Depathologizing The Symptoms Of Adverse Childhood Experiences

depathologize: refusing to label something as a disease or illness

Adverse Childhood Experiences (ACEs) have become an important area of study in the last 25 years, revealing the lasting impacts of childhood stress and trauma on our minds, bodies, behaviours, and relationships. This research brings a biological, psychological, social perspective that challenges traditional notions locating the problem within the person by labelling it a disease (a problem with your body), a disorder (a problem with your mind/personality), or problematic behaviour (a problem with your morality). Instead, ACEs research invites us to consider how our protective biological survival responses can have a devastating impact our lives when they are chronically activated in our early years of development.

What Are ACEs?

Adverse childhood experiences (ACEs) are stressful or traumatic events experienced during childhood that have a strong, graded relationship with life-long negative health outcomes. What’s graded relationship you ask? Well that means that for each additional ACE one accumulates risk like taking another dose. For example, if one ACE increases your risk by 10% then two ACEs might increase your risk by 20%, and three by 30%. The most commonly identified ACEs are physical abuse, psychological abuse, sexual abuse, physical neglect, emotional neglect, parental loss through divorce, death or abandonment, parental imprisonment, parental mental illness, parental substance abuse, or violence against their mother figure. But these are not the only ACEs, research continues to identify more such as: childhood bullying, peer victimization, isolation, peer rejection, and poverty.

The higher one’s ACE score (experiencing multiple categories of ACE exposure) the higher the likelihood of having multiple health risk factors later in life. For example, experiencing four or more ACEs increases one’s risk of obesity 1.9 times, sleep disturbance 2.2 times, anxiety 3.6 times, impaired cognitive function 4.4 times, depression 4.6 times, substance use 4–12 times. This relationship to increased risk factors has been confirmed across a broad spectrum of the human experience including: poor mental health such as: panic reactions, depression, anxiety, hallucinations, and sleep disturbances; adult diseases such as: diabetes, asthma, stroke, myocardial infarction, cancer, skeletal fractures, liver disease, sexually transmitted infections, adiposity, obesity, and all-cause mortality; and potentially harmful behaviours such as: physical inactivity, substance use, addictions, promiscuity, self-harm, suicide, early sexual intercourse, poor anger control, and perpetuating intimate partner violence.

Whether directly or indirectly, ACEs impact us all. ACE Research suggests more than half the world’s population has experienced at least one ACE. While ACEs are common across sociodemographic characteristics, vulneable and marginalized groups such as: racial minorities, high school dropouts, low income, unemployed, unable to work, and gay or lesbian populations are at higher risk of experiencing ACEs. Perhaps it should not be a surprise, then, that vulnerable populations are often the most pathologized.

Roots of ACE Symptoms

From our brain and nervous system to our stress response, immune, and endogenous opioid systems to our attachment and defence systems to our very cell strucures these underlying and interconnected biological systems help us adapt and survive in our environments. Because many of these protective systems are immature at birth, their function and development are heavily influenced by the environment with which they interact. When these systems function appropriately, they are highly adaptive to protect us. However, given their malleable nature, particularly in childhood, their protective function can become disorganized, impaired, or over-activated resulting in a lifetime of potentially problematic outcomes. For example, the stress response system produces high levels of cortisol to increases blood sugar availability to provide the energy needed to meet the percieved threat but when this system becomes chronically activated the higher blood sugar levels increase risk of developing obesity and diabetes.

Responding To ACEs

Historically, the scientific method has sought to sort, categorize, and specialize in treating many of the challenges that we now understand to have a strong-graded relationship with ACEs. The creation of discrete siloed areas of expertise has created experts, yet it has also hindered the cross-pollination of ideas and possibly misdirected the location of the underlying problem. Physical illness gets labelled a disease to be treated by medical doctors. Mental illness gets labelled a disorder to be treated by a psychologist, problematic behaviours get labelled immoral, deviant, sinful, or anti-social by societies and treated accordingly. Yet scientific research is now has come full circle, reaffirming the interconnectedness of the human experience.

Understanding the possible common underlying source of diseases, disorders, and problematic behaviours help us to better know ourselves, our world, and the solutions available to us. Unfortunately, many of the labels for ACEs symptoms mislocate the source of problem and fall into the trap of symptom management. This mislocation risks pathogizing ACE sufferers by locating the problem within themselves rather than recognizing it as biologically protective responses to external danger. When one locates the problem within ourselves, we experience the self-alienating and the maladaptive emotion of shame.

