Category Archives: adverse childhood experiences

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Complicit men: Epstein’s accessories

Trigger warnings: human trafficking, sexual abuse, crimes against humanity, Epstein

The men listed in the Epstein files are silent or are saying, “Not me. I didn’t do it.” But men did do it. And YOU men were at the parties and saw the young women, teenagers, underage. You may have been offered a massage. Maybe you didn’t do it: but if not, why aren’t you speaking up? Why aren’t you saying who DID do it? You are complicit and protecting the rich and powerful and protecting criminals. You are Epstein’s accessories to crime and you are guilty.

Wikipedia: “An accessory is a person who assists, but does not actually participate, in the commission of a crime. The distinction between an accessory and a principal is a question of fact and degree:

If two or more people are directly responsible for the actus reus, they can be charged as joint principals (see: Common purpose). The test to distinguish a joint principal from an accessory is whether the defendant independently contributed to causing the actus reus rather than merely giving generalised and/or limited help and encouragement.

The principal is the one whose acts or omissions, accompanied by the relevant mens rea (Latin for “guilty mind”), are the most immediate cause of the actus reus (Latin for “guilty act”).”

When my son is 16, his friend gets suspended. The friend and my son are outraged, because he wasn’t the one who “did it”. “But you were there when the crime was committed. That makes you an accessory to the crime.”

I explained. “If someone is doing something illegal and you stand by and don’t leave or stop them, you could be arrested as an accessory. For example, if you go to a party and underage people are drinking or smoking pot, even if you aren’t doing it, you could be arrested too. You need to leave.”

“We need to know the laws!” said my son.

Years later I heard that there was a party that they decided not to attend, “because either it will be boring or it will be busted.” It was busted. The father of the young man who threw the party was outraged that his son was benched from the basketball team. I disagreed and my son knew very well that I would have turned off the computers and seen him benched from sports and grounded if he had been involved.

So, people who partied with Epstein, explain your thinking to me? I keep reading that it’s not illegal to party, but it is illegal to stand by when young women are trafficked and sexually abused. Teenage girls at the party? Massage offered? What did you think was going on? You thought they were whores or no better than they should be. You thought it was just fine that a 15 year old girl was having sex with a forty year old man. Or you were a little creeped out but you didn’t do anything. You just turned your face away. You are complicit. You are an accessory. You remain silent and don’t name names. You protect the other rich men, not the teen girls. You are guilty.

Early in my medical career, a teenager was lured from home by a man more than twice her age. He got her pregnant and abandoned her in Mexico. She managed to get home. I called the attorneys for our clinic and said, “Can’t we take him down for sexual abuse?” The answer was that only the girl or her parents could press charges because of the “age of consent” in that state. So a teen can’t make any decision except whether or not to have sex? Do you realize how twisted that is and how it still victimizes young women and makes sex and pregnancy their fault? Legally I cannot see a sixteen year old in clinic or treat them for anything in clinic without parental consent EXCEPT for sexually transmitted disease, birth control and pregnancy. The first baby I had the honor of helping at delivery in medical school was to a 14 year old: her second child.

I wrote about this regarding Bill Cosby: the women spoke up but all the men around him were silent.

So: to Epstein’s partyers: you are complicit, you are accessories to his crimes, you are guilty. When you choose to continue to deny and be silent, you protect all the other men. You are criminals, you are filthy, and you are guilty.

Epstein files: ‘No one is too wealthy or too powerful to be above the law’; rights experts demand accountability

For the Ragtag Daily Prompt: vertigo.

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Perspective: beneath the clouds

Beloved why?
I am glad for your love
and warmth
and connection
and my cat’s
and my adult children
friends
family
patients
work
and why? Beloved

A high Adverse Childhood Experience Score
Two alcoholic parents
One sick with tuberculosis through pregnancy
Letters from the hospital to her mother
After birth
Never mention me
As if I do not exist

She told a story that she dreamed
she gave birth to kittens
played with them
and gave them away

Not a dream of joyously welcoming her new baby
Me.
Yet I didn’t hate her or my father
My damaged parents
My damaged sister
Who followed their path, not mine
There was nothing I could do
Only three years old when she was born
Try to shield and mother her
As best I could

Why Beloved
I have tried so hard to grow
to love
to forgive
and yet I have no human lover

My cat jumps on my notebook
And interrupts this writing
She is happier to welcome me home
Than any man I’ve ever dated

My daughter’s boyfriend picks her up
at the airport and has made her dinner

If I am a failure at love with a partner
Or too smart or damaged or difficult
To love
For humans
At least my children have both found love
And if I were to choose me or them
Yes, I’d choose them

Is that why, Beloved?
Sacrifice to heal the next generation?
It is worth it.

And yet, that small child part of me
That even as a toddler thought the adults were unpredictable, dangerous, mean when drunk as they laughed.
She is angry at them, Beloved
She is angry at you, Beloved
Or at people
Or at the universe
She still believes in every cell, in her bone marrow, in the vast universe in her mind

that she too could be, should be

loved.

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Climbing the walls

When my father died, he left me a will written more than 40 years earlier. He and my mother and my maternal grandparents were all pack rats. It was a house and two barns and ten years worth of some mail. A mess.

After working on it for a year, I felt like I was in knots and couldn’t relax. I was quite sick of counseling and wanted to do body work instead. I found a massage person and worked with him for over a year.

On the first visit he talked to me and then had me stand and walk around. “You are head forward and your toes are gripping the floor.” “I am not!” I said, lifting my toes. He was right, though. I had to relearn how to walk for two weeks, lifting my toes up.

I went to see him once last spring, knotted up again. I thought I was much better at unknotting during the work. I asked, “So am I pretty relaxed?”

