Depression isn’t a disease; depression is a normal response to abnormal life experiences.
For every category of traumatic experience you go through as a kid, you are radically more likely to become depressed as an adult. The greater the trauma, the greater your risk of depression, anxiety, or suicide.
Chronic adversities change the architecture of a child’s brain, altering the expression of genes that control stress hormone output, triggering an overactive inflammatory stress response for life, and predisposing the child to adult disease.
Emotional abuse especially, is more likely to cause depression than any other kind of trauma, even sexual molestation. Being treated cruelly by your parents is the biggest driver of depression, out of all categories.
Vincent Felitti didn’t want to discover just a sad fact, he wanted to discover a solution. He was the doctor who uncovered the startling evidence about the role childhood trauma plays in causing depression and anxiety later in life. He proved that childhood trauma makes you far more likely to be depressed or severely anxious as an adult. He traveled across the United States explaining the science, and there is now a broad scientific consensus that he was right. But for Vincent, that wasn’t the point. He didn’t want to tell people who’d survived trauma that they were broken and doomed to a diminished life because they were not properly protected as kids. He wanted to help them out of this pain. But how?
He had established these facts partly by sending a questionnaire to every single person who received health care from the insurance company Kaiser Permanente. It asked about ten traumatic things that can happen to you as a kid, and then matched them against your current health. It was only after he had been doing this for more than a year, and the data was clear, that Vincent had an idea.
What if, when a patient checked that they had suffered a trauma in childhood, the doctor waited until they next came in for health care of any kind, and asked the patient about it? Would that make any difference?
So they began an experiment. Every doctor providing help to a Kaiser Permanente patient, for anything from hemorrhoids to eczema to schizophrenia, was told to look at the patient’s trauma questionnaire, and if the patient had suffered a childhood trauma, the doctors were given a simple instruction. They were told to say something like: “I see you had to survive X or Y in your childhood. I’m sorry that happened to you, it shouldn’t have. Would you like to talk about those experiences?” If the patient said she did, the doctor was told to express sympathy, and to ask: Do you feel it had negative long-term effects on you? Is it relevant to your health today?
The goal was to offer the patient two things at the same time. The first was an opportunity to describe the traumatic experience, to craft a story about it, so the patient could make sense of it. As this experiment began, one of the things they discovered almost immediately is that many of the patients had literally never before acknowledged what happened to them to another human being.
The second, just as crucial, was to show them that they wouldn’t be judged. On the contrary, as Vincent explained to me, the purpose was for them to see that an authority figure, who they trusted, would offer them real compassion for what they’d gone through.
So the doctors started to ask the questions. While some patients didn’t want to talk about it, many of them did. Some started to explain about being neglected, or sexually assaulted, or beaten by their parents. Most, it turned out, had never asked themselves if these experiences were relevant to their health today. Prompted in this way, they began to think about it.
What Vincent wanted to know was, would this help? Or would it be harmful, stirring up old traumas? He waited anxiously for the results to be compiled from tens of thousands of these consultations.
Finally, the figures came in. In the months and years that followed, the patients who had their trauma compassionately acknowledged by an authority figure seemed to show a significant reduction in their illnesses, they were 35 percent less likely to return for medical help for any condition.
At first, the doctors feared that this might be because they had upset the patients and they had felt shamed. But literally nobody complained; and in follow-ups, a large number of patients said they were glad to have been asked. For example, one elderly woman, who had described being raped as a child for the first time, wrote them a letter: “Thank you for asking,” it said simply. “I feared I would die, and no one would ever know what had happened.”
In a smaller pilot study, after being asked these questions, the patients were given the option of discussing what had happened in a session with a psychoanalyst. Those patients were 50 percent less likely to come back to the doctor saying they felt physically ill, or seeking drugs, in the following year.
So it appeared that they were visiting the doctor less because they were actually getting less anxious, and less unwell. These were startling results. How could that be? The answer, Vincent suspects, has to do with shame. “In that very brief process,” he told me, “one person tells somebody else who’s important to them something [they regard as] deeply shameful about themselves, typically for the first time in their life. And she comes out of that with the realization, ‘I still seem to be accepted by this person.’ It’s potentially transformative.”
What this suggests is it’s not just the childhood trauma in itself that causes these problems, including depression and anxiety, it’s hiding away the childhood trauma. It’s not telling anyone because you’re ashamed. When you lock it away in your mind, it festers, and the sense of shame grows. As a doctor, Vincent can’t (alas) invent time machines to go back and prevent the abuse. But he can help his patients to stop hiding, and to stop feeling ashamed.
There is a great deal of evidence that a sense of humiliation plays a big role in depression. I wondered whether this was relevant here, and Vincent told me: “I believe that what we’re doing is very efficiently providing a massive reduction in humiliation and poor self-concept.” He started to see it as a secular version of confession in the Catholic Church. “I’m not saying this as a religious person because I’m not [religious, but confession has been in use for eighteen hundred years. Maybe it meets some basic human need if it’s lasted that long.”
You need to tell somebody what has happened to you, and you need to know they don’t regard you as being worth less than them. This evidence suggests that by reconnecting a person with his childhood trauma, and showing him that an outside observer doesn’t see it as shameful, you go a significant way toward helping to set him free from some of its negative effects.
“Now, is that all that needs to be done?” Vincent asked me. “No. But it’s a hell of a big step forward.”
Can this be right? There is evidence, from other scientific studies, that shame makes people sick. For example, closeted gay men, during the AIDS crisis, died on average two to three years earlier than openly gay men, even when they got health care at the same point in their illness. Sealing off a part of yourself and thinking it’s disgusting poisons your life. Could the same dynamic be at work here?
The scientists involved are the first to stress that more research needs to be done to find out how to build on this encouraging first step. This should only be the start. “Right now, I think that is waiting to happen, in terms of the science of it,” Vincent’s scientific partner, Robert Anda, told me. “What you’ve asked about is going to require a whole new thinking, and a generation of studies that has to put all this together. It hasn’t been done yet.”
I didn’t talk at all about the violence and abuse I survived as a child until I was in my mid-twenties, when I had a brilliant therapist. I was describing the course of my childhood to him, and I told him the story I had told myself my whole life: that I had experienced these things because I had done something wrong, and therefore I deserved it.
“Listen to what you’re saying,” he said to me. At first I didn’t understand what he meant. But then he repeated it back to me. “Do you think any child should be treated like that? What would you say if you saw an adult saying that to a ten-year-old now?”
Because I had kept these memories locked away, I had never questioned the narrative I had developed back then. It seemed natural to me. So I found his question startling.
At first I defended the adults who had behaved this way. I attacked the memory of my childhood self. It was only slowly, over time, that I came to see what he was saying.
And I felt a real release of shame.
Also on TPPA = CRISIS
CHILDHOOD TRAUMA AND MENTAL ‘ILLNESS’. Beyond the smoke