If the brain and body are inherently adaptive, then the legacy of trauma response must also reflect an attempt at adaptation, rather than evidence of pathology. Through that neurobiological lens, what appears clinically as stuckness and resistance, untreatable diagnoses, or character-disordered behavior simply represent how an individual’s mind and body adapted to a dangerous world in which the only “protection” was the very same caretaker who endangered him or her. Each symptom was an ingenious solution by the body to create some semblance of safety for the developing child or endangered adult. The trauma-related issues with which the client present for help, I now believe, are in truth a “red badge of courage” that tells the story of what happened even more eloquently than the events each individual consciously remembers. (Fisher, 2017, p. 1–2)

Five Assumptions To Help Depathologize ACE Suffers

1. ACE Impacts Are Symptoms

ACE impacts are not the problem, they are a symptom of the problem. For example, addiction is not the problem. Addiction is problematic because it is often harmful, but it’s not the problem. Instead, ACE research invites us to investigate and treat the underlying problems that have created the symptoms such as: disconnection, isolation, alienation, shame, rejection, fear, abuse, neglect, and nervous system dysregulation to name a few. Too often, oppressed and vulnerable groups are further dehumanized by the coping mechanisms they have adopted to survive the trauma of their experiences. Depathologizing seeks to understand coping strategies such as addiction as resiliency and resistance in the face of systemic harm.

2. Treat The Problem, Not The Symptoms

If the underlying problems behind ACE symptoms are disconnection, isolation, alienation, shame, rejection, fear, abuse and dysregulation then focusing treatment on the symptoms is a temporary solution. Like swatting flies without cleaning up the stuff attracting them, they almost always return, and sometimes they bring their bigger and scarier friends. Our clients typically come to therapy seeking help for their symptoms, but those are typically just the external manifestations of something deeper. Treating symptoms looks like taking anti-depressants without understanding and changing how you got depressed in the first place, or only taking diuretics for weight loss, or expecting willpower alone will help you quit an addiction. Taking this even further ACEs research invites us to ask if medical conditions such as heart disease and cancer are ACE symptoms that could or should be treated at least partially through counselling. More often than not when we as counsellors concentrate solely on treating ACE symptoms, we become focused behaviour and thought management. This risks the unintentional pathologizing of our clients because we subtly reinforced the message that the problem is located in their body, thoughts, behaviours, or morality rather than their experience and response to disconnection, isolation, alienation, shame, rejection, fear, abuse and dysregulation.

3. Our Symptoms Are Still Trying To Protect Us

The third assumption is that symptoms result from what went right in a client’s life to survive their ACEs. Short-term survival responses are rarely adaptive long-term, and thus we see the devastating cost of surviving ACEs in our physical health, mental health and relationships. Yet, when we retroactively view the things our mind and body did to survive as maladaptive because they no longer help us, we become further alienated from ourselves. Instead, suppose we can approach ourselves with the compassion that comes through a deep conviction that our current symptoms were initially and have always will be trying to protect us.

4. Integrative Compassion

In truly understanding the protective motivation behind the symptoms that frustrate and alienate us from ourselves and others, then we can begin to step into true compassion for ourselves and compassion for others. Orson Scott Card’s character Ender expresses this concept beautifully when he says,

“In the moment when I truly understand my enemy, understand him well enough to defeat him, then in that very moment I also love him. I think it’s impossible to really understand somebody, what they want, what they believe, and not love them the way they love themselves. And then, in that very moment when I love them… I destroy them.” (Card, p. 238)

When we know our enemy completely, we can love them, and at that moment, we destroy them by making them our friends. True self-compassion comes through understanding the aspects of ourselves we most want to reject, and true compassion for others comes through truly understanding their story.

5. The Solution Lies Within

The final assumption is that the solution is located within the person. We find this assumption in many counselling modalities. In Somatic Experiencing, it is guiding the body’s own innate abilities, resources, and resiliency to complete biological processes that were interrupted. In Eye Movement Desensitization and Reprocessing, it can be seen in the client’s positive replacement cognition and using the eye movement to activate the brain’s ability to process and consolidate disturbing memories. In Internal Family Systems, this is called the Self, which is accessible to everyone for healing. This is not advocating for self-help or that there’s no need for help from others, or that external resources such as spirituality are not part of the solution, but rather it is a strength-based conviction that believes that people are innately resilient and have access to everything they need to move towards healing and that we as therapists should help clients access and leverage this innate wisdom and ability located within ourselves.

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