Neuroscience

“Scared Sick: The Role of Childhood Trauma in Adult Disease,” the new book by Robin Karr-Morse and Meredith S. Wiley (respectively, a family therapist and a nonprofit worker with a background in family policy), explains just how profoundly babies and young children are affected by traumatic experiences. In the remarkably researched work, the two women show that early life malnutrition and abuse can affect a kid’s nervous system well into adulthood. Children raised in traumatic environments are more prone to cancer, chronic pain and even diabetes. The duo’s previous book, “Ghosts From the Nursery,” looked at the childhood roots of violence, but this new work is no less significant in its conclusions about American culture.

Salon spoke to Karr-Morse over the phone from Oregon about, among other things, trauma during pregnancy, its effect on later life — and what her findings mean for the future of America.

The subtitle of your book is “The Role of Childhood Trauma in Adult Disease.” What do you consider trauma?

A lot of people think of trauma as a physical occurrence, as big events: earthquakes or disasters, car accidents and so on. In the book, we are talking about emotional trauma very early in life — in the prenatal months and the first three years. We talk about what happens to a fetus and an early developing brain when there is chronic emotional trauma. In the case of the fetus, this trauma happens to the mother.

Central to this is something called the HPA axis, which is composed of the hypothalamus, the pituitary gland and the adrenal gland. What is it, and why does it matter?

There are two pieces of information that really provide the bridge to understand the connection between emotional trauma and adult disease, and the HPA axis is one of those pieces. The other is epigenetics. It starts with the hypothalamus in the brain, so that when we perceive any kind of threat to ourselves through the senses, through eyes or ears or nose or touch or whatever, that message comes into the brain and hits the hypothalamus. Then hypothalamus sends the message to the pituitary gland, which sits just below it, which in turn sends the message to the adrenal glands, which sit on top of each of the kidneys. This generates the flow of adrenaline and cortisol in the body. Adrenaline and cortisol are the hormones of stress. So there’s a connection between the hypothalamus, the pituitary, which is part of the endocrine system, and the adrenal gland, which is part of the immune system. That means that what happens to us emotionally affects our immune and endocrine functions.

When that happens early in life and chronically, it disregulates that whole system. “Trauma” means that stress is occurring over and over again chronically, so the HPA gets revved up and stays in the red zone. It upsets literally all of our physiology, activating the genetic proclivity we might have for whatever disease, setting the stage for it in the beginning, and oftentimes those systems don’t appear later in our lives until after our reproductive years. There is often a total disconnect between those diseases and its root in early chronic emotional trauma.

One of the ways children deal with trauma is that they simply freeze and become unresponsive. What is happening when that occurs?

Freeze is the signature of trauma. When we are upset, we go into fight/flight; the system is designed to enable our whole body to fight or flee. So our hearts pump, our breathing goes rapid and often shallow, our hands perspire, our stomachs tighten. Basically, our digestive systems stop and adrenaline shoots blood and enables oxygen to all of the limbs in the body to fight or flee, but if that happens over and over and over again, and you’re a baby and you can’t fight or flee, fight/flight becomes trauma or freeze state. It’s sort of like an electrical current, an outlet that is overwhelmed. The baby goes into freeze state, no longer crying, screaming, but rather sort of frozen and dissociated and removed from reality. It’s nature’s anesthesia to numb the brain and numb in preparation for death. But in a brand-new little nervous system, it doesn’t take a lot to put a baby into trauma or freeze state. With a brain that has developed normally and in a protected fashion, and then hits trauma later in life, we have one set of outcomes; but with a tiny baby, when this happens routinely, they can spend a great deal of time in frozen or dissociative trauma state.

So why is this trauma so much more significant when it happens to babies or young children than for adults?

That’s a really good question. The answer is that it’s in this prenatal period and in the first two to three years that the brain is developing structurally and chemically, so the whole rhythm of the brain, the chemical regulation of the brain, is set up then. If that little brain is set up with a great deal of trauma or chronic stress, the HPA axis is going to be activated chronically, and it truly disregulates everything. One of the things that they found out, for example, about post-traumatic stress was [in] soldiers returning from Afghanistan and Iraq: There’s a real difference in how people have experienced these violent scenes of blood and warfare. It appears as though there is a correlation between people who have come back with PTSD and early childhood trauma versus those who come back, obviously with terrible difficulties from having seen this, but not with post-traumatic stress.

And you use the metaphor of kindling to describe how this plays itself out.

