.
The more categories of Adverse Childhood Experiences a child has faced, the greater the chances of developing heart disease as an adult. Again, a child who has 7 or more ACEs grows up with a 360 percent higher chance of developing heart disease.
Medical Adverse Experience
Not all Adverse Childhood Experiences are about poor parenting.
Michele had the kind of lovely parents who created a home life that fits the happy family mold; they gave their son and daughter all the parental love and support that every child deserves. “Life was good,” Michele says. Then, when she was thirteen years old, she had a bladder infection and was placed on a routine course of antibiotics. “Within twenty-four hours I had a headache and rash.”
Michele’s doctor told Michele’s mom, “it’s a virus.”
But the rash didn’t go away. Michele started wincing at bright lights. The eye doctor couldn’t figure out what was wrong. Blisters began developing along her upper lip. The pediatrician didn’t know what to do, so Michele’s parents took her to the hospital. They saw a dermatologist who had read about Michele’s symptoms in an article. He thought she might have Stevens-Johnson syndrome, or SJS, a rare illness caused by a severe allergic reaction to a medication.
Michele was admitted to Columbia Presbyterian hospital in New York City. Within twenty four hours blisters the size of large hands broke out across her body. At first, they covered “30 percent of my body, then 100 percent,” Michele says. She was diagnosed with an advanced form of SJS, known as toxic epidermal necrolysis syndrome, or TENS. The bowl sized blisters began to “connect and combine until my entire torso was one enormous blister. Even my corneas were blistered.”
Today, when patients develop TENS, they’re put in an induced coma, because the physical pain is simply too unbearable. But in 1981, when Michele was diagnosed with the illness, doctors “just watched the progression.” Her physicians converted Michele’s hospital room into a burn unit, she looked like a burn victim, so she was treated as if she’d been rescued from a fire. “I felt as if I were being scalped over every inch of my skin.” Michele says she started dissociating from her body. “My body and l parted ways in that hospital, we stopped talking to each other. I couldn’t bear to feel that pain.”
Miraculously, Michele survived. She missed two months of school, while her mom helped to nurse her back to health. Little by little, life began to regain a rhythm of normality, except for the fear Michele still carried within. Every year on the anniversary of the day she was first admitted to the hospital, “my hair would fall out,” she says. “Then it would grow slowly back in.” Michele attended the University of Pennsylvania and held it together, but the whole time, she says, “I was having insomnia and recurring nightmares.” In her late twenties she was diagnosed with chronic fatigue, Epstein-Barr virus, and irritable bowel syndrome. “I had terrible muscle pains all over my body and chronic sinus infections. I had trouble sitting still for even five minutes because of the pain.” Her liver enzymes went “sky high.” It was, she says, “one mysterious illness after another.”
And then, at the age of thirty five, Michele’s doctor sat her down and told her that she had “severe, advanced osteoporosis.” Her bones were going to start disintegrating, he said. “If we don’t get this under control, sometime in the next ten years your bones are going to spontaneously crumble.”
Michele’s early adversity had nothing to do with bad parenting. But her early life stress was extreme, and the damage that stress did to her developing immune system and cells was just as corrosive.
Life is complex and messy, and suffering comes in many forms. Bad things happen. Parents get sick or pass away. Accidents come out of nowhere, as do medical crises.
How do the biophysical changes and inflammation triggered by very different types of early childhood adversity translate years later into autoimmune diseases, heart disease, and cancer?
Flipping Crucial Genetic Switches
On an unusually brisk December morning, Margaret McCarthy, PhD, professor of neuroscience at the University of Maryland School of Medicine, meets me at a downtown Baltimore coffee shop. Her schedule is tight, so we pick up two cups of soup to go and head to her office. As we enter the hall that serves as the main artery for McCarthy’s four room lab, we pass a sign that says, “Research saves lives,” on a large photo of a young, smiling girl holding a stuffed bunny. McCarthy has taught science for years to med students, grad students, and even high schoolers, whom she takes on as lab assistants to help “turn them on to science.”
She offers a primer on what research has unveiled about childhood adversity and altered brain development.
“Early stress causes changes in the brain that reset the immune system so that either you no longer respond to stress or you respond in an exacerbated way and can’t shut off that stress response,” she says.
This change to our lifelong stress response happens through a process known as epigenetics. Epigenetic changes occur when early environmental influences both good (nurturing caregivers, a healthy diet, clean air and water) and bad (stressful conditions, poor diet, infections, or harmful chemicals) permanently alter which genes become active in the body.
These epigenetic shifts take place due to a process called gene methylation. McCarthy explains, “Our DNA is not just sitting there. It’s wrapped up very tightly and coated in protected proteins, which together make up the chromosome. It doesn’t matter what your genome is; what matters is how your genome is expressed. And for genes to be expressed properly, the chromosome has to be unwound and opened up, like a flower, right at that particular gene.”
McCarthy unfurls the fingers of both hands. “Imagine this,” she says. “You’re watching a flower bloom, and as it opens up, it’s covered with blemishes.” She folds several of her fingers back in, as if they’re suddenly unable to budge. “Those blemishes keep it from flourishing as it otherwise would. If, when our DNA opens up, it’s covered with these methylation marks, that gene can’t express itself properly in the way that it should.”
