Childhood Disrupted: How Your Biography Becomes Your Biology, and How You Can Heal

ISBN-13: 9781476748368

Media Type: Paperback

Publisher: Atria Books

Publication Date: 07-26-2016

Pages: 304

Product Dimensions: 5.50(w) x 8.30(h) x 0.90(d)

Donna Jackson Nakazawa is an award-winning science journalist, public speaker, and author of The Last Best Cure, in which she chronicled her yearlong journey to health, and The Autoimmune Epidemic, an investigation into the reasons behind today’s rising rates of autoimmune diseases. She is also a contributor to the Andrew Weil Integrative Medicine Library book Integrative Gastroenterology. Ms. Nakazawa lectures nationwide. Learn more at DonnaJacksonNakazawa.com.

Read an Excerpt

Childhood Disrupted
If you saw Laura walking down the New York City street where she lives today, you’d see a well-dressed forty-six-year-old woman with auburn hair and green eyes who exudes a sense of “I matter here.” She looks entirely in charge of her life—as long as you don’t see the small ghosts trailing after her.

When Laura was growing up, her mom was bipolar. Laura’s mom had her good moments: she helped Laura with school projects, braided her hair, and taught her the name of every bird at the bird feeder. But when Laura’s mom suffered from depressive bouts, she’d lock herself in her room for hours. At other times she was manic and hypercritical, which took its toll on everyone around her. Laura’s dad, a vascular surgeon, was kind to Laura, but rarely around. He was, she says, “home late, out the door early—and then just plain out the door.”

Laura recalls a family trip to the Grand Canyon when she was ten. In a photo taken that day, Laura and her parents sit on a bench, sporting tourist whites. The sky is blue and cloudless, and behind them the dark, ribboned shadows of the canyon stretch deep and wide. It is a perfect summer day.

“That afternoon my mom was teaching me to identify the ponderosa pines,” Laura recalls. “Anyone looking at us would have assumed we were a normal, loving family.” Then, something seemed to shift, as it sometimes would. Laura’s parents began arguing about where to set up the tripod for their family photo. By the time the three of them sat down, her parents weren’t speaking. As they put on fake smiles for the camera, Laura’s mom suddenly pinched her daughter’s midriff around the back rim of her shorts, and told her to stop “staring off into space.” Then, a second pinch: “no wonder you’re turning into a butterball, you ate so much cheesecake last night you’re hanging over your shorts!”

If you look hard at Laura’s face in the photograph, you can see that she’s not squinting at the Arizona sun, but holding back tears.

When Laura was fifteen, her dad moved three states away with a new wife-to-be. He sent cards and money, but called less and less often. Her mother’s untreated bipolar disorder worsened. Laura’s days were punctuated with put-downs that caught her off guard as she walked across the living room. “My mom would spit out something like, ‘You look like a semiwide from behind. If you’re ever wondering why no boy asks you out, that’s why!’” One of Laura’s mother’s recurring lines was, “You were such a pretty baby, I don’t know what happened.” Sometimes Laura recalls, “My mom would go on a vitriolic diatribe about my dad until spittle foamed on her chin. I’d stand there, trying not to hear her as she went on and on, my whole body shaking inside.” Laura never invited friends over, for fear they’d find out her secret: her mom “wasn’t like other moms.”

Some thirty years later, Laura says, “In many ways, no matter where I go or what I do, I’m still in my mother’s house.” Today, “If a car swerves into my lane, a grocery store clerk is rude, my husband and I argue, or my boss calls me in to talk over a problem, I feel something flip over inside. It’s like there’s a match standing inside too near a flame, and with the smallest breeze, it ignites.” Something, she says, “just doesn’t feel right. Things feel bigger than they should be. Some days, I feel as if I’m living my life in an emotional boom box where the volume is turned up too high.”

To see Laura, you would never know that she is “always shaking a little, only invisibly, deep down in my cells.”

