Tuesday, September 30, 2014
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Recognizing the Consequences of Childhood Stress. Are WE There Yet?

The American Academy of Pediatrics two weeks ago officially recognized the harmful effects of childhood trauma, toxic stress, and adversity on health and development. The question is, will anybody listen?

Recognizing the Consequences of Childhood Stress. Are WE There Yet?

Sigmund Freud actually got it, but then changed his mind . . .
Sigmund Freud actually got it, but then changed his mind . . .

Perhaps the American Academy of Pediatrics (AAP) is following through on a New Year’s resolution to save the world.

Two weeks ago, the AAP issued a policy statement and technical report about the harmful effects of childhood trauma, toxic stress, and adversity on health and development. This is no small feat, as medical associations like the AAP typically don’t support much of anything unless it’s backed by indisputable scientific evidence. In effect, the AAP’s statement validates decades of research indicating that substantial gains in public health will require us to address the seemingly intractable problems of poverty, community violence, and child abuse—not just give people more pills, doctors, and better insurance.

The scientific evidence supporting this public health imperative is there, and now valorized by the AAP, but it is unlikely to go much further unless the social and political climate supports it. As history tells us, this wouldn’t be the first time that scientific findings on the deleterious effects of trauma failed to gain traction.

In 19th century France, Jean-Martin Charcot was a star. In front of crowds at the famed Salpêtrière Hospital, Charcot would press on the abdomens of his “hysteric” female patients as they would writhe, flail, and exclaim nonsensical remarks. While Charcot had no interest in the cause of their condition, two of his protégés did: one was Pierre Janet; the other was Sigmund Freud.

Freud set up shop in Vienna and Janet continued to work in France. Both sought to identify the causes of hysteria. Through their in-depth interviews with women hundreds of miles apart, both Freud and Janet came to the same conclusion: the childhoods’ of hysteric women were filled with sexual assault, abuse, and neglect. In 1896 Freud put forth his thesis in The Aetiology of Hysteria, stating “that at the bottom of every case of hysteria there are one or more occurrences of premature sexual experience.” As trauma expert Judith Herman explains in Trauma and Recovery, The Aetiology of hysteria reads like a contemporary journal article on the effects of sexual abuse. Freud got it.

Freud, however, was a smart cookie. His knack for inquiry may have only been surpassed by his ability to climb social hierarchies and impress elites with his ideas. Freud quickly realized that his thesis on trauma was incompatible with the social and political forces of the times. You see, Freud’s research on hysteria was conducted with many well-to-do women. If his thesis were correct, sexual abuse was prevalent in the homes of many bourgeois families.

Recognizing that such claims would surely prompt his demise, Freud quickly disavowed The Aetiology of Hysteria and stated that the traumatic events described by his female patients had never actually happened and were in fact their own lucid fantasies. Freud became famous; Janet, who stood by the notion that childhood trauma had adverse consequences for health and well-being, slipped into obscurity.

So, now it’s the year 2012 and the science is stronger than ever. The Adverse Childhood Experience (ACE) Study, research from the Harvard Center on the Developing Child, and an ever growing mound of evidence tell us that toxic childhood stress—be it in the form of abuse, persistent poverty, or other means—is both prevalent and is the root cause of much sickness, social dysfunction, and death in our society. Are we ready to accept this? And thus do something about it?

Clichéd as this may sound, our children really are our future. If we like to envision a healthy, happy, well-functioning society 20, 30, 50 years from now, we need to take care of all children today. This means taking action to reduce the sources of toxic stress in all communities, especially those plagued by abject poverty and community violence—places most of us would rather ignore. In short, it means embracing notions of collectivity and mutual responsibility—both at the local and national levels.

The question is—in the words of my former 6-year-old self, sitting in the back seat of a Chevette on the way to Ocean City, N.J.—are we there yet?


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About this blog

What is public health — and why does it matter?

Through prevention, education, and intervention, public health practitioners - epidemiologists, health policy experts, municipal workers, environmental health scientists - work to keep us healthy.

It’s not always easy. Michael Yudell, Jonathan Purtle, and other contributors tell you why.

Michael Yudell, PhD, MPH Associate Professor, Drexel University School of Public Health
Jonathan Purtle, DrPH, MSc Assistant Professor, Drexel University School of Public Health
Janet Golden, PhD Professor of history, Rutgers University-Camden
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