It’s really not my term, that’s really Dr. Rob Scaer’s term, and I think he could explain it much more clearly than I can, but basically it’s the concept that the brain, once alerted or once becoming hypervigilant, tends to go into that trauma state much more quickly or tends to go into a reactivity or hypervigilance much more quickly. What early chronic exposure does is set the stage for the kindling process. It’s a way of describing the fact that a person who has had early chronic trauma is much more susceptible to later reactivity to stressful events.

What kind of traumas are we talking about when it comes to pregnancy?

There are two categories. One of them is hunger. If the mother is not getting adequate nutrition, the fetus may grow and form normally, but it will be compromised in terms of the number of cells in the various organs, so that the baby may be born at a low birth weight, fully formed and looking normal, but in reality the kidneys can have fewer nephrons, the heart can have fewer cells, and so on. So that it’s sort of like planned obsolescence when that individual reaches their reproductive years; their organs literally begin to fall apart, begin to wear much more quickly than organs that have been formed more fully. A second form is maternal stress, and that surprised us. We know that it’s common for women in pregnancy to be stressed, but to be extremely stressed chronically, where the mother’s HPA axis is already chronically on fight/flight, means that the baby is growing in an environment that is bathing in far too much cortisol. And that can have a tremendous influence on the nervous system of the fetus, so that baby, from birth, might be susceptible or hypervigilant or vulnerable to any form of stimulation, because their nervous system is set on high.

So what kind of things would trigger this in the mother? You mention poverty and war in the book.

Well ,you know, even in poverty and war, if she is part of a support system that anchors her or grounds her or protects her… but the studies have been done on women who have lived through concentration camps, have lived through violent histories with their partners, the children who have survived the Holocaust. Even the following generation can be still affected.

What kinds of traumas affect young children once they are born?

The research on this is prolific. A traumatic birth can certainly set off a series of problems: being born too soon, prematurity, and a stint in the NICU [neonatal intensive care unit]. Maternal depression is very profound, has a huge impact: as profound an impact as child abuse on that little brain. It can be caused by ongoing maternal neglect or family neglect. The attachment process early in life is really the hub, the core of that baby learning how to self-regulate its own nervous system. When it’s interrupted over and over again, as it is for infants who are left in various forms of childcare with neighbors, friends, catch as catch can, that’s a huge problem. So those are just a few examples from early in our lives that can set that little nervous system on high. One of them alone does not do this, and it’s terribly important that people realize that even when the mother is stressed, if things settle down, and the baby goes home with mom who moves into a more relaxed state and develops a strong stable environment for the baby and herself, that’s fine.

Prematurity, similarly, all by itself is a problem and it’s certainly associated with emotional and learning disabilities later, but that’s because so often prematurity accompanies or occurs in conjunction with issues like poverty and all kinds of stressors on the mom: drug abuse, mental illness, separation, single parenthood, teen parenthood and so on.

So what kinds of disease does this early trauma cause in people once they are grown?

Some of the really obvious ones are fibromyalgia and IBS, irritable bowel syndrome. Gut problems, chronic back pain, many forms of arthritis, cardiovascular issues, are probably the ones that occur to me first. Often times in chronic pain. Many of the subtler problems like fibromyalgia and many forms of chronic pain are diseases that doctors are flummoxed by. They don’t understand where the source of the problem is. It doesn’t appear to be genetic. The bridge to really understanding that is the adverse-childhood-experience study, the Felitti and Anda study that I mentioned in “Scared Sick,” that mentioned the histories of 58,000 Kaiser Permanente patients and correlated their middle-age health issues with the number of what they called adverse childhood experiences. It asked people specific questions like, “Was anyone in your family incarcerated in this period of time in your life?” It asks about child abuse, it asks about neglect, it asks about addiction, it asks about very specific issues early in life. And the correlations between the number of early childhood experiences and certain diseases is shocking. Cardiovascular being the glowing one, but some forms of cancer, some forms of arthritis, and as I say, gut and intestinal problems.

In the last few years, there’s been a big pushback against helicopter parenting. Is this an argument for or against that?

I kind of agree with the pushback against helicopter parenting. I spend my daytimes as a family therapist, working with people every day, with kids who are being thrown out of preschool for biting, kicking, hitting other kids, or who are having trouble learning for all kinds of reasons. That’s what I do for a living, and I work with families with children. We have many families in this country where the inmates are running the asylum: The children are running the family. And if children grow up thinking that they are the absolute center of the universe, and adults are abdicating their role of providing cortical-brain-based decent decision making and boundaries for kids, I do think that’s very troubling. But this is not what we are talking about here. We are talking about recognition of the fact that early in life, in pregnancy and early life for a child, we need a calm and balanced nervous system to guide and shape and build a calm and balanced nervous system in a baby. So I don’t see a conflict.

