PART I
How It Is We Become Who We Are
CHAPTER ONE
Every Adult Was Once a Child
If you saw Laura walking down the New York City street where she lives today, youâd see a well-dressed forty-six-year-old woman with auburn hair and green eyes who exudes a sense of âI matter here.â She looks entirely in charge of her lifeâas long as you donât see the small ghosts trailing after her.
When Laura was growing up, her mom was bipolar. Lauraâs mom had her good moments: she helped Laura with school projects, braided her hair, and taught her the name of every bird at the bird feeder. But when Lauraâs mom suffered from depressive bouts, sheâd lock herself in her room for hours. At other times she was manic and hypercritical, which took its toll on everyone around her. Lauraâs dad, a vascular surgeon, was kind to Laura, but rarely around. He was, she says, âhome late, out the door earlyâand then just plain out the door.â
Laura recalls a family trip to the Grand Canyon when she was ten. In a photo taken that day, Laura and her parents sit on a bench, sporting tourist whites. The sky is blue and cloudless, and behind them the dark, ribboned shadows of the canyon stretch deep and wide. It is a perfect summer day.
âThat afternoon my mom was teaching me to identify the ponderosa pines,â Laura recalls. âAnyone looking at us would have assumed we were a normal, loving family.â Then, something seemed to shift, as it sometimes would. Lauraâs parents began arguing about where to set up the tripod for their family photo. By the time the three of them sat down, her parents werenât speaking. As they put on fake smiles for the camera, Lauraâs mom suddenly pinched her daughterâs midriff around the back rim of her shorts, and told her to stop âstaring off into space.â Then, a second pinch: âno wonder youâre turning into a butterball, you ate so much cheesecake last night youâre hanging over your shorts!â
If you look hard at Lauraâs face in the photograph, you can see that sheâs not squinting at the Arizona sun, but holding back tears.
When Laura was fifteen, her dad moved three states away with a new wife-to-be. He sent cards and money, but called less and less often. Her motherâs untreated bipolar disorder worsened. Lauraâs days were punctuated with put-downs that caught her off guard as she walked across the living room. âMy mom would spit out something like, âYou look like a semiwide from behind. If youâre ever wondering why no boy asks you out, thatâs why!â â One of Lauraâs motherâs recurring lines was, âYou were such a pretty baby, I donât know what happened.â Sometimes Laura recalls, âMy mom would go on a vitriolic diatribe about my dad until spittle foamed on her chin. Iâd stand there, trying not to hear her as she went on and on, my whole body shaking inside.â Laura never invited friends over, for fear theyâd find out her secret: her mom âwasnât like other moms.â
Some thirty years later, Laura says, âIn many ways, no matter where I go or what I do, Iâm still in my motherâs house.â Today, âIf a car swerves into my lane, a grocery store clerk is rude, my husband and I argue, or my boss calls me in to talk over a problem, I feel something flip over inside. Itâs like thereâs a match standing inside too near a flame, and with the smallest breeze, it ignites.â Something, she says, âjust doesnât feel right. Things feel bigger than they should be. Some days, I feel as if Iâm living my life in an emotional boom box where the volume is turned up too high.â
To see Laura, you would never know that she is âalways shaking a little, only invisibly, deep down in my cells.â
Lauraâs sense that something is wrong inside is mirrored by her physical health. In her midthirties, she began suffering from migraines that landed her in bed for days at a time. At forty, Laura developed an autoimmune thyroid disease. At forty-four, during a routine exam, Lauraâs doctor didnât like the sound of her heart. An EKG revealed an arrhythmia. An echocardiogram showed that Laura had a condition known as dilated cardiomyopathy. The left ventricle of her heart was weak; the muscle had trouble pumping blood into her heart. Next thing Laura knew, she was a heart disease patient, undergoing surgery. Today, Laura has a cardioverter defibrillator implanted in the left side of her chest to prevent heart failure. The two-inch scar from the implant is deceivingly small.