When such “epigenetic silencing” occurs, McCarthy continues, these small chemical markers, also known as methyl groups, adhere to specific genes that are supposed to govern the activity of stress hormone receptors in our brain. These chemical markers silence important genes in the segment of our genome that oversees our hippocampus’s regulation of stress hormones in adulthood. When the brain can’t moderate our biological stress response, it goes into a state of constant hyperarousal and reactivity. Inflammatory hormones and chemicals keep coursing through the body at the slightest provocation.
In other words, when a child is young and his brain is still developing, if he is repeatedly thrust into a state of fight or flight, this chronic stress state causes these small, chemical markers to disable the genes that regulate the stress response, preventing the brain from properly regulating its response for the rest of his life.
Researcher Joan Kaufman, PhD, director of the Child and Adolescent Research and Education (CARE) program at Yale School of Medicine, analyzed the DNA in the saliva of ninety six children who’d been taken away from their parents due to abuse or neglect as well as that of ninety six other children who were living in what we might think of as seemingly happy family settings. Kaufman found significant differences in epigenetic markers in the DNA of the children who’d faced hardship, in almost three thousand sites on their DNA, and on all twenty three chromosomes.
The children who’d been maltreated and separated from their parents showed epigenetic changes in specific sites on the human genome that determine how appropriately and effectively they will later respond to life’s stressors.
Seth Pollak, PhD, professor of psychology and director of the Child Emotion Laboratory at the University of Wisconsin, found that fifty children with a history of adversity and trauma showed changes in a gene that helps to manage stress by signaling the cortisol response to quiet down so that the body can return to a calm state after a stressor. But because this gene was damaged, the body couldn’t rein in its heightened stress response. Says Pollak:
“A crucial set of brakes are off.”
This is only one of hundreds of genes that are altered when a child faces adversity.
When the HPA stress axis is overloaded in childhood or the teenage years, it leads to long lasting side effects, not just because of the impact stress has on us at that time in our lives, but also because early chronic stress biologically reprograms how we will react to stressful events for our entire lives. That long term change creates a new physiological set point for how actively our endocrine and immune function will churn out a damaging cocktail of stress neurochemicals that barrage our bodies and cells when we’re thirty, forty, fifty, and beyond. Once the stress system is damaged, we overrespond to stress and our ability to recover naturally from that reactive response mode is impaired. We’re always responding.
Imagine for a moment that your body receives its stress hormones and chemicals through an IV drip that’s turned on high when needed, and when the crisis passes, it’s switched off again. Now think of it this way: kids whose brains have undergone epigenetic changes because of early adversity have an inflammation promoting drip of fight-or-flight hormones turned on high every day, and there is no off switch.
When the HPA stress system is turned on and revved to go all the time, we are always caught in that first half of the stress cycle. We unwittingly marinate in those inflammatory chemicals for decades, which sets the stage for symptoms to be at full throttle years down the road, in the form of irritable bowel syndrome, autoimmune disease, fibromyalgia, chronic fatigue, fibroid tumors, ulcers, heart disease, migraines, asthma, and cancer.
These changes that make us vulnerable to specific diseases are already evident in childhood. Joan Kaufman and her colleagues discovered, in the first study to find such direct correlations, that:
Children who had been neglected showed significant epigenetic differences “across the entire genome” including in genes implicated in cardiovascular disease, diabetes, obesity, and cancer.
Yet by the time signs of an autoimmune condition creep up at forty or a heart condition rears its head at fifty, we often can’t link what happened when we were children to our adult illness. We become used to that old sense of emotional stress, of not being okay. It just seems normal. We have a long daily commute, a thirty year mortgage, and our particular mix of family dynamics. We generally deal with it and we’re usually okay. Then something minuscule happens: we have an argument with our sister over something said at a family dinner; we get a notice in the mail that our insurance isn’t going to cover a whopping medical bill; the refrigerator tanks the day before a big dinner party; our boss approves a colleague’s ideas in a meeting and ignores ours; a car honks long and hard as it swerves from behind to cut in front of us on the freeway. We react to these events as if they are a matter of life or death. We trigger easily. We begin to realize that we’re not so fine.
An adult who came of age without experiencing traumatic childhood stress might meet the same stressor and experience that same spike in cortisol, but once that stressor has passed, he or she quickly returns to a state of rest and relaxation. But if we had early trauma, our adult HPA stress axis can’t distinguish between real danger and perceived stress. Each time we get sidetracked by a stressful event, it sends split-second signals that cause our immune system to rev into high gear. We get that adrenaline rush but the genes that should tell our stress system to return to a state of rest and relaxation don’t do their job.
Over days and years, the disparity between a long “cortisol recovery” period and a short one makes a significant, life changing difference in the number of hours we spend marinating in our own inflammatory stress hormones. And over time, that can deeply distort your life.
The Ever Alert Child
Adults with Adverse Childhood Experiences are on alert. It’s a habit they learned in childhood, when they couldn’t be sure when they’d face the next high tension situation.
After her terrifying childhood illness, Michele never felt at peace, or whole, as an adult: “I was afraid I could be blindsided by any small medical crisis that could morph and change my entire life.”
Laura, as an adult, holds a high profile DC job that requires lightning decisions and heightened awareness. She’s good at it since, as a child, Laura and her brain learned to always be on high alert for the next snipe from her mother, as if being prepared could make it hurt less. “I became an expert at gauging my mom’s moods,” she says. “Whenever I was in the same room with her, I was thinking about how to slink away.”
