Healthy and Normal

Healthy and Normal 121910

A recent Center for Disease Control (CDC) report states that almost 60% of adults report having a difficult childhood, or “adverse childhood experiences” (ACE).

There is an article on this in U.S. News, which will serve to show what the data might mean.  The article is HERE  and the interested or bored should read it.  The report from the CDC is HERE.

What the study attempts to demonstrate is not very important, but the world-view it reveals is very important.

The report, found HERE begins:
Adverse childhood experiences (ACEs) include verbal, physical, or sexual abuse, as well as family dysfunction (e.g., an incarcerated, mentally ill, or substance-abusing family member; domestic violence; or absence of a parent because of divorce or separation).

In short, misfortune is common.  Extremely common.  Indeed, reason and experience would tell us that all people experienced some misfortunate and unhappy events as children.

Keen readers will notice the study sought only certain kinds of misery; the report left out, or more likely masked, other misfortunes such as chronic physical illness of a sibling, family homelessness, and other common misfortunes of a social and physical nature. It also included “verbal abuse”, which is a very subjective category, and has not really been strongly tied to negative outcomes.  Including “verbal abuse” dramatically lowers the bar for “ACE”, but probably not low enough,  most likely all of us (100%) have experienced an “adverse” experience before age 18.  

The study was not poorly run, however, it has a number of shortcomings, some mentioned in the report itself, and among them is that the survey was “self-report” which means people had to decide for themselves if they had experienced an “ACE”.
These are not things that happen with clear, bright lines.  Human behaviors occur over a spectrum.  

To see what the study used for thresholds, see all the way down; the definitions are important, read them and see how badly abused you were as a child.

In the data one thing is clear at once: either people used to be better parents, or for some reason older people did not interpret the “ACE’s” in the same way as younger people.  One reason for this might be that older people have seen more of life, which puts minor events into context; they did not define the events as “traumatic”.  It is also possible that those older people still carry the “culture of child abuse” as a recent bureaucrat defined those who see the world “old school”.  

ACEs by age; blue line is 55+ years.  Notice the significant increase across the 30 or so years between the group.  One likely explanation for the difference: the younger a person is the more “sensitized” they are because of re-culturalization.  Is this a good thing?  No one can say with certainty, though many do try.

It is also possible that 35 years of government meddling in families has actually made things worse.  The numbers are further inflated, as an editorial to the report acknowledges, by the dramatic increase in incarceration rates, especially among the poor, and people of color.

The report repeatedly lumps “verbal abuse” in with severe, traumatic physical abuse or disabling medical neglect which very dramatically inflates the number of abused people who may have suffered negative consequences of unfortunate experiences.  There is some evidence in the report of the realization that not all unfortunate experiences are equally traumatic, nor are all such experiences equally traumatic to all people even when the experiences are similar.  However, the report constantly “ratchets” the meaning of the study upward, always aiming it toward the inescapable conclusion: we need more money for more people to intervene in more families.  

The report acknowledges, in the fine print, the problem of “severity”:
In addition, more research is needed to disentangle the specific role each ACE plays in the development of health problems later in life. As it currently exists, the ACE total captures the cumulative risk associated with child maltreatment and family dysfunction, but could be further refined to address issues of unequal severity.

Regardless the questions created by the data, the report delivers some huge, invisible assumptions with the data, some not very scientific assumptions.
Those assumptions are revealed in the features of the study, but even more so of the report.

1.  The report begins by overstating what they feel to be the negative consequence of ACEs:

ACEs have been linked to a range of adverse health outcomes in adulthood, including substance abuse, depression, cardiovascular disease, diabetes, cancer, and premature mortality (1--3).

The key here is that the ACEs are “linked” to “adverse health outcomes”.   A good sociologist could have corrected the authors of the paper.  The likelihood of ACEs is correlated with health and mental health problems, not “linked to adverse outcomes”.  The phrase intends to link in the reader’s mind, as it was linked in the author’s mind before the study was conducted and report written, that one thing is the cause of the other.