Laura’s sense that something is wrong inside is mirrored by her physical health. In her midthirties, she began suffering from migraines that landed her in bed for days at a time. At forty, Laura developed an autoimmune thyroid disease. At forty-four, during a routine exam, Laura’s doctor didn’t like the sound of her heart. An EKG revealed an arrhythmia. An echocardiogram showed that Laura had a condition known as dilated cardiomyopathy. The left ventricle of her heart was weak; the muscle had trouble pumping blood into her heart. Next thing Laura knew, she was a heart disease patient, undergoing surgery. Today, Laura has a cardioverter defibrillator implanted in the left side of her chest to prevent heart failure. The two-inch scar from the implant is deceivingly small.

John’s parents met in Asia when his father was deployed there as an army officer. After a whirlwind romance, his parents married and moved to the United States. For as long as John can remember, he says, “my parents’ marriage was deeply troubled, as was my relationship with my dad. I consider myself to have been raised by my mom and her mom. I longed to feel a deeper connection with my dad, but it just wasn’t there. He couldn’t extend himself in that way.”

John occasionally runs his hands through his short blond hair, as he carefully chooses his words. “My dad would get so worked up and pissed off about trivial things. He’d throw out opinions that we all knew were factually incorrect, and just keep arguing.” If John’s dad said the capital of New York was New York City, it didn’t matter if John showed him it was Albany. “He’d ask me to help in the garage and I’d be doing everything right, and then a half hour into it I’d put the screwdriver down in the wrong spot and he’d start yelling and not let up. There was never any praise. Even when he was the one who’d made a mistake, it somehow became my fault. He could not be wrong about anything.”

As John got older, it seemed wrong to him that “my dad was constantly pointing out all the mistakes that my brother and I made, without acknowledging any of his own.” His dad chronically criticized his mother, who was, John says, “kinder and more confident.”

When John was twelve, he interjected himself into the fights between his parents. One Christmas Eve, when he was fifteen, John awoke to the sound of “a scream and a commotion. I realized it was my mother screaming. I jumped out of bed and ran into my parents’ room, shouting, ‘What the hell is going on here?’ My mother sputtered, ‘He’s choking me!’ My father had his hands around my mother’s neck. I yelled at him: ‘You stay right here! Don’t you dare move! Mom is coming with me!’ I took my mother downstairs. She was sobbing. I was trying to understand what was happening, trying to be the adult between them.”

Later that Christmas morning, John’s father came down the steps to the living room where John and his mom were sleeping. “No one explained,” he says. “My little brother came downstairs and we had Christmas morning as if nothing had happened.”

Not long after, John’s grandmother, “who’d been an enormous source of love for my mom and me,” died suddenly. John says, “It was a terrible shock and loss for both of us. My father couldn’t support my mom or me in our grieving. He told my mom, ‘You just need to get over it!’ He was the quintessential narcissist. If it wasn’t about him, it wasn’t important, it wasn’t happening.”

Today, John is a boyish forty. He has warm hazel eyes and a wide, affable grin that would be hard not to warm up to. But beneath his easy, open demeanor, John struggles with an array of chronic illnesses.

By the time John was thirty-three, his blood pressure was shockingly high for a young man. He began to experience bouts of stabbing stomach pain and diarrhea and often had blood in his stool. These episodes grew more frequent. He had a headache every day of his life. By thirty-four, he’d developed chronic fatigue, and was so wiped out that sometimes he struggled to make it through an entire day at work.

For years, John had loved to go hiking to relieve stress, but by the time he was thirty-five, he couldn’t muster the physical stamina. “One day it hit me, ‘I’m still a young man and I’ll never go hiking again.’”

John’s relationships, like his physical body, were never quite healthy. John remembers falling deeply in love in his early thirties. After dating his girlfriend for a year, she invited him to meet her family. During his stay with them, John says, “I became acutely aware of how different I was from kids who grew up without the kind of shame and blame I endured.” One night, his girlfriend, her sisters, and their boyfriends all decided to go out dancing. “Everyone was sitting around the dinner table planning this great night out and I remember looking around at her family and the only thing going through my mind were these words: ‘I do not belong here.’ Everyone seemed so normal and happy. I was horrified suddenly at the idea of trying to play along and pretend that I knew how to be part of a happy family.”