By the time she was nine, Laura had learned to be “unconsciously on the lookout for a very subtle narrowing of my mom’s eyes,” which would tell her that she was about to be blamed for “something I didn’t even know that I’d done, like eating half of a sandwich in the fridge or taking too long to tie my shoe.” Laura grew up “learning to toe my way forward, as if blindfolded, to figure out what was coming next, where the next emotional ledge might be, so I wouldn’t get too near to my mother’s sharp edges?
From Laura’s perspective, her mom was dangerous. “I knew she would never physically hurt me,” she explains. “But I was terrified, even when she was in a good mood. At night, when I would hear her lightly snoring, I would feel this overwhelming sense of freedom, relief.”
Laura’s life was never at risk of course, she lived in a safe suburban neighborhood, had food to eat, clothes to wear. But she felt as if her life was at stake. Like all children whose parents display terrifying behavior, Laura carried the overwhelming biological fear that if her primary caregiver turned against her, she would not survive. After all, if the person upon whom you depend for food, shelter, and life itself, turns on you, how are you going to stay alive in the world? You feel as if your life depends on the adult’s goodwill, because when you were very small, how your caregiver treated you really was a matter of life or death.
As an adult, Laura “schooled” herself to believe that the early adversity she faced wasn’t that bad compared with that of other people who also grew up with alcoholic, angry, divorced, or depressed parents. She keeps telling herself that she’s over her childhood troubles.
But her body is far from over them. Laura lives with heart disease and a defibrillator in her chest. Like Michele, her anxiety sensors are set on high alert, and she doesn’t know how to turn them off.
The Rattled Cage
We might reasonably intuit that some types of childhood adversity are more damaging to us than others. For instance, we’d expect that the trauma that Kat experienced in knowing that her father murdered her mother would have a dramatically worse biological impact on her than Laura’s having been chronically put down by her depressive mom.
We’d certainly assume that Kat’s story would be more biologically damaging than that of Ellie, who was the second youngest of five children and grew up in a quiet suburban neighborhood outside Philadelphia. Ellie remembers having a very close relationship with her parents, but, as she got older, she says, “I knew something wasn’t right. My two oldest brothers were time bombs of violent emotion, just waiting to go off. Sitting at the dinner table with my parents, talking about politics, they’d start fighting each other over nothing at all, and the fights got ugly.”
Soon the boys were getting into trouble with alcohol and drugs, “and the police started showing up.” Ellie recalls, “I’d often hear my parents and my brothers screaming at each other at two in the morning. My mom and dad would come in my room and tell my little sister and me not to be scared, that everything was okay, but it was terrifying,” especially when her older brother ended up in jail.
Ellie got good grades, despite the stressors at home, and went to college in California on an athletic scholarship. But, after college, she began having suicidal thoughts and, at age twenty-four, was diagnosed with severe autoimmune psoriasis. “My body was attacking itself,” she says.
According to ACE research, growing up with a family member who is in jail is related to a much higher risk of poor health related outcomes as an adult.
Chronic unpredictable stress
Laura, John, Georgia, Kat, Michele, and Ellie tell six unique stories of childhood adversity. And yet their brains reacted to these different levels of trauma in a similar biological way. The developing brain reacts to different types and degrees of trauma so similarly because all the categories of Adverse Childhood Experience stressors have a very simple common denominator: they are all unpredictable. The child can’t predict exactly when, why, or from where the next emotional or physical hit is coming.
Researchers refer to stress that happens in unpredictable ways and at unpredictable times as “chronic unpredictable stress,” and they have been studying its effects on animal development for decades, long before Felitti and Anda’s investigation into ACEs first began.
In classic studies, investigators expose animals to different types of stressors for several weeks, to see how those stressful stimuli affect their behavior. In one experiment, McCarthy and her postdocs exposed male and female rats to three weeks of chronic unpredictable mild stress. Every day, rats were exposed to a few low grade stressors: their cage was rotated; they were given a five minute swim, their bedding was dampened; they went for a day without food; they were physically restrained for thirty minutes; or they were exposed to thirty minutes of strobe lights.
At the end of the three weeks, McCarthy’s team examined the rats to evaluate brain differences. In the group exposed to chronic unpredictable mild stress, she and her team found significant changes in the receptors in the brain’s hippocampus, an area of the brain associated with emotion, which would normally help modulate stress hormone production and put the brakes on feelings of stress and anxiety after a stressor has passed.
The rats who’d been exposed to chronic unpredictable stress weren’t able to turn off the stress response, but the control group that experienced no stress showed no brain changes.
However, when stress is completely predictable, even if it is more traumatic, such as giving a rat a regularly scheduled foot shock accompanied by a sharp, loud sound, the stress does not create these exact same brain changes. “Rats exposed to a much more traumatic stressor get used to it if it happens at the same time and in the same way every day,” says McCarthy. “They manage. They know it’s coming, then it’s over.” Moreover, she says, “They don’t show signs of these same brain changes, or inflammation, or illness.”
On the other hand, she adds, “if you introduce more moderate but unpredictable stressful experiences at a different time each day, with different levels of intensity, adding in different noises, such as loud clapping at unpredictable intervals, those rats show significant changes to the brain. And they get physically sick; they get ulcers.”
This is why researchers believe that it is the unpredictability of stress that is particularly damaging.