Johnâs parents met in Asia when his father was deployed there as an army officer. After a whirlwind romance, his parents married and moved to the United States. For as long as John can remember, he says, âmy parentsâ marriage was deeply troubled, as was my relationship with my dad. I consider myself to have been raised by my mom and her mom. I longed to feel a deeper connection with my dad, but it just wasnât there. He couldnât extend himself in that way.â
John occasionally runs his hands through his short blond hair, as he carefully chooses his words. âMy dad would get so worked up and pissed off about trivial things. Heâd throw out opinions that we all knew were factually incorrect, and just keep arguing.â If Johnâs dad said the capital of New York was New York City, it didnât matter if John showed him it was Albany. âHeâd ask me to help in the garage and Iâd be doing everything right, and then a half hour into it Iâd put the screwdriver down in the wrong spot and heâd start yelling and not let up. There was never any praise. Even when he was the one whoâd made a mistake, it somehow became my fault. He could not be wrong about anything.â
As John got older, it seemed wrong to him that âmy dad was constantly pointing out all the mistakes that my brother and I made, without acknowledging any of his own.â His dad chronically criticized his mother, who was, John says, âkinder and more confident.â
When John was twelve, he interjected himself into the fights between his parents. One Christmas Eve, when he was fifteen, John awoke to the sound of âa scream and a commotion. I realized it was my mother screaming. I jumped out of bed and ran into my parentsâ room, shouting, âWhat the hell is going on here?â My mother sputtered, âHeâs choking me!â My father had his hands around my motherâs neck. I yelled at him: âYou stay right here! Donât you dare move! Mom is coming with me!â I took my mother downstairs. She was sobbing. I was trying to understand what was happening, trying to be the adult between them.â
Later that Christmas morning, Johnâs father came down the steps to the living room where John and his mom were sleeping. âNo one explained,â he says. âMy little brother came downstairs and we had Christmas morning as if nothing had happened.â
Not long after, Johnâs grandmother, âwhoâd been an enormous source of love for my mom and me,â died suddenly. John says, âIt was a terrible shock and loss for both of us. My father couldnât support my mom or me in our grieving. He told my mom, âYou just need to get over it!â He was the quintessential narcissist. If it wasnât about him, it wasnât important, it wasnât happening.â
Today, John is a boyish forty. He has warm hazel eyes and a wide, affable grin that would be hard not to warm up to. But beneath his easy, open demeanor, John struggles with an array of chronic illnesses.
By the time John was thirty-three, his blood pressure was shockingly high for a young man. He began to experience bouts of stabbing stomach pain and diarrhea and often had blood in his stool. These episodes grew more frequent. He had a headache every day of his life. By thirty-four, heâd developed chronic fatigue, and was so wiped out that sometimes he struggled to make it through an entire day at work.
For years, John had loved to go hiking to relieve stress, but by the time he was thirty-five, he couldnât muster the physical stamina. âOne day it hit me, âIâm still a young man and Iâll never go hiking again.â â
Johnâs relationships, like his physical body, were never quite healthy. John remembers falling deeply in love in his early thirties. After dating his girlfriend for a year, she invited him to meet her family. During his stay with them, John says, âI became acutely aware of how different I was from kids who grew up without the kind of shame and blame I endured.â One night, his girlfriend, her sisters, and their boyfriends all decided to go out dancing. âEveryone was sitting around the dinner table planning this great night out and I remember looking around at her family and the only thing going through my mind were these words: âI do not belong here.â Everyone seemed so normal and happy. I was horrified suddenly at the idea of trying to play along and pretend that I knew how to be part of a happy family.â
So John faked âbeing really tired. My girlfriend was sweet and stayed with me and we didnât go. She kept asking what was wrong and at some point I just started crying and I couldnât stop. She wanted to help, but instead of telling her how insecure I was, or asking for her reassurance, I told her I was crying because I wasnât in love with her.â
Johnâs girlfriend was, he says, âcompletely devastated.â She drove John to a hotel that night. âShe and her family were shocked. No one could understand what had happened.â Even though John had been deeply in love, his fear won out. âI couldnât let her find out how crippled I was by the shame and grief I carried inside.â
Bleeding from his inflamed intestines, exhausted by chronic fatigue, debilitated and distracted by pounding headaches, often struggling with work, and unable to feel comfortable in a relationship, John was stuck in a universe of pain and solitude, and he couldnât get out.
Georgiaâs childhood seems far better than the norm: she had two living parents who stayed married through thick and thin, and they lived in a stunning home with walls displaying Ivy League diplomas; Georgiaâs father was a well-respected, Yale-educated investment banker. Her mom stayed at home with Georgia and two younger sisters. The five of them appear, in photos, to be the perfect family.
All seemed fine, growing up, practically perfect.