We also live in a modern society with a lot of advantages that humans in previous centuries and thousands of years did not. Children in the Stone Age were exposed to a tremendous amount of trauma on a daily basis. Doesn’t that suggest we should have evolved to deal with this by now?

They experienced stress for certain. Potentially trauma, yes. But the reality was that in place was a family, in place was a tribe, in place was a village that provided the stability and the regular protection of that little nervous system. A child might be traumatized by a saber-tooth tiger or whatever your fantasy is, but the familial system and the extended family were in place to pull that kid in. There was no, “Oh, that’s that person’s kid, I won’t touch them because I might get sued.” That provides some of the pieces of attachment that are so critical to building that little nervous system competently.

Given the sort of correlation between poverty and a higher incidence of potential trauma, this has real implications for the class system in the U.S. It shows how hard poverty works to keep itself alive.

That’s entirely correct. The reality is that we are a nation of idiots about infancy. We are the only postindustrial First World nation that hasn’t signed the U.N. rights of the child. We have a huge black eye in our nation regarding our rate of child abuse  and neglect. Our rate of incarceration is the greatest in the history of the world, and our childcare system in this country is deplorable still. It is simply not keeping up with the need. We have this wonderful catchphrase about leaving no child behind. Well, we’re leaving a lot of children behind.

It’s so much cheaper to build healthy kids than to fix broken adults. It’s so much cheaper in financial terms and more humane to attend to the front end, but we absolutely have huge pieces in place to keep that from happening. We have huge lobbies for the existing incarceration system, huge lobbies for the existing late-stage medical system, drug system, drug companies and so on. What can we do, really, that makes a difference? Certainly for ourselves there are some things to be done if we realize that trauma is at the root. There are some very different implications for adult health than we are currently practicing in Western medicine. If we recognize that that’s true for the babies we know about in this crazy world, there are some things that we can do that can set up our children and grandchildren for a very different future.

Two fundamental American ideals are that you can pull yourself out of any hardship no matter your background, and that whatever doesn’t kill us makes us stronger. Your findings go against this.

You are exactly right. What you need to understand first of all is that the human nervous system runs the world for better or for worse.  Genes do not explain the realities of the rates of disease we are seeing. The new information out of epigenetics, out of the Human Genome Project, is that DNA is only a part of a gene. Circulating around DNA are these proteins whose whole job is to sense the environment and then work with the DNA to express or repress pieces of DNA to enable that organism to survive the environment. So if the environment is stressful, or a mother is hungry, the epigenetic influences are profound from the very beginning of life. We are talking about issues like preserving the environment, and war, and health, but if our kids’ brains are disregulated from the beginning, we aren’t going to have that critical mass of people to think about and shape our future.

In his new book, “Too Big to Know,” David Weinberger, a senior researcher at Harvard’s Berkman Center for Internet and Society, attempts to answer that question by looking at the ways our newly interconnected society is transforming the media, science and our everyday lives. In an accessible yet profound work, he explains that in our new universe, facts have been replaced by “networked facts” that exist largely in the context of a digital network. As a result, Weinberger believes we have entered a new golden age, one in which technology has finally caught up with humans’ endless curiosity, and one that has the potential to revolutionize a wide swath of occupations and research fields.

Salon spoke to Weinberger over the phone about the rise of the information cloud, the demise of expert knowledge, and why this is the greatest time in human history.

In the book you mention the “smartest guy in the room” metaphor. According to your book, that’s an outdated metaphor. Now it’s the room itself that’s smart.

In the West we’ve pegged knowledge to what fits in books or gets written down. That’s been our medium for preserving and communicating knowledge. Because books are written by individuals, it has often made knowledge seem like the product of individuals, even though everybody has always understood that individuals are working within the social network. With the new medium of knowledge — the Internet — knowledge not only takes on properties of that medium but also lives at the level of the network. So rather than simply trying to cultivate smart people, we also need to be looking above the level of the individual to the network in which he or she is embedded to see where knowledge lives.

Historically, we have thought of knowledge as something that experts have on a given topic. We call on experts to explain things to us, on TV or in the news. How is this changing?

In the West, knowledge begins as a winnowing process. It goes back to ancient Greece, where the rich, free menfolk were debating politics and steering the state. Many opinions were expressed, but only some of them were true, so knowledge became the winnowing of those opinions defined to be rare gems of truth. That idea — that knowledge is what makes it through a winnowing process — not by coincidence fits perfectly with the paper medium that we used for it. Paper is expensive, libraries are small, very few people can get published. So we’ve thought of knowledge as that which makes it through a very small aperture.

