Vincent Felitti, a Kaiser Permanente physician in San Diego in the 1990s, had a radical idea. Instead of just asking patients about their symptoms, what would happen if doctors asked them about their childhoods?
His hypothesis, built on a hunch informed by experience, was that childhood trauma was connected to poor health later in life. Felitti helped lead an exhaustive study of 17,000 patients that seemed to confirm his theory.
That was in 1998. But for years Felitti’s study and his conclusions had little impact, even at Kaiser. The findings were common sense and hardly disputable. But no one seemed to know what to do with them. And many doctors, comfortable with medical procedures and prescribing drugs, were reluctant to cross over into what seemed like psychology.
Now all of that is changing. More and more studies have shown that health and longevity are determined largely by things that happen outside of doctors’ offices and hospitals. Where and how we live and work and play are crucial.
This newfound appreciation for prevention has put Felitti’s work in the spotlight. A recent study by the California Department of Public Health examined the possible effect of 12 “adverse childhood experiences,” including parents divorcing, witnessing domestic abuse or being the victim of emotional or physical violence. That study found that people with at least four of those experiences had twice the likelihood of heart disease and cancer and more than double the risk of stroke compared to those with just one or no adverse experiences.
“There’s been an upsurge of interest across the country,” says Barbara Stern, a Sacramento marriage and family therapist helping to coordinate an awareness and education campaign in the region. “There’s an interest in trauma-informed practices in all aspects of society.”
How can being more aware of childhood experiences change health care?
Felitti found that simply asking adult patients about their childhood trauma and letting them talk about it might help alleviate chronic illness. Others have developed new ways of dealing with school discipline. If a child’s disruptive behavior stems from years of abuse or other trauma at home, simply suspending him or her will do little to fix the problem.
But if teachers and school authorities delve into what’s causing the behavior, there are tools they can use to help children understand their issues and gain more self-control.
Last year a local group screened the documentary film “Paper Tigers” at the Crest Theater and held a workshop for teachers. The San Juan Unified School District has embraced the idea, and Stern is working with Sacramento City Unified School District to try to use the research about adverse experiences to change its discipline practices.
One way to address the effects of childhood trauma is to practice what is known as “mindfulness” – a form of meditation that helps a person be more aware of what is going on with their mind and body, and learn to relax and think more clearly. There is some evidence that mindfulness can help people deal with chronic illness.
Felitti said resistance to his ideas is wearing down the same way the skeptical medical community eventually embraced the germ theory or anesthesia. But old ways are tough to change.
“We’ve all been very subtly and effectively taught as children that nice people don’t talk about certain things, and certainly don’t ask,” he said.
Daniel Weintraub is editor of the California Health Report. He can be contacted at firstname.lastname@example.org.