âBut I felt, very early on, that something wasnât quite right in our home, and that no one was talking about it,â Georgia says. âOur house was saturated by a kind of unease all the time. You could never put your finger on what it was, but it was there.â
Georgiaâs mom was âemotionally distant and controlling,â Georgia recalls. âIf you said or did something she didnât like, she had a way of going stone cold right in front of youâsheâd become what I used to think of as a moving statue that looked like my mother, only she wouldnât look at you or speak to you.â The hardest part was that Georgia never knew what sheâd done wrong. âI just knew that I was shut out of her world until whenever she decided I was worth speaking to again.â
For instance, her mother would âgive my sisters and me a tiny little tablespoon of ice cream and then say, âYou three will just have to share that.â We knew better than to complain. If we did, sheâd tell us how ungrateful we were, and suddenly she wouldnât speak to us.â
Georgiaâs father was a borderline alcoholic and âwould occasionally just blow up over nothing,â she says. âOne time he was changing a light-bulb and he just started cursing and screaming because it broke. He had these unpredictable eruptions of rage. They were rare but unforgettable.â Georgia was so frightened at times that âIâd run like a dog with my tail between my legs to hide until it was safe to come out again.â
Georgia was âso sensitive to the shifting vibe in our house that I could tell when my father was about to erupt before even he knew. The air would get so tight and Iâd knowâitâs going to happen again.â The worst part was that âWe had to pretend my fatherâs outbursts werenât happening. Heâd scream about something minor, and then heâd go take a nap. Or youâd hear him strumming his guitar in his den.â
Between her motherâs silent treatments and her dadâs tirades, Georgia spent much of her childhood trying to anticipate and move out of the way of her parentsâ anger. She had the sense, even when she was nine or ten, âthat their anger was directed at each other. They didnât fight, but there was a constant low hum of animosity between them. At times it seemed they vehemently hated each other.â Once, fearing that her inebriated father would crash his car after an argument with her mother, Georgia stole his car keys and refused to give them back.
Today, at age forty-nine, Georgia is reflective about her childhood. âI internalized all the emotions that were storming around me in my house, and in some ways itâs as if Iâve carried all that external angst inside me all my life.â Over the decades, carrying that pain has exacted a high toll. At first, Georgia says, âMy physical pain began as a low whisper in my body.â But by the time she entered Columbia graduate school to pursue a PhD in classics, âIâd started having severe back problems. I was in so much physical pain, I could not sit in a chair. I had to study lying down.â At twenty-six, Georgia was diagnosed with degenerative disc disease. âMy body just started screaming with its pain.â
Over the next few years, in addition to degenerative disc disease, Georgia was diagnosed with severe depression, adrenal fatigueâand finally, fibromyalgia. âIâve spent my adult life in doctorsâ clinics and trying various medications to relieve my pain,â she says. âBut there is no relief in sight.â
Lauraâs, Johnâs, and Georgiaâs life stories illustrate the physical price we pay, as adults, for childhood adversity. New findings in neuroscience, psychology, and medicine have recently unveiled the exact ways in which childhood adversity biologically alters us for life. This groundbreaking research tells us that the emotional trauma we face when we are young has farther-reaching consequences than we might have imagined. Adverse Childhood Experiences change the architecture of our brains and the health of our immune systems, they trigger and sustain inflammation in both body and brain, and they influence our overall physical health and longevity long into adulthood. These physical changes, in turn, prewrite the story of how we will react to the world around us, and how well we will work, and parent, befriend, and love other people throughout the course of our adult lives.
This is true whether our childhood wounds are deeply traumatic, such as witnessing violence in our family, as John did; or more chronic living-room variety humiliations, such as those Laura endured; or more private but pervasive familial dysfunctions, such as Georgiaâs.
All of these Adverse Childhood Experiences can lead to deep biophysical changes in a child that profoundly alter the developing brain and immunology in ways that also change the health of the adult he or she will become.
Scientists have come to this startling understanding of the link between Adverse Childhood Experiences and later physical illness in adulthood thanks, in large part, to the work of two individuals: a dedicated physician in San Diego, and a determined medical epidemiologist from the Centers for Disease Control (CDC). Together, during the 1980s and 1990sâthe same years when Laura, John, and Georgia were growing upâthese two researchers slowly uncovered the stunning scientific link between Adverse Childhood Experiences and later physical and neurological inflammation and life-changing adult health outcomes.
The Philosophical Physicians
In 1985 physician and researcher Vincent J. Felitti, MD, chief of a revolutionary preventive care initiative at the Kaiser Permanente Medical Program in San Diego, noticed a startling pattern: adult patients who were obese also alluded to traumatic incidents in their childhood.
Felitti came to this realization almost by accident. In the mid-1980s, a significant number of patients in Kaiser Permanenteâs obesity program were, with the help and support of Felitti and his nurses, successfully losing hundreds of pounds a year nonsurgically, a remarkable feat. The program seemed a resounding success, up until a large number of patients who were losing substantial amounts of weight began to drop out. The attrition rate didnât make sense, and Felitti was determined to find out what was going on. He conducted face-to-face interviews with 286 patients. In the course of Felittiâs one-on-one conversations, a striking number of patients confided that they had faced trauma in their childhood; many had been sexually abused. To these patie...