On a walking tour of her lab, McCarthy points out the metal stand on which rodents’ cages can be gently shaken for a short time. “Even the most mild unpredictable stressors, something as simple as gently shaking the cage, playing rock music, putting a new object in the cage that they aren’t used to, all these cause very specific changes in the brain when we do them without warning.”
The bottom line, McCarthy says, is that the brain can “tolerate severely stressful events if they are predictable, but you cannot tolerate even mild stressful events if they are very unpredictable.”
Yet even though researchers have known for years about the effects of chronic unpredictable stress on the adult brain, only recently have they examined what happens to the brains of children exposed to chronic unpredictable stressors.
The Difficulty of Not Knowing
Mary, now in her midfifties, grew up as the oldest of four kids in a small town in Oregon. Life with her artist parents was a lot like living with unpredictable cage rattling, shaking, and odd, loud noises. Mary’s dad had his own damaged childhood. He’d grown up never knowing who his own dad was, and his mom died when he was seven. His maternal grandparents adopted his brother, but not him because his parents hadn’t married, and he was seen as damaged goods. (His ACE Score was very high.)
Years later, when he was a father of four, he drank heavily, partied, and played cards. “I remember hearing my dad and friends, up all night drinking and swearing really loud in the living room outside my bedroom, even on school nights. I didn’t feel safe.” Mary has large, sympathetic eyes and shoulder length brown hair that she neatly tucks behind her ears with long, graceful fingers. “I can remember my mother yelling at him, ‘You need to make them leave. Your children can’t sleep!’ And he’d yell back, ‘I can’t make them leave, these are my friends!’ My sleep, and sense of being safe, weren’t important to him.”
Mary’s mother was managing her own anxiety that came with having four children and being stuck in a marriage with an alcoholic, so she, too, was emotionally absent. “I got bullied a lot in grade school,” Mary tells me. “I was scrawny and short and kids would terrorize me.” Her mom was preoccupied with an affair her dad was having and didn’t listen to Mary’s problems; eventually she took Mary and her younger siblings to the East Coast to live with her own mother.
“A part of me quite enjoyed that time away from all the partying and the tension in their marriage, the fighting,” says Mary.
After her parents got back together, at first Mary was happy and hopeful. But her dad was still drinking heavily. He’d get so drunk that “my mom would literally kick him out of bed and he’d come sleep with me.” Nothing happened, Mary says, “nothing like that.” But still, it was disconcerting to sometimes wake in the night at age ten to find her dad in bed with her, sleeping off another drunken stupor.
At school things hadn’t improved much. “We were still wearing dresses back then,” says Mary. “All the boys called me ‘Gladiator’ because when they’d tease me I’d go at them, I’d fight back.” That made the bullying worse. “They’d chase me and hold me down on the ground and forcibly pull off my underwear.”
Mary didn’t even think of telling her father about the bullying. “When he was drunk, he would spank us really hard. Once when my sister was in second grade, he pulled down her pants and spanked her in front of all his drunken friends.”
Mary’s sensors were always on high alert, getting ready for the next unpredictable, incoming emotional bomb. Her stress axis was constantly kicking into high gear; her immune system, in overdrive. By then, Mary had started to show signs of an autoimmune disorder called vitiligo, in which the body’s immune cells attack the pigmentation in the skin. Areas of her skin turned white, as if the skin had been bleached or burned in the past and new skin was trying to form over it.
“Our skin is our first line of defense against the world, the thing that’s supposed to keep us safe, secure our physical boundaries,” Mary says. “And yet my parents hadn’t set any boundaries to keep me or my siblings safe.” It was as if her skin were pleading for her parents to set those boundaries, the kind of safe zone parents are supposed to set for kids.
Even worse than the skin disorder, however, “were my constant stomachaches,” she recalls. “I’d have chronic constipation and cramping, and then terrible diarrhea, all the symptoms of irritable bowel, though we didn’t know what to call it back then.” Sometimes, she’d find herself getting physically jittery and nervous “seemingly for no reason. I’d just be standing there and I’d get these rushes of fear, ripping and prickling through my body.”
Over time, her father’s boundaryless behavior grew more bizarre. When Mary was fourteen, he cut out hundreds of naked bodies from a stack of old Playboys, took off their heads, and pasted their disembodied boobs, legs, butts, and crotches on the walls of the kitchen. Andrea, one of Mary’s few friends, told her parents about the “wallpaper.” “After that, Andrea wasn’t allowed at my house,” Mary says. “I started to realize that other kids weren’t comfortable around me because of my dad.”
When she was fifteen, her parents moved to a house in the country. “I think they were trying to salvage their marriage.” One crisp winter night, when Mary was coming out of the garage, one of her dad’s drunken friends was standing by his car in the driveway. “As I walked by to go in the house he stared at me hard and said, ‘You are so beautiful!’ Then he threw me into the backseat of his car and got on top of me. He stuck his tongue down my throat and was groping me.”
Mary forced him off and ran in to tell her dad, who was also drunk. “He told me to stop making such a big deal about it.”
And yet, at other times, Mary’s dad did show concern for her. Once, when Mary was in a car accident, “he got in the ambulance with me and cried the whole way to the hospital.” He was completely unpredictable.
By the time she was eighteen, Mary had developed “unwavering depression,” which would progress over the next thirty years, getting worse after she married and had her four children. She developed a severe lower back problem that worsened every year. And her autoimmune vitiligo started to cover her arms and neck.
