Adverse Childhood Experiences 14: Hope

I keep reading bits about despair and about how a generation of children is being “ruined” by the pandemic.

Not so, I say. There is hope. We need to support each other to survive and then to thrive.

This generation WILL have a higher than average ACE score. If the Adverse Childhood Experience scale is from zero to eight, children in this time period will have at least one higher point than average and many will have three or four or more. Loss of a parent, a sibling, beloved grandparents during covid. Increases in domestic violence, child abuse and addiction. These are all part of the ACE score.

What does this do to children? They have survival brain wiring. They will do their best to survive what is happening. A friend and I both have high ACE scores, 5 or more, and we are both oppositional defiant. We showed this in different ways. He grew up in the same community. He escaped from home and knew all the neighbors. He walked to the local church and attended at age 3 or 4. He has lived in this community all his life.

His oppositional defiance showed up at home, where he consistently refused to obey. And in school, where he confounded and disobeyed teachers and passed anyhow.

My family moved every 1-5 years. I hated moving. I wouldn’t talk to kids in a new school for a year. It was very difficult. So my oppositional defiance was very very internal. I hid in books and in my head. In 6th grade I got in trouble for hiding novels inside the school book I’d already read. I also would just not listen and my respect for the teacher got even lower when she would be angry that I knew the answer to the question once she’d repeated it. I wasn’t listening because I was bored. She was the first teacher that I thought, well, she is not very bright. The next year they stuck me in the honors class and I stopped being bored, though I still questioned practically every opinion every teacher had. I wanted evidence and I did not believe it just because the teacher said it.

I am not saying that oppositional defiance is in every high ACE score. I don’t know that. Why oppositional defiance? Imagine you are a small child and you are beaten. There isn’t rhyme or reason. You can’t predict when the adult will be out of control. Why would you behave “well” if it makes no difference? You might as well do what you want, because nothing you do will change the adult. Or imagine you are a small child who is with one person, passed to another, then to another. You may not exactly trust adults after two or three repetitions. And you want to survive.

There is an increase in addictions, behavioral health diagnoses, and chronic illness in adults with a high ACE score. A researcher when I first heard a lecture about it said, “We think perhaps that addiction is a form of self medication.” I thought, oh, my gosh, how are we ever going to treat THIS? Well, we have to figure that out now, and we’ve had 30 years to work on it.

I was very comfortable with the oppositional defiant patients in clinic. I got very good at not arguing with them and not taking their behavior personally. They might show up all spiky and hostile and I might be a little spiky and gruff back: sometimes that was enough. I think the high ACE score people often recognize each other at some level, though not always a conscious one. With some people I might bring up ACE scores and ask about their childhood. Sometimes they wanted to discuss it. Sometimes they didn’t. Either was ok.

One thing we should NOT do is insist that everyone be “nice”. We had a temporary doctor who told us her story. Her family escaped Southeast Asia in a boat. They had run out of water and were going to die when they were found by pirates. The pirates gave them water. They made it to land and were in a refugee camp for eight years or so. She eventually made it to the US. She was deemed too “undiplomatic” for our rural hospital. I wondered if people would have said that if they knew her history and what she had been through. It’s not exactly a Leave it to Beaver childhood, is it? When she was telling us about nearly dying of thirst in the boat, my daughter left her chair and climbed on my lap. She was under ten and understood that this was a true and very frightening story.

We can support this generation of children. This has been and is still being Adverse Experiences for adults as well. Family deaths, job loss, failure of jobs to support people, inflation. Remember the 1920s, after World War I and the last pandemic, of influenza. “On October 28, 1919, Congress passed the National Prohibition Act, also known as the Volstead Act, which provided enabling legislation to implement the 18th Amendment.” (wikipedia). There were forces trying to legislate behavior, as there are now. The result in 1920s of making alcohol illegal was speakeasies, illegal alcohol, and violence. Some people acted wild after WWI and the influenza pandemic and some people tried to lock down control, by controlling other peoples’ behavior. It did not work then and it will not work now. The wildness is out of control grief, I think, grief dysfunctional and drinking and shooting and doing anything and everything, legal or not. We remember how the 1920s ended too. Let us not repeat that. Let us mourn and grieve and support each other and support each other’s decisions and autonomy.


14 thoughts on “Adverse Childhood Experiences 14: Hope

  1. TamrahJo says:

    RE: Addiction/self-mediation, I ran across a saying, at an EFT conference I attended with a friend, that I latched onto, “Every problem USED to be a solution” – I’ve yet, in my own life, seen where that one liner fails to be correct and HELPFUL in me addressing any portion of my life where ‘what used to work, just ain’t workin’ no more…” :D

    How politicians, various special interest groups with bullhorns and their avid (to fanatical!) followers are choosing to ‘frame’ the bullet points, stump speeches and telling us all ‘who to blame’, frustrates and, at times, disgusts me – It’s as if so many are choosing to turn a blind eye to the failings of our systems on many fronts, the recent trauma of COVID, fears, financial insecurity/growing poverty and questions of basic survival, that somehow….all these things, have ‘nothing, really’ to do with the current rise in violence, crime, mass shootings, the great resignation, inflation, etc….