So John faked “being really tired. My girlfriend was sweet and stayed with me and we didn’t go. She kept asking what was wrong and at some point I just started crying and I couldn’t stop. She wanted to help, but instead of telling her how insecure I was, or asking for her reassurance, I told her I was crying because I wasn’t in love with her.”

John’s girlfriend was, he says, “completely devastated.” She drove John to a hotel that night. “She and her family were shocked. No one could understand what had happened.” Even though John had been deeply in love, his fear won out. “I couldn’t let her find out how crippled I was by the shame and grief I carried inside.”

Bleeding from his inflamed intestines, exhausted by chronic fatigue, debilitated and distracted by pounding headaches, often struggling with work, and unable to feel comfortable in a relationship, John was stuck in a universe of pain and solitude, and he couldn’t get out.

Georgia’s childhood seems far better than the norm: she had two living parents who stayed married through thick and thin, and they lived in a stunning home with walls displaying Ivy League diplomas; Georgia’s father was a well-respected, Yale-educated investment banker. Her mom stayed at home with Georgia and two younger sisters. The five of them appear, in photos, to be the perfect family.

All seemed fine, growing up, practically perfect.

“But I felt, very early on, that something wasn’t quite right in our home, and that no one was talking about it,” Georgia says. “Our house was saturated by a kind of unease all the time. You could never put your finger on what it was, but it was there.”

Georgia’s mom was “emotionally distant and controlling,” Georgia recalls. “If you said or did something she didn’t like, she had a way of going stone cold right in front of you—she’d become what I used to think of as a moving statue that looked like my mother, only she wouldn’t look at you or speak to you.” The hardest part was that Georgia never knew what she’d done wrong. “I just knew that I was shut out of her world until whenever she decided I was worth speaking to again.”

For instance, her mother would “give my sisters and me a tiny little tablespoon of ice cream and then say, ‘You three will just have to share that.’ We knew better than to complain. If we did, she’d tell us how ungrateful we were, and suddenly she wouldn’t speak to us.”

Georgia’s father was a borderline alcoholic and “would occasionally just blow up over nothing,” she says. “One time he was changing a light-bulb and he just started cursing and screaming because it broke. He had these unpredictable eruptions of rage. They were rare but unforgettable.” Georgia was so frightened at times that “I’d run like a dog with my tail between my legs to hide until it was safe to come out again.”

Georgia was “so sensitive to the shifting vibe in our house that I could tell when my father was about to erupt before even he knew. The air would get so tight and I’d know—it’s going to happen again.” The worst part was that “We had to pretend my father’s outbursts weren’t happening. He’d scream about something minor, and then he’d go take a nap. Or you’d hear him strumming his guitar in his den.”

Between her mother’s silent treatments and her dad’s tirades, Georgia spent much of her childhood trying to anticipate and move out of the way of her parents’ anger. She had the sense, even when she was nine or ten, “that their anger was directed at each other. They didn’t fight, but there was a constant low hum of animosity between them. At times it seemed they vehemently hated each other.” Once, fearing that her inebriated father would crash his car after an argument with her mother, Georgia stole his car keys and refused to give them back.

Today, at age forty-nine, Georgia is reflective about her childhood. “I internalized all the emotions that were storming around me in my house, and in some ways it’s as if I’ve carried all that external angst inside me all my life.” Over the decades, carrying that pain has exacted a high toll. At first, Georgia says, “My physical pain began as a low whisper in my body.” But by the time she entered Columbia graduate school to pursue a PhD in classics, “I’d started having severe back problems. I was in so much physical pain, I could not sit in a chair. I had to study lying down.” At twenty-six, Georgia was diagnosed with degenerative disc disease. “My body just started screaming with its pain.”

Over the next few years, in addition to degenerative disc disease, Georgia was diagnosed with severe depression, adrenal fatigue—and finally, fibromyalgia. “I’ve spent my adult life in doctors’ clinics and trying various medications to relieve my pain,” she says. “But there is no relief in sight.”