“I fell into a postpartum depression after each birth, and after my fourth son, I was suicidal. My physical and emotional pain had snowballed. If I was driving without any of my kids in the car, I’d find myself thinking, ‘How can I crash this car into a tree in such a way that no one will know it’s suicide, and so that I’m not just impaired and a burden to my family afterward?”
And that was when, says Mary, “I realized something potent was haunting me; something was terribly wrong with how unsafe I felt in the world. I had these beautiful sons and I just didn’t feel okay inside in any way, shape, or form.”
To the developing brain, knowing what’s coming next matters most. This makes sense if you think back to how the stress response works optimally. You meet a bear in the woods and your body floods with adrenaline and cortisol so that you can decide quickly: do you run away or try to frighten away the bear? After you deal with the crisis, you recover, your stress hormones abate, and you go home with a great story.
McCarthy presents another situation. “What if that bear is circling the house and you can’t get away from it and you never know if it’s going to strike, or when, or what it will do next? There it is, threatening you every single day. You can’t fight or flee.” Then, she says, “Your emergency response system is set into overdrive over and over again. Your anxiety sensors are always going full blast.”
Even subtle, common forms of childhood stress, e.g., a hypercritical, narcissistic, or manic depressive parent can cause just as much damage as a parent who deals out angry, physical beatings or just disappears.
And in that sense, Kat’s story and Mary’s story are very similar to Laura’s, John’s, Georgia’s, Michele’s, and Ellie’s. All of them, even in adult life, felt that the bear was still out there, somewhere, circling in the woods, stalking, and might strike again any day, anytime.
According to Vincent Felitti, the one area in which a “yes” answer on the Adverse Childhood Experiences questionnaire has been correlated to a slightly higher level of adult negative health outcomes is in response to ACE question number 1, which addresses the issue of “chronic humiliation.” Would adults in the home often swear at you, insult you, put you down, or humiliate you?
This strong correlation between adverse health problems and unpredictable, chronic humiliation by a parent suggests that it is not knowing if you are safe from the “bear” that matters most.
There are a lot of bears out there. Depression, bipolar disease, alcohol, and other addictions are remarkably prevalent adult afflictions. According to the National Institute of Mental Health, over 18 percent of adults, or nearly forty four million Americans, suffer from a diagnosable mental health disorder in any given year. Twenty three million adult Americans suffer from an alcohol or drug addiction. Indeed, according to the original ACE Study, one in four people with Adverse Childhood Experiences had a parent who was addicted to alcohol.
Often, alcoholism and depression go hand in hand, addiction can be an unconscious effort to self medicate a mood disorder. But even when they are not working in tandem, mood disorders and alcoholism share one thing: both make adults behave in emotionally undependable ways. The parent who hugs you one day when picking you up from school might humiliate you in front of your friends the next afternoon. The sense of not knowing what’s coming next never goes away.
The Sadness Seed
Adversity in childhood can be the precursor to deep depression and anxiety later in life. A growing body of research shows that there is a close correlation between Adverse Childhood Experiences and emotional health disorders in adulthood. In Felitti and Anda’s Adverse Childhood Experiences Study, 18 percent of individuals with an ACE Score of 1 had suffered from clinical depression, and the likelihood rose sharply with each ACE Score. Thirty percent of those with an ACE Score of 3 and nearly 50 percent of those with an ACE Score of 4 or more had suffered from chronic depression.
Twelve and a half percent of respondents to the Adverse Childhood Experiences Study cite having an ACE Score of 4 or more.
For women, the correlation is even more disturbing. While 19 percent of men with an ACE Score of 1 suffered from clinical depression, 24 percent of women with that score did. Likewise, while 24 percent of men with a score of 2 developed adult clinical depression, 35 percent of women did. Thirty percent of men with a score of 3 developed clinical depression, compared to 42 percent of women who had three categories of Adverse Childhood Experiences. And 35 percent of men, versus nearly 60 percent of women, with a score of 4 or more suffered from chronic depression.
The strongest precursor of adult depression turned out to be Adverse Childhood Experiences that fell into the category of “childhood emotional abuse.”
Whether you are male or female, the loss of a parent in childhood triples your chances of depression in adulthood. Being raised by a mother who suffers from depression puts you at a higher risk of living with chronic pain as an adult. Children who experienced severe trauma before the age of sixteen are three times more likely to develop schizophrenia later in life.
Most disturbing are the statistics on suicide: while only 1 percent of those with an ACE Score of 0 have ever attempted suicide, almost one in five individuals with an ACE Score of 4 or more has tried to end his or her life. Indeed, a person with an ACE Score of 4 or more is, statistically, 1,220 percent more likely to attempt suicide than someone with an ACE Score of 0.
It certainly makes sense that childhood emotional trauma will spill out in our adulthood. Psychology and psychotherapy help us understand the link between our childhood wounds and adult emotional problems, and making this connection can help free us from the pain of our past.
But research tells us that often, childhood adversity leads to more deep seated changes within the brain, and that depression and mood dysregulation are also set in motion on a cellular and neurobiological level.
So what is causing neurobiological changes inside the brain itself?
