Another Heartbreaking Problem That Could Be Mitigated, But Won't Be

The New Yorker had a nice article last month called “The Poverty Clinic.” It described recent experiences of Dr. Nadine Burke. Dr. Burke got her MD from U.C. Davis, then added an MA in Public Health from Harvard. She's thirty-six-years-old or so, and she's beautiful, she has a wonderful smile. She has a house in Portero Hill in San Francisco, and she's engaged to a rich solar-energy entrepreneur. She was raised in a happy, prosperous family in Palo Alto. She is the director of the Bayview Child Health Center, in the poorest section of San Francisco, where the life experiences of the children are as different from her's as night is from day. They're all depressed; I doubt if she's ever had a depressed day in her life.

Dr. Burke is naturally concerned with the depression of her patients, it is no surprise to her that they are all depressed. The surprise came when she read a six year old article, based in research from the early 1990's, that described how adverse childhood experiences engendered permanent physical changes to the brain (and various chemical systems) that led not only to adult depression, but also to a lifetime of dangerous health results. The surprise was that she was surprised.

(The article that she read was “The Relationship of Adverse Childhood Experiences to Adult Health,” by Vincent J. Felitti, a Kaiser preventative medicine doctor. The prior study was “The Adverse Childhood Experiences Study,” done at Kaiser between 1994 and 1998.)

Surely this is all common knowledge in the medical and public health communities by now. I'm not a doctor, and I do not read medical literature, yet even I have been reading about this phenomenon for many years now. I will spare you a detailed description of the physical changes that prolonged exposure to serious stress creates. They are permanent and negative, and you can look it up if you don't want to take my word for it. It is now accepted as a basis for long-term clinical depression.

My vested interest in this problem is that I am a sufferer. These are the adversities listed for the study:

Divorce in the family (let's include abandonment);

Physical abuse;

Emotional neglect;

Sexual abuse;

Parental mental illness; and

Parental alcoholism/drug abuse.

My own “ACE score” is five-out-of-six ACE's, and my own experience of my life informs me that this is a bad score. Many doctors agree.

And these are big-time doctors too. The New Yorker article lists as researchers/believers Bruce McEwen, a Rockefeller University neuroendocrinologist; Frances Champagne, a Columbia neuroscientist; and Michael Meaney, a McGill neurobiologist. So maybe doctors should be paying more attention, or at least be more aware of what's going on in their profession.

This ACE thing is fact-based, research-based, and the literature is clear. So obvious questions arise: why are serious-minded doctors and public health officials still surprised to discover this information? More importantly: why hasn't this knowledge led to more interventionist policies to mitigate the conditions that give rise to such disastrous results?

The article was silent on the attitude of officialdom to this whole scene, but I can explain it well enough. As so often happens, the answers to these questions are related to money. Dr. Burke skirts the real problem when she says, “this is a huge, huge issue, and as a society I don't think we've even come close to grasping its significance.”

That's “huge, huge . . .” as in really, really expensive. Expenditures would be very helpful, and lead to savings down the line and quality-of-life improvements for many individuals. And yet it's all preventative, it's all prospective, which in today's financial climate means that no budget can be justified. People want to cut funds for Head Start, for Christ's sake, and that program has always shown provable, positive results.

So it's a lot like Global Climate Change. The power brokers criticize the research, condemn the results of the research, offer disingenuously to perform studies, and push the whole issue down the road. It's just not possible these days to spend money now to avoid certain, expensive problems in the future.

It is way too late for any of this to help me, but I feel sympathy for all of the children living now in conditions that will inevitably lead to a lifetime of negative consequences. Our medical system deigns to treat their current medical symptoms, because they are real and observable, while choosing to ignore the ticking time bomb lying inside the very experiences of their lives.