Laura’s, John’s, and Georgia’s life stories illustrate the physical price we pay, as adults, for childhood adversity. New findings in neuroscience, psychology, and medicine have recently unveiled the exact ways in which childhood adversity biologically alters us for life. This groundbreaking research tells us that the emotional trauma we face when we are young has farther-reaching consequences than we might have imagined. Adverse Childhood Experiences change the architecture of our brains and the health of our immune systems, they trigger and sustain inflammation in both body and brain, and they influence our overall physical health and longevity long into adulthood. These physical changes, in turn, prewrite the story of how we will react to the world around us, and how well we will work, and parent, befriend, and love other people throughout the course of our adult lives.

This is true whether our childhood wounds are deeply traumatic, such as witnessing violence in our family, as John did; or more chronic living-room variety humiliations, such as those Laura endured; or more private but pervasive familial dysfunctions, such as Georgia’s.

All of these Adverse Childhood Experiences can lead to deep biophysical changes in a child that profoundly alter the developing brain and immunology in ways that also change the health of the adult he or she will become.

Scientists have come to this startling understanding of the link between Adverse Childhood Experiences and later physical illness in adulthood thanks, in large part, to the work of two individuals: a dedicated physician in San Diego, and a determined medical epidemiologist from the Centers for Disease Control (CDC). Together, during the 1980s and 1990s—the same years when Laura, John, and Georgia were growing up—these two researchers slowly uncovered the stunning scientific link between Adverse Childhood Experiences and later physical and neurological inflammation and life-changing adult health outcomes.

In 1985 physician and researcher Vincent J. Felitti, MD, chief of a revolutionary preventive care initiative at the Kaiser Permanente Medical Program in San Diego, noticed a startling pattern: adult patients who were obese also alluded to traumatic incidents in their childhood.

Felitti came to this realization almost by accident. In the mid-1980s, a significant number of patients in Kaiser Permanente’s obesity program were, with the help and support of Felitti and his nurses, successfully losing hundreds of pounds a year nonsurgically, a remarkable feat. The program seemed a resounding success, up until a large number of patients who were losing substantial amounts of weight began to drop out. The attrition rate didn’t make sense, and Felitti was determined to find out what was going on. He conducted face-to-face interviews with 286 patients. In the course of Felitti’s one-on-one conversations, a striking number of patients confided that they had faced trauma in their childhood; many had been sexually abused. To these patients, eating was a solution: it soothed the anxiety, fear, and depression that they had secreted away inside for decades. Their weight served, too, as a shield against unwanted physical attention, and they didn’t want to let it go.

Felitti’s conversations with this large group of patients allowed him to perceive a pattern—and a new way of looking at human health and well-being—that other physicians just were not seeing. It became clear to him that, for his patients, obesity, “though an obvious physical sign,” was not the core problem to be treated, “any more than smoke is the core problem to be treated in house fires.”

In 1990, Felitti presented his findings at a national obesity conference. He told the group of physicians gathered that he believed “certain of our intractable public health problems” had root causes hidden “by shame, by secrecy, and by social taboos against exploring certain areas of life experience.”

Although Felitti’s peers blasted him for his presentation—one stood up in the audience and accused Felitti of offering “excuses” for patients’ “failed lives”—Felitti was unfazed. At that conference, a colleague and epidemiologist from the CDC advised Felitti that if what he was saying was true, it had enormous import for medicine in general. He suggested that Felitti set up a study with thousands of patients suffering from all types of diseases, not just obesity. Felitti agreed. Indeed, he suspected that a wide-scale study would reveal a larger societal health pattern: a link between many types of childhood adversity and the likelihood of developing a range of serious adult health problems.

Felitti joined forces with the CDC. At that time, the Health Appraisal Division of Kaiser Permanente’s Department of Preventive Medicine was providing unusually comprehensive medical exams and evaluations to fifty-eight thousand adults a year. One of the CDC’s medical epidemiologists, Robert Anda, MD, who had been researching the relationship between coronary heart disease and depression, visited the clinic in San Diego. And he recommended that Felitti turn it into a national epidemiology laboratory. With such a vast patient cohort, they might be able to discover if patients who experienced different types of adverse experiences in childhood were more likely to suffer from adult diseases such as heart disease, autoimmune disease, and cancer.