How Early Adversity Changes the Shape and Size of the Brain
When a young child faces emotional adversity or stressors, cells in the brain release a hormone that actually shrinks the size of the brain’s developing hippocampus, altering his or her ability to process emotion and manage stress. Magnetic resonance imaging (MRI) studies show that the higher an individual’s childhood trauma score, the smaller the cerebral gray matter, or brain volume, is in key processing areas of the brain, including the prefrontal cortex, an area related to decision making and self regulatory skills; the amygdala, or fear processing center of the brain; and the sensory association cortices and cerebellum, both of which affect how we process and regulate emotions and moods.
MRIs also show that kids raised in orphanages have much smaller brains than those of others. That smaller brain volume may be due to a reduction in the brain’s gray matter which is made up of brain cells, or neurons, as well as white matter, which includes nerves (with coated, or myelinated, axons) that allow for the fast transmission of messages in the brain. Other studies show that this smaller sized amygdala in adults who’ve experienced childhood maltreatment shows marked “hyperactivity.” Frontal regions of the brain display “atypical activation” throughout daily life making individuals hyperreactive to even very small stressors.
The lnflamed Brain
“Early stress impacts the developing brain in a way that, until very recently, we just didn’t think was possible,” McCarthy says. “It turns out that chronic, early unpredictable stress can trigger a process of low grade inflammation within the brain itself.”
That is pretty revolutionary news. Until recently, most scientists thought that inflammation could not be generated by the brain. “We thought that the brain was what we call ‘immune-privileged,’ ” explains McCarthy. “Inflammation in the brain occurred only when there was an external event, such as a brain injury or head trauma, or an infection such as meningitis.”
But, “That has turned out not to be the case. When we are chronically stressed, the brain responds by creating a state of neuro inflammation. And that neuro inflammation can be present at levels that, until very recently, we could not even detect.”
This type of inflammation develops due to a type of non neuronal brain cell known as microglia. Our microglial cells make up about one tenth of our brain cells. For years, researchers thought that these microglia cells were “just there to get rid of stuff we didn’t need,” explains McCarthy. “They were taking out the trash, so to speak?
Microglia play an integral role in pruning our brain’s neurons and in brain development. They are crucial to the normal processing of the brain all the time, continuously scanning their environment, determining, Are we good here? Or not so good? Are we safe? Or not safe?
Shake the cage. Flash the lights. The microglia in the brain take note, fast. They don’t like chronic, unpredictable stress. They don’t like it at all.
“Microglia go off kilter in the face of chronic unpredictable stress,” says McCarthy. “They get really worked up, they crank out neurochemicals that lead to neuro inflammation. And this below-the-radar state of chronic neuro inflammation can lead to changes that reset the tone of the brain for life.”
“It is very possible that when microglia go off kilter, they are actually pruning away neurons,” McCarthy says. That is, they are killing off brain cells that we need.
In a healthy brain, microglia control the number of neurons that the cerebral cortex needs, but unhappy microglia can excessively prune away cells in areas that would normally play a key role in basic executive functions, like reasoning and impulse control. They are essential in a healthy brain, but in the face of chronic unpredictable stress, they can start eating away at the brain’s synapses.
“In some cases, microglia are engulfing and destroying dying neurons, and they are taking out the trash, just as we always thought,” says McCarthy. “But in other cases, microglia are destroying healthy neurons and in that case, it’s more like murder.” This excessive pruning can lead to what McCarthy refers to as a “reset tone” in the brain. You might think of that stressed brain as a muscle that’s lost its tone and is atrophying. And that loss of gray and white matter can trigger depression, anxiety disorders, and even more extreme psychopathology such as schizophrenia and Alzheimer’s disease.
Microglia may also prune a special group of neurons in the hippocampus that are capable of regenerating. “We used to think that you could never make new neurons but one of the most revolutionary new findings in the last decade is the discovery that there are new neurons being born in the hippocampus all the time,” says McCarthy. The growth of new neurons is very important to adult mental health. “If something interferes with their growth, depression can set in.” Indeed research suggests, says McCarthy, that “microglia, when they are overly exuberant, may kill these new neurons as soon as they are born.”
Scientists have introduced healthy microglia back into the mouse brain. The results have been stunning: once mice brains are repopulated with microglia, all signs of depression completely disappear.
So much depends on the microglia in our brain being happy, unrattled. So much depends on our microglia not pruning away too many neurons.
We might hypothesize that “angry, worked-up microglia could impair the growth of healthy new neurons in the brain’s hippocampus,“ says McCarthy. “When healthy neurons in the hippocampus die, our emotional well-being would be impaired over the long term.”
Facing situation after situation of sudden and unpredictable stress in childhood can trigger microglia to prune away important neurons and initiate a state of neuroinflammation that resets the tone of the brain, creating the conditions for long lasting anxiety and depression.
A Perfect Storm: Childhood Stress, Brain Pruning, and Adolescence
When children come into adolescence, they naturally undergo a period of developmental pruning of neurons. When we are very young, we have an overproduction of neurons and synaptic connections. Some of them die off naturally to allow us to “turn down the noise in the brain,” says McCarthy, and to increase our mastery in skills that interest us. The brain prepares for becoming more specialized at the things we’re good at and interested in, while we lose what we don’t need.
But if, due to childhood stress, lots of neurons and synapses have already been pruned away, then when the natural pruning that occurs during adolescence begins to take place, and the brain starts to naturally prune neurons it doesn’t need so that a teenager can focus on building particular skills, baseball, singing, poetry, then suddenly, there may be too much pruning going on.