Some people have described this process as a pyramid.

In 1988, Russell Ackoff, an organizational theorist, proposed a pyramid that has become really standard in many business environments. You have data at the bottom, then information, and then knowledge — and then at the top, wisdom, as if wisdom is the reduced set of knowledge. The idea is in line with our traditional idea of knowledge, which is based on the idea that there’s too much to know, there’s more than can fit into any skull, so we need to come up with strategies to deal with it. And that pyramid is the information age’s elaboration of this. In every step you get quality and value by reducing what was at lower steps, but we’ve had a reductive sense of knowledge for about 2,500 years.

In the last few years, there’s been concern that the Internet is giving us far more information than our brain can handle. But that’s not a new concern…

Yes. Clay Shirky very pithily said a few months ago, “There’s no such thing as information overload — only filter failure.” I think Clay was partly trying to provide some historical continuity so that we shouldn’t feel like we need to freak out, that we have faced this same issue over and over again, and we need to fix our filters. But filters work differently in the digital age. Physical filters work by removing that which doesn’t make it through the filter, whether it’s the manuscripts that get sent to publishers or journals that never see the light of day, or books that don’t make it into the library, or coffee grinds. Digital filters don’t remove anything; they only reduce the number of clicks that it takes to get to something.

So by “filter” you’re referring to things like, for example, a blog post about the “top 10 magazine articles of 2011.”

Yes, exactly. In the digital age we filter forward instead of filtering out. As a result, all that material is still available to us and to others to filter in their own ways, and to bring forward in other contexts. That is a very significant difference. You may filter those 10 articles, but all the other ones will still show up in a search, or tomorrow you may get them in an email from a friend or Google+ recommending that particular link. Nothing is removed. It’s all there and available. That is a huge difference.

You talk about the rise of the networked fact. What is that?

Over the past couple hundred years, we’ve had this idea that knowledge is composed of facts about the world, and together we are engaged in this multigenerational enterprise of gathering facts and posting them, and ultimately we’ll have a complete picture of the world. That view of facts as the irreducible atoms of knowledge has some benefit, but we’re seeing a different type of fact emerge on the Net as well. Traditional facts are still there. Facts are facts. But we’re seeing organizations of all sorts releasing their data, their facts, onto the Web as huge clouds of triples [another word for linked data]. They’re a connection of two ideas through some relationship — that’s why they’re called triples — but not only can they be linked together by computers, they themselves consist of links. Each of the elements of a linked atom is a pointer to some resource that disambiguates it and explains what it is.

Let’s think of an example of a fact.

OK. I’m in Edmonton, Canada, right now, so let’s say: “Edmonton is in Canada.”

OK, so, if the triple is “Edmonton is in Canada,” ideally each of those should link to some other spot on the Web that explains exactly which Edmonton, because there’s probably more than one, along with which Canada (though there’s probably only one). And “is in” is a very ambiguous statement, so you would point to some vocabulary that defines it for geography. Each of these little facts is designed not only to be linked up by computers, but it itself consists of links. It’s a very different idea than that facts are bricks that lay a firm foundation. The old metaphor for knowledge was architectural and archaeological: foundations, bricks. Now we have clouds.

One of the advantages of networked thinking is that we can harness diverse opinions in a way that was impossible before. Why is this important?

We’ve known for a long time, and I think culturally we’ve accepted, that diversity is an important thing in the work of knowledge. Doris Kearns Goodwin’s “Team of Rivals” takes Lincoln’s Cabinet as an example. Knowledge was traditionally about driving out difference and settling things, and not coincidentally the medium of knowledge was amenable to that. If you print a book, you can’t really change it. Books settle things, and so does knowledge. We don’t say we know something if there is significant debate about it. We have viewed diversity as a path to settling things and believe we get the best results if we have a diverse set of people.

But in the networked world that’s shifting a bit. It’s not simply that diversity is a good means to the ends of knowledge, but knowledge consists of a network of people and ideas that are not totally in sync, that are diverse, that disagree. Books generally have value because they encapsulate some topic and provide you with everything you know, because when you’re reading it you cannot easily leap out of the book to get to the next book. The Web only has value because it contains difference. When I link to you, I’ll say why I am linking to you and I’ll explain what the difference is between the site you’re currently reading and what I’m pointing you at. We are beginning to think of knowledge itself as having value insofar as it contains difference.