Felitti and Anda asked twenty-six thousand patients who came through the department “if they would be interested in helping us understand how childhood events might affect adult health,” says Felitti. More than seventeen thousand agreed.

Drawing upon Felitti’s original 286 interviews, Anda conceptualized and designed a new study, adding additional survey questions to Felitti’s existing patient questionnaires. These questions focused on ten types of adversity, or Adverse Childhood Experiences (ACEs), and probed into patients’ childhood and adolescent histories.

The first five questions were personal; they had to do with emotional and physical stressors a patient might have faced as a child or teenager. These included having had a parent who insulted, humiliated, or made the child feel emotionally afraid; hit, pushed, or slapped them; or touched them sexually. These questions also included feeling that no one in the family thought the patient was important or that the family members didn’t look out for one another; feeling there was no one to provide protection; or being neglected to the point of not having clean clothes or enough food, or not being taken to the doctor when ill.

The next five questions had to do with other family members—the specifics of one’s household situation while growing up: loss of a parent due to separation or divorce; witnessing one’s mother being hit, grabbed, threatened or beaten; someone in the home suffering from alcoholism or another addiction; someone in the home suffering from depression or another mental or behavioral health problem, or being suicidal; or a family member being sent to prison. After the interviews, each participant in Felitti and Anda’s study was assigned an ACE Score corresponding to the number of categories of adverse or traumatic events he or she had experienced while young.

In one way or another, all ten questions spoke to family dysfunction.

And with these ten questions, the Adverse Childhood Experiences Study was born.

If you have also taken the Adverse Childhood Experiences questionnaire for yourself, now might be an excellent time to turn back to it on page xxi. It might prove helpful to you in further understanding yourself and your health.

The patients Felitti and Anda surveyed were not troubled or disadvantaged; the average patient was fifty-seven, and three-quarters were college educated. These were “successful” men and women with good educations, mostly white, middle class, with health benefits and stable jobs. The scientist expected that the number of “yes” answers on the Adverse Childhood Experiences Survey would be fairly low.

But the number of “yes” answers turned out to be far higher than anyone had predicted. Two-thirds—64 percent—of participants answered yes to one or more categories, meaning they had experienced at least one of these forms of childhood adversity before turning eighteen. And 87 percent of those who answered yes to one ACE question also had additional Adverse Childhood Experiences. Forty percent had experienced two or more categories of Adverse Childhood Experiences, and 12.5 percent had an ACE Score of 4 or more.

Only a third of participants had an ACE Score of zero.

Felitti and Anda wanted to find out whether there was a correlation between the number of categories of Adverse Childhood Experiences each individual had faced and the degree of illness and physical disorders he or she developed as an adult.

Indeed, the correlation proved so powerful that Anda was not only “stunned,” but deeply moved.

“I wept,” Anda says. “I saw how much people had suffered and I wept.”

Felitti was also deeply affected. “Our findings exceeded anything we had conceived. The correlation between having a difficult childhood and facing illness as an adult offered a whole new lens through which we could view human health and disease.”

Here, says Felitti, “was the missing piece as to what was causing so much of our unspoken suffering as human beings.”

How many categories of Adverse Childhood Experiences patients had encountered could by and large predict how much medical care they would require in adulthood: the higher one’s ACE Score, the higher the number of doctor visits they’d had in the past year, and the higher their number of unexplained physical symptoms.

People with an ACE Score of 4 were twice as likely to be diagnosed with cancer than someone with an ACE Score of 0. For each ACE Score an individual had, the chance of being hospitalized with an autoimmune disease in adulthood rose 20 percent. Someone with an ACE Score of 4 was 460 percent more likely to be facing depression than someone with a score of 0.

An ACE Score of 6 and higher shortened an individual’s life-span by almost twenty years.

Felitti and Anda wondered if they were finding this strong correlation because individuals who had been traumatized in childhood were more likely to smoke, drink, and overeat as a sort of self-coping strategy to manage chronic anxiety—and this accounted for their poorer health. But while these unhealthy coping mechanisms were common, they were not the main explanation. For instance, those with ACE Scores of 7 or higher who didn’t drink or smoke, and who weren’t overweight, diabetic, and didn’t have high cholesterol, still had a 360 percent higher risk of heart disease than those with an ACE Score of 0.