Dan Siegel, MD, child neuropsychiatrist and clinical professor at the University of California, Los Angeles (UCLA), is the pioneer of a growing field known as “interpersonal biology,” which integrates the fields of neuroscience and psychology. According to Siegel, “The stress of Adverse Childhood Experiences causes toxicity to the neurons and neural pathways that integrate different areas of the brain.” When adolescent pruning occurs in the integrated circuitry between the hippocampus, which is important in storing memories; the corpus callosum, which links the left and right hemispheres of the brain; and the prefrontal cortex, these brain changes, says Siegel, have a profound effect on our decision making abilities, self-regulatory processes, attention, emotional regulation, thoughts, and behavior.
When these integrated circuits are affected by adversity, or genetic vulnerability, or both, during preadolescence, says Siegel, and then puberty hits, “adolescent pruning pares down the existing but insufficient number of integrated fibers, which makes a child vulnerable to mood dysregulation. It is when this brain integration is impaired that a dysfunction in mood regulation may emerge.”
Imagine, hypothetically speaking, that all kids start with 4,000 neurons (that’s a made-up number, for illustration purposes). Now, let’s say that we have two five year old boys, Sam and Joe. Sam faces early adversity and Joe doesn’t. As Sam meets up with chronic unpredictable stress in his childhood, his neurons are slowly pruned away. By the time Sam is twelve, after a lot of stress-related neuronal pruning, he has 1,800 neurons left. He is still okay, functioning well; 1,800 neurons are enough (using our hypothetical numbers) to get by on, since kids start out with so many more than they need in the first place.
But then Sam and Joe both go through the adolescent period of neuronal pruning. Let’s say that Sam and Joe, like all kids, each lose a hypothetical 1,000 more neurons during adolescence. Sam, who grew up with early chronic unpredictable stress, begins to emerge with a notably different brain from Joe.
Suddenly, the difference between Sam’s brain and Joe’s trauma free brain becomes extreme. Joe, who’s grown up fairly adversity free, still has his 3,000 neurons, plenty to go forward and live a healthy and happy life.
Meanwhile, Sam is left with only 800 neurons.
And that makes all the difference. It is not enough for the brain to function in a healthy manner.
For kids who have already had pruning due to early stress, Siegel explains, “when average adolescent pruning occurs, what remains may be insufficient for mood to be kept in balance. If stressors are high, this pruning process may be even more intense, and more of the at risk circuits may be diminished in number and effectiveness.”
The child who faced Adverse Childhood Experiences will be more likely to develop depression, bipolar disorder, eating disorders, anxiety disorders, or poor executive function and decision making, many of which can lead to substance abuse. This may be why, statistically, so many young people first show signs of depression or bipolar disorders in high school, and in college, even kids who just a year or two earlier seemed absolutely fine.
Stephen’s parents, both investment bankers, were hardly around when he was growing up in New York City. Stephen ate dinner at night with his older sister and their nanny. When his parents came home around nine o’clock, a time when most kids were getting tucked into bed and kissed good night, they’d all sit down together at the kitchen table, and the nanny would give her daily report. She was an older woman who loved to “give a laundry list of what we’d done wrong.” Stephen “lived in fear of that moment. Especially for my sister.”
His sister, who was five years older, was “already expected to be a genius like our parents, by the time she was in fourth grade. If she brought home an eighty-five on a math test, my parents would drill her on math problems until eleven o’clock.” Then, they’d tell their friends at the next weekend party at our country house how “Alexis is already doing algebra!”
Stephen, as the baby, often got off lightly when he was young, and recalls feeling “that my parents loved me and wanted everything for me. But they were also terrifying.”
As Stephen got older, his parents stopped “treating me like the cute baby.” He did well academically and his standardized test scores were sometimes off the charts. “My parents decided that I must be the genius they’d been waiting for. I got their laser focus.”
But he soon started to feel that “I wasn’t as smart as my parents hoped I’d be.” When he was nine, Stephen started having acute asthma attacks. He was also “perpetually forgetful. I’d lose everything. I’d forget to bring my sweater or my Spanish book home. I’d leave my clarinet in the band room. It made my parents furious. They’d tell me, ‘Get it together! We don’t have time for your nonsense, Stephen!’ ”
Once, while staying at a plush lakeside resort, he walked into water with his flip-flops on to look for tadpoles. As he walked out, one flip-flop got stuck in the mud. “I tried to find it. I was digging in the muck. My dad just lost it. He stood on the edge of the lake yelling, ‘You lost your flip-flop? Really, Stephen? You can’t take a walk without losing your shoes? You think we’re going to just buy you another pair? We’re not buying you anything!’ ” On the ride home, Stephen had a full-blown asthma attack.
Stephen was also a “nonjock.” He liked to read more than he liked to play ball. “My dad started calling me ‘pretty boy.’ I’d come in the door from being at a concert with my friends and he’d say, ‘Hey, pretty boy, good time?’ He was pissed that I hadn’t spent the weekend on an athletic field the way he had when he was seventeen, the way his colleagues’ and friends’ kids were.”