In truth, being poor predisposes one to all those maladies including “ACEs” and many of the causes of ACEs such as “incarcerated parents”.  There simply is no way to tease one or two of the correlated features of poverty out and seek to establish causality, but the report did that, by making assumptions, and by basing those assumptions on the dubious but accepted work of others.  

From the report, evidence of the consequences of poverty:
Respondents with the lowest educational attainment were significantly more likely to report five or more ACEs compared with those with higher education levels (14.9% versus 8.7% among high school graduates and 7.7% in those with more than a high school education [p<0.05]).

It is unlikely the authors intended to suggest all social workers and psychologists should lobby congress to roll back mandatory minimums, since they won’t be paid to do that, and it is biting the very velvety hand of government that feeds them.

2. The report makes the assumption that all unfortunate childhood experiences have negative outcomes.  
If one assumes that being poor and/or a person of color disposes one to a broad array of variables in which wealthy persons are less well represented, it becomes clear that “normalcy” and “health” for you exist within that broad array.  Put in that perspective, what we all know about life is still possible: difficult challenges in life often carry their own reward in terms of personal growth and the accumulation of what we might well call “wisdom”.  Difficult times, like illness and financial misfortune, are important in the lives of all people.  The report is simply blind to this possibility, since it doesn’t exist in the worldview of the authors.

3. The report makes the unsupported assumption that more and more intervention in people’s lives will actually lead to happier or more fulfilled people.   The correlation is founded on studies which consider absolutely no intervention against modest intervention.  In other words, send  a nurse around to visit new moms if they want to entertain them, and you’ll dramatically reduce a number of mothering errors, particularly with young mothers.  
However, there is a curve of diminishing returns on systems like that.  People become “institutionalized,” meaning they lose the ability and the will to decide for themselves, since their own decisions have been so frequently corrected by experts.  
Nowhere in the report is there a hint of doubt in the system, or the worldview that is its culture.  Nowhere is there doubt.

Diminishing returns, from HERE
Actually, beyond a certain point, and using more than only selected variables, there is no real evidence that, in a general way, intervention is in everyone’s best interest.  Intervention is life-altering, it changes the definitions and meanings of people and experiences, it over-writes familial and cultural bonds and estranges people from each other and themselves.  The result of too much “help” is the dysfunction a family experiences when it tries to live in a way that the social worker or counselor won’t disapprove of.  That isn’t education, it isn’t making life better, it’s simply adding a new dysfunction.

4. The study makes the assumption that the only solution is more social workers, counselors, master’s degree programs and so on.  
The report states:
CDC is developing, evaluating, and promoting dissemination of programs for the primary prevention of child maltreatment…Therefore, secondary and tertiary efforts are important complementary approaches to primary prevention efforts to improve the health and well-being of affected adults and families. Psychological treatments that can mitigate the progression of ACE-related health problems, such as trauma-focused cognitive-behavioral therapy, are effective (9) and should be widely disseminated.

There is simply no need to stop if we can add secondary, tertiary, and why not quatiary, why not pentuary efforts?
Valerie J. Edwards, co-author of the study and team leader for the “Adverse Childhood Experiences Team at CDC's National Center for Chronic Disease Prevention and Health Promotion” is quoted in the Healthday article as saying: "We need to do a lot more to protect children and help families.”

5. Because of the incipient assumptions, the report is tautological.
  That means “it defines itself” or “it refers to itself”.  It refers to its own experts and witnesses, it marches toward an inevitable conclusion.