The chronic stress of emotional or physical adversity these adults had experienced when they were growing up was making them ill decades later—even though they had healthy habits and lifestyles. In a few years (as we will see in Chapter Two) scientists would discover the precise mechanisms by which this early stress converted into biomedical disease. But the overall pattern was undeniable.

“Time,” says Felitti, “does not heal all wounds. One does not ‘just get over’ something—not even fifty years later.” Instead, he says, “Time conceals. And human beings convert traumatic emotional experiences in childhood into organic disease later in life.”

Often, these illnesses can be chronic and lifelong. Autoimmune disease. Heart disease. Chronic bowel disorders. Migraines. Persistent depression. Even today, doctors puzzle over these very conditions: why are they so prevalent; why are some patients more prone to them than others; and why are they so difficult to treat?

At seventy-nine, Felliti has a full head of silver hair and salt-and-pepper eyebrows, and has, with Adna, coauthored seventy-four more papers based on the Adverse Childhood Experiences Study. He and Anda are widely regarded as the scientific fathers of the extensive body of research that has led to a global understanding that adverse childhood events can change people’s biology and lead to chronic illness and negative health effects over their life-span. Today, more than 1,500 studies cite ACE research and the World Health Organization now utilizes the Adverse Childhood Experiences questionnaire in fourteen countries to help screen for emotional distress and trauma that might lead to poor health. In the United States, twenty-nine states and Washington, DC, are using the ACE questionnaire to help improve public health.

The more research that’s done, the more granular details emerge about the profound link between adverse experiences and adult disease. Scientists at Duke, the University of California, San Francisco, and Brown have shown that childhood adversity damages us on a cellular level in ways that prematurely age our cells and affect our longevity. Adults who faced early life stress show greater erosion in what’s known as telomeres—which are protective caps that sit on the ends of strands of DNA to keep DNA healthy and intact. As telomeres erode, we’re more likely to develop disease, and we age faster. As our telomeres age and expire, our cells expire, and eventually, so do we.

Researchers have also seen a correlation between specific types of Adverse Childhood Experiences and a range of diseases. For instance, children whose parents die, or who face emotional or physical abuse, or experience childhood neglect, or witness marital discord between their parents are more likely to develop cardiovascular disease, lung disease, diabetes, headaches, multiple sclerosis, and lupus as adults. They are more likely to develop cancer or have a stroke. Facing difficult circumstances in childhood increases sixfold your chances of having chronic fatigue syndrome, also known as myalgic encephalomyelitis, as an adult. Kids who lose a parent have triple the risk of depression as adults. Children whose parents divorce are twice as likely to suffer a stroke at some point in their lifetime.

Kat was five years old when her mom left her father. Her mom had good reason to end her marriage. Kat recalls that during one of her parents’ arguments, “my father ripped my mom’s glasses off her face, threw them on the ground, and crushed them under his heel.”

One day, Kat’s mom drove her to her father’s carpet-cleaning business. When they arrived, her mother told her to stay put in the “way way back” of their wood-paneled station wagon. “I’ll be back in a minute,” she told her five-year-old daughter. “I need to talk to your father.” Kat remembers lying there happily and coloring in a book. Sometime later, Kat thought she heard a scream. Startled, she looked up and realized that her mom wasn’t back. She didn’t know how much time had passed, but she was hot, hungry, and suddenly wanted her mom. She climbed out of the car and walked to the building. The front door was locked, so Kat walked over to the side window and stood on her tippy-toes to see inside for any sign of her mom or dad.

Beyond the lobby, she could see the glass door to her father’s office. Through it, she saw her mother’s feet and ankles on the floor—“as if she were facedown on the carpet. She wasn’t moving. So I tried the door but it was locked. I tried it again. No one heard me. No one came. I ran back to the station wagon and locked myself inside.”

When her father came out to the car a few minutes later, he told her, “Your mom got caught up on the phone, Kitty.” He smiled and said, “I’m taking you to my place.” Kat got out of the station wagon and into her dad’s car. “As he drove us to his town house, he kept