Fear is a part of everyday life, for all of us. We worry about the mortgage, about the way we look, whether we'll be fired. We worry whether we'll be able to take the kids on vacation, or how we'll afford to pay the bills. The fact is, the more stressed we are, the less healthy we are. Doctors and scientists point out parallels between our growing rates of trauma and questionable decision making, and the fact that they're leading to greater rates of obesity, diabetes, heart disease and high cholesterol. But when it comes to children, the effects of trauma can be much, much worse.
"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.