    I believe the last 3 years has massively HIGHLIGHTED on many fronts, the vulnerabilities and instabilities of the very core infrastructure systems we have built, depend upon, in this country, but rather than remembering the lessons learned, it seems many, from individuals, up to leaders, are content to sit in denial or double-downing on their yearning ‘when will things return to normal?” – um, what we had before, isn’t ‘normal’ in what it takes to sustain life, daily, for many – to my mind…

    Sorry for long comment, but it is so WONDERFUL to find another voice of insight and reason in the great cyber-verse! :D

    • drkottaway says:

      Thank you. I’ve worked for single payer healthcare since 2009 and hope we get it from this stupid pandemic.

      • TamrahJo says:

        I have to ‘get to work’ to earn my living, here soon, so, since you appear to be on line, do me a solid and if there is a website for Mad As Hell doctor coaltion, would you be so kind as to share the link?? I already have and sites bookmarked (still open in another browser) for deeper learning/research/possible action –

        Also, have you read “An American Sickness” by Elisabeth Rosenthal? I devoured that book, and I loved how the author organized it, even my own ‘small experiences, here and there through jobs I have worked, doctors I loved being a patient of, etc., but I really loved her 3rd section on ‘what the average citizen/patient can do, themselves, to help” section – and yet, so often, what she suggests? Is either out of my realm of possibilities, via either financial means, or, sadly, within my options if I and a care provider I love, are to remain in the realm of ‘law abiding citizens’ – I don’t have much, but I do so want to, in my own life, and through connections/support of care providers AND through educating those in my sphere of ‘influence'(if you will, friends, family, community) highlight ways where we, the patients seeking care, can take personal action to both meet our own needs, but also support those in your sphere, who are trying mightily to ‘keep to their oath’ and passion to care for others….it is increasingly hard to do so, from my perspective….any guidance or ideas are greatly appreciated!!!!

        • drkottaway says:

          Not very active currently as a group, we’ve all worked locally and some at the state or national level. We all have worked with Physicians for a National Healthcare Program too. They weren’t too sure about us in 2009, but they’d decided they liked us by 2010.

          • TamrahJo says:

            Interesting – thank you for the link!

          • TamrahJo says:

            And, for the love of all that is holy! Either explore options for getting a free SSL license OR Get your site over to hosting that provides you with SSL as part of it – Let’s Encrypt is free, has been for a long time, and even with paypal embedded buttons, EVEN if you’re not ‘very active’ etc., SSL, to me, from my ‘world of what I do’ is not just front facing best practices, it protects the publisher/group who does the website, too! from heartache of BS in cybercrime world – it’s sorta like the difference between leaving your keys in your vehicle with a full tank of gas, or not – really – ๐Ÿ˜€

          • drkottaway says:

            oh, this one about the…. I can forward to the group boss. Don’t know who (if anyone) is running the site now.

          • TamrahJo says:

            yeah – I hear ya – most of the work I get called upon to ‘salvage’ is from coalitions of volunteers who, in the end, trusted someone to always be alive/take care of/care about and all I can say is, from my work experience and world? every member of MAHDrs should care about where your digital assets are, what backups are in place, should someone die, fall ill, etc….
            In my lifetime of work? Never pays to ever, be the ‘golden link’ of failure – and well – to me? In your frustration of ‘each health care providers note’s not being seen by others/being either to lazy or overwhelmed to request, (with your permission for them to be shared!) and administrative costs in time, $ resources to try to ‘do it right’?

            I see a similar thing in my world – there are those who depend upon me, who don’t have time to write out the SOP, or have a ‘if Tamrah dies, suddenly, do any of us know how to access/do what she does???” – which, given who I serve? That’s really important, for me, for everyone – in digital/website/public channels world – for the individual and groups and companies – no one should ever count on ‘always being there’ – in my mind – that’s why I mentioned it – :D

          • drkottaway says:

            I have set that up and my adult children each have a copy of will and etc.

          • TamrahJo says:

            Delete my previous comment or show I was referring to the – sigh – sorry – this is, afterall, where I WORK to earn my living and no SSL on any site? You will be weeded out searches on many fronts (should you ever again decide to be active) and/or, you are just waving a red flag to bot searches by the nefarious arse-wipes of cyber world!

          • drkottaway says:

            ?? Which one or all?

          • TamrahJo says:

            LOL! Any you wish to delete, dearheart! I sometimes treat comments like ’email/Private message’ that is my ‘failing’ and sometimes, I get focused in on what I feel is ‘protection and care of VIPs as I see them” in areas that are in ‘my wheelhouse’ of expertise – I try to ‘help myself/stop myself’ but sometimes, I just ‘care so much’ on these cyber fronts that seem small, but are, to my mind, just the slaughter fields of the trusting, naive or beginners, that I …have ….a….really….HARD….time… mouth shut and typing fingers still and NOT commenting, in the ‘moment’ – :D Up to you! Your blog and yours to as you will with! <3

  2. lifelessons says:

    A fascinating analysis of current affairs and oppositional defiance and the ACE scale which I had never heard of.

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