Some writers won’t hyperlink their pieces on principle, because they think it ruins the reading experience.

There are lots of ways to write, and people should write the way they want to. But if an author posts something that has no links out, it nevertheless becomes a part of the Web — other people will link to it and say what they think about it. There’s no escaping that now. But I should acknowledge I wrote a paper book. There are no hyperlinks in the paper book. There are URLs, but you can’t click on them, so apparently I do think there is still some value in writing in non-linked media.

But parts of your book are probably going to make their way online.

And I blogged about many parts of it and discussed it in my course, so it is a continuous process. Nevertheless, especially for people of my generation, books still count.

In the book you explain that one of the advantages of the Web is that it is cumulative, by which you mean that online facts will never go away. But if someone posts something that says “Thomas Rogers shot someone’s dog,” the Internet will never let me live that down, despite the fact that it’s untrue. Isn’t that a reason to be worried?

All of these blessings are highly mixed, but the good part about the Internet being cumulative is that we don’t have to take special steps in order to preserve that which is of value even if it is of minimal value, is tiny or insignificant, or only has value when it’s aggregated with tons of other pieces that may in themselves have no intrinsic value. You used to have to go to great lengths to preserve that stuff and to make it public. The Net lowers the hurdle for what we record. The good side of it is that we’re able to go through that and discover what escaped us. The bad part is that we can discover stuff that would have escaped malevolent eyes.

One of the characteristics of the Web seems to be the flattening of news. If you look at a site like Buzzfeed, it has reports about the death of Kim Jong Il right next to viral videos about cats. It’s jarring — and seems a little amoral.

You are pointing to the benefits of having a very small aperture for news. That aperture was controlled by full-time professional editors, but it means that what comes through the news hole now is anything anybody is interested in enough to post. On the other hand, when you have so few apertures for news and they’re controlled by such a similar set of people, you get a certain limited set of stories. We at least now have the opportunity to create filters that let in more than the traditional room of middle-aged white men. If we’re not reading the stuff that matters, it’s our fault.

Sites like Buzzfeed or reddit that are aggregating based upon user suggestions reflect what users are interested in. It turns out that we’re interested in is a pretty broad range of stuff, and most of it isn’t all that serious. A lot of it is just funny or in some cases distasteful, but it turns out that is what we’re interested in. The challenge is trying to educate our interests, but that’s what education is about.

In the book you talk quite a lot about Darwin as an example of an old-school information gatherer. What would a modern-day Darwin look like?

I use Darwin throughout the book because there’s no arguing with him as a deep and wonderful thinker. Darwin is also a peculiarly good example because he was so reluctant to write; he remained relatively private about his theory for decades and published only when somebody else, Wallace, was on the verge of beating him to it. So here we have Darwin working alone and talking with a refined social network (he had colleagues who were very important and helpful to him), but working slowly, spending seven years working to determine a single fact: whether barnacles were crustaceans or mollusks. The first five chapters of “The Origin of Species” explain his theory, and the next six chapters deal with objections that either had been raised or he imagines would be raised.

Darwin today would not be operating this way. He would very likely be tweeting from the Beagle. He would be announcing his findings and initial ideas online, and people would be arguing with him all along, taking his ideas, applying them elsewhere, pushing back, criticizing him deeply — all of the things we do on the Web. That work has revolutionary, incredible value, but put into the Web, it gets teased out, amplified, corrected, as well as misunderstood and degraded. Nevertheless, that Web itself has more value than the individual content, so I would expect that Darwin today would be gathering his data from clouds of linked data, trying out ideas on the Web, and drawing those ideas in the tussle. The old rhythm of knowledge and science not coincidentally is the rhythm of publishing. The Web has completely broken that rhythm.

Do you think all of these changes are good or bad?

It’s both good and bad. It’s both impossible and unhelpful to ask if it’s making us smarter or stupider. But I am actually very hopeful. Ask anybody who is in any of the traditional knowledge fields, and she or he will very likely tell you that the Internet has made them smarter. They couldn’t do their work without it; they’re doing it better than ever before, they know more; they can find more; they can run down dead ends faster than ever before. In the sciences and humanities, it’s hard to find somebody who claims the Internet is making him or her stupid, even among those who claim the Internet is making us stupid. And I believe this is the greatest time in human history.

That’s a very lofty statement.

I’m pretty confident about that one, actually. Curiosity can lead you to lots of bad directions. It can steer you wrong and waste your time, but it is fundamental. We need it more than anything else if we’re going to try to understand our world. Now we have a medium that is as broad as our curiosity.