As many adult children recall, “It wasn’t all bad. My dad taught me how to fish, how to sail, and how to analyze the financial pages of the newspaper. My mom left work to come to every single concert I was in when I played in the state youth orchestra. Sometimes when my dad was out of town, she’d let my sister and me snuggle in her bed and we’d watch movies and eat sandwiches from the deli downstairs. She’d tell me, ‘Your dad loves you so much, he’s just very stressed with work, it’s not about you, Stevie.’ She was not affectionate. But she tried.”
In high school Stephen, despite high test scores, couldn’t seem to manage his workload and get papers in on time, and was diagnosed with attention deficit disorder, high stakes performance anxiety, and depression. “I just stopped wanting to go out with my friends, or do anything. I wanted the world to just let me be.” Then he developed a condition known as alopecia areata, in which the immune system attacks the hair follicles and segments of hair fall out, leaving bald patches. “My hair started falling out in huge chunks.’ ”
Stephen went on to grad school, getting his PhD in psychology. Today, Stephen is forty-two, a high school counselor. He shaves his head so that he doesn’t have to deal with the recurring bald spots from alopecia. “For me, knowing what not to do with the kids I teach, I like to think that’s the gift my parents gave me. I can see when a kid is showing signs of anxiety or depression. I see how at this age, some kids who have been struggling to hold it together for so long just can’t anymore. Things start to fall apart, and they just can’t understand what’s happening to them. I was that kid.”
The research on neuro inflammation, pruning, and the brain helps to explain why adverse experiences in childhood are so highly correlated to depression and anxiety disorders in adulthood. It also sheds light on why, according to the National Institute of Mental Health (NIMH), depression affects eighteen million Americans. The World Health Organization recently cited depression as “the leading cause of disability worldwide,” responsible for more years of disability than cancer, HIV/AIDS, and cardiovascular and respiratory diseases combined.
This also may explain other brain based health disorders. For instance, a recent study of brain scans of people suffering from chronic fatigue syndrome, or CFS, myalgic encephalomyelitis, or ME, show higher levels of inflammation in specific parts of the brain, including the hippocampus and amygdala. The greater a patient’s level of self-reported CFS symptoms, the greater the degree of visible brain inflammation.
This may also help to account for why it is that those who faced Adverse Childhood Experiences are six times more likely to develop chronic fatigue in the first place.
The Walking Wounded
It’s impossible to estimate how many adults who experienced Adverse Childhood Experiences are getting by, day by day, unwittingly navigating a state of low grade neuro inflammation, functioning despite their “reset tone” in the brain, dealing with general low mood, depression, and anxiety.
This lowered “set point of well-being,” this generalized emotional misery, predicts with startling accuracy how likely we are to find ourselves as adults navigating mood fluctuations, anxiety, sadness, fear-reacting to life without resilience, rather than really living life fully.
It’s kind of the proverbial cat chasing its tail. Epigenetic changes in life cause inflammatory chemicals to increase. Chronic unpredictable stress sends microglia off kilter. Microglia murder neurons. Neurons die, synapses are less able to connect. Microglia proliferate and create a state of neuro inflammation. Essential gray matter areas of the brain lose volume and tone. White matter, the myelin in the brain that allows for synapses to connect between neurons is lost. This lack of brain tone impairs thought processes, making negative thoughts, fears, reactivity, and worries more likely over time. An Uberalert, fearful brain leads to increased negative reactions and thoughts, creating more inflammatory hormones and chemicals that lead to more microglial dysfunction and pruning and chronic inflammation in the brain. The cycle continues.
As McCarthy puts it, “Neuro inflammation becomes a runaway process.”
This, she says, “contributes to a chronic overreactivity. Things that most people would get over quickly would send someone with a low level of inflammation into a tailspin. They may not be able to sort out rational thought about what’s happening around them, is what’s happening right now good, or is it bad? They may be far more prone to see everything as bad.”
This is the new psychosocial theory of everything: our early emotional stories determine the body and brain’s operating system and how well they will be able to guard our optimal physical and emotional health all of our adult lives.
We take whatever reactive brain and increased sensitivity to stress we develop in childhood with us wherever we go, at any age. We’re likely to feel bad mentally and physically a lot of the time. That state of neuro inflammation means we are more likely to walk around in an irritable mood, be easily ticked off and annoyed.
Our relationships will suffer. We see hurt where none is intended. We’ll likely find the world more aggravating than gratifying. Our chances for a healthy, stable, and satisfying life narrow, and continue to narrow as the years go by. But we can take action to remove the early “fingerprints” that childhood adversity leaves on our neurobiology so that imprint does not stay with us.
The Really Good News
As scientists have learned more about how childhood adversity becomes biologically embedded, they have also learned how we can intervene in this process to reverse the damage of early stress, no matter whether we grew up in a happy, functional family or an often unhappy, dysfunctional one. And no matter what happened to us when we were young.
“The beauty of epigenetics is that it’s reversible, and the beauty of the brain is that it’s plastic,” says McCarthy:
“There are many ways that we can immuno-rehabilitate the brain to overcome early negative epigenetic changes so that we can respond normally to both pleasure and pain. The brain can restore itself.”
We can heal those early scars to get back to who it is we really are, who we might have been had we not faced so much adversity in the first place. But to do that, we first have to understand why we may be more prone to epigenetic changes than others in the first place, even though we are no less capable of epigenetic reversal and change.
Childhood Disrupted. How Your Biography Becomes Your Biology, and How You Can Heal
by Donna Jackson Nakazawa
get it at Amazon.com