To help clarify the problem of tautology, consider the worldview that predominated, and so created definitions and logical systems about people’s lives, prior to the rise of “science” like the report.  That would be the Church in Medieval Europe.
The church was the ultimate expert in all things; to reaffirm this, merely ask any of the experts of anything.  The ultimate cause was God, and so God could be found in the explanation of everything.  
There was always sin, and so there was always the need for churchmen to provide salvation, and the more the experts looked into the lives of the average person, the more sin they found, and the more things that became known as sins, the more sinners there were, requiring ever more clergy, meaning ever more money.
If that were ever in doubt, then a panel of Godly men, experts sent by the Vatican, would deliberate, they would look for evidence, and they would reference it according to God.  Any wisdom which did not contain God was not wisdom worth knowing.
Most importantly, for the great and the humble but especially for the humble (who had “adverse childhood experiences” every day) the only way to salvation in this world or the next was through God, and more specifically, through the complicated hierarchy of experts in His holy church.  

That is precisely the kind of tautology reports like this one from the CDC use.
  They start with the assumption that their science holds all truth, and to evidence that, they bring forth testimony from experts like themselves.  They deliberate, they look for evidence, and they reference it to the salvation only science can provide, and more specifically, through the complicated hierarchy of people who educate, administer and manage the endlessly growing army of service providers.

Could God help you too much?  If you thought so, you were clearly possessed by demons.
Can the army of providers help you too much?  If you think so, you must have issues.  

How can we deny that science has made life better?
We can’t deny that, science and technology have made the world better.  
For that matter, so did the Church, which brought order and law and set forth modern banking practices, and even encouraged medicine in a Europe which was functioning without a rudder.  It was when the Church got too good at what it did that it became a problem.

The same is true of science.  It isn’t so that if a little is good, more is better.  We need only look at the looming disasters in the form of super-pathogens, or oceans filled with plastic, or the re-organization of genetic material, to see that science and technology, like the old religion, can help too much.

This is particularly true of our most intimate and personal relationships, family relationships. 
It is certainly true that some cultural features are problematic, but it might not be for science to define and evaluate all experiences, or to determine, except in the most severe cases, what experiences are negative, and which were simply learning experiences.

The study itself reaffirms what we all know: life is dangerous.  This is natural.  It is by facing hardship and misfortune that we shape ourselves into whole, mature beings.

The report puts forth what we are allowed to doubt:
that government intervention, or the intervention of those closely associated with government, is going to help more than it will hurt.

It is not at all compelling that intervention can or should save all of us from misfortune, or that everyone will benefit more than they will lose by “experts who help”.

What can you do?

Not much.

The report explains how the terms in the study were used:

The 11 ACE questions were modified from the Kaiser-CDC ACE study questions (1) to conform to fewer BRFSS question response categories and were tested for understanding using focus groups. Respondents were told that the 11 questions referred to the time before they were aged 18 years.
Less than 0.5% responded "don't know or not sure" to any one of the questions, which was defined as a negative response for that ACE category.

Verbal abuse was defined as a "more than once" response to the question "How often did a parent or adult in your home ever swear at you, insult you, or put you down?" in contrast to "never," "once," or "don't know/not sure."

Physical abuse was defined for a response of either "once" or "more than once" to the question "How often did your parents or an adult in your home ever hit, beat, kick, or physically hurt you in any way? Do not include spanking."

Sexual abuse was defined for a response of either "once" or "more than once" to any one of the three following questions: "How often did anyone at least 5 years older than you or an adult, ever touch you sexually?", "How often did anyone at least 5 years older than you or an adult try to make you touch them sexually?", or "How often did anyone at least 5 years older than you or an adult, force you to have sex?"

Two separate household dysfunction variables were defined by affirmative responses to questions about living with anyone who "was depressed, mentally ill, or suicidal" or "served time or was sentenced to serve time in a prison, jail, or other correctional facility."

Living with a household substance abuser was defined by an affirmative response to at least one of two questions about living with anyone who "was a problem drinker or alcoholic" or "used illegal street drugs or abused prescription medications."

Having "parents who were separated or divorced" was defined by an affirmative response to a question asking about that in contrast to those answering "no," "don't know/not sure," or "parents not married."

Witnessing domestic violence was defined by either a response of "once" or "more than once" to the question "How often did your parents or adults in your home ever slap, hit, kick, punch, or beat each other up."

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