He laughed. “You’re NEVER relaxed. Your baseline is 7/10 but you notice that you are tight when you get up to a 9 or 10.” He said that relaxed was 1-3.

I was hurt and annoyed. All that work and he’d never said that and never given me tools. I tried to contact him by email but he either didn’t remember what he said or just wouldn’t deal with it.

I was grumpy.

Meanwhile in clinic, I was teaching the breathing technique to try to relax, to go from sympathetic fight or flight, to parasympathetic. Breath in for a slow count of 4 seconds, then out for a slow count of 4 seconds. I thought, well, I should do it more too. I decide that when I wake up, I will do the breathing technique.

It promptly put me back to sleep. I have used slowing my breathing to go to sleep. I also had three years in college and after where I did daily zen meditation, facing the wall, on a zafu, for forty minutes. Add my flute playing and singing in chorus for the last 24 years and I can do the count way past four. My mind, however, is a very busy place, and meditation often felt like letting a cage full of crazy monkeys out. They all wanted attention. My understanding of zen is that I am supposed to let the monkeys show up but not hold on to them, converse with them, or let them hold the floor. Return to the breath.

When we wake up, we have a cortisol burst in the morning. It gets us going. I am pretty sure that I have some adrenaline too. The slowed breathing calms that right down. According to the pain clinics, twenty minutes of slowed breathing calms almost everyone down into the parasympathetic state. I don’t think that the high Adverse Childhood Experience people are used to parasympathetic. Honestly, looking at the movies and television and video games, I think our culture is not used to it either.

The breathing in the morning is working. My neck and shoulder muscles are more relaxed (in spite of computer use). Maybe I am down to a 5/10! That would be huge progress, right?

And my muscles love the climbing walls, too. Not that I am that good at it, but my muscles really like the intensity and focus. It is so different from clinic, where everything is focused on listening to the patient, typing as they talk, watching, sensing, trying to get a handle on what is happening with them. The wall is like clinic in focus, but my whole body is involved and there is lots of reaching and stretching out of that contained focus.

Sol Duc seems to be good at slow breathing. Cats go from 1/10 to 10/10 in just a heartbeat, or that’s my impression.

There is no alabaster in this house. Not a bit. Perhaps I will meditate on that.

For the Ragtag Daily Prompt: meditate and alabaster.

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Adverse Childhood Experiences 15: Guidelines

I wrote Adverse Childhood Experiences 14: Hope quite a while ago.

The American Academy of Pediatrics has a guideline that physicians should introduce and screen for Adverse Childhood Experiences. The American Academy of Family Practice is skeptical, here: https://www.aafp.org/pubs/afp/issues/2014/1215/p822.html. Here are two more writeups: https://www.aafp.org/pubs/afp/issues/2020/0701/p55.html and https://www.aafp.org/pubs/fpm/blogs/inpractice/entry/screen_for_aces.html.

It is difficult to screen for ACE scores for the same reason that it is difficult to screen for domestic violence and to talk about end of life plans. These are difficult topics and everyone may be uncomfortable. Besides, what can we DO about it? If growing up in trauma wires someone’s brain differently, what do we do?

I don’t frame it as the person being “damaged”. Instead, I bring up the ACE score study and say that first I congratulate people for surviving their childhood. Good job! Congratulations! You have reached adulthood! Now what?

With a high ACE score comes increased risk of addictions (all of them), mental health diagnoses (same) and chronic disease. Is this a death sentence? Should we give up? No, I think there is a lot we can do. I frame this as having “survival” brain wiring instead of “Leave it to Beaver” brain wiring. The need to survive difficulties and untrustworthy adults during childhood can set up behavior patterns that extend into adulthood. Are there patterns that we want to change and that are not serving us as adults?

This week a person said that they blow up too easily. Ah, that is one that I had to work on for years. Medical training helps but also learning that anger often covers other feelings: grief, fear, shame. I had to work to uncover those feelings and learn to feel them instead of anger. Anger can function as a boundary in childhood homes where there are not adult role models, or where the adults behave one way when sober and an entirely different way when impaired and under the influence. There may be lip service to behave a certain way but if the adult doesn’t behave, it is pretty confusing. And then the adult may not remember or be in denial or try to blame someone else, including the child, for “causing” them to be impaired.

What if someone had a “normal” childhood but the trauma all hit as a young adult? I think adults can have trauma that changes the brain too. PTSD in non-military is most often caused by motor vehicle accidents. At least, that is what I was told in the last PTSD talk I went to. Now that overdose deaths have overtaken motor vehicle accidents as the top death by accident yearly in the US, I wonder if having a fentenyl death in the family causes PTSD. Certainly it causes trauma and grief and anger and shame.

I agree with the American Academy of Pediatrics that we should screen for Adverse Childhood Experiences. We need training in how to talk about it and how to respond. I have had people tell me that their childhood was fine and then later tell me that one or both parents were alcoholics. The “fine” childhood might not have been quite as fine as reported initially. One of the hallmarks of addiction families is denial: not happening, we don’t talk about it, everything is fine. Maybe it is not fine after all. If we can learn to talk to adults about the effects on children and help people to change even in small ways, I have hope that we will help children. We can’t prevent all trauma to children, but we can mitigate it. All the ACE scores rose during the Covid pandemic and we are still working on how to help each other and ourselves.

Here is another article: https://www.aafp.org/pubs/fpm/issues/2019/0300/p5.html.

Blessings.

For the Ragtag Daily Prompt: open wound.

The photograph is one of Elwha’s cat art installations. He would pile toys on his bowl. Two bowels because I need to keep out the little ants. Sol Duc would do it too but not as often. I fed them in separate rooms. They would pile things on the bowl whether there was food left or not.

Elwha is still missing, sigh. That is a wound. The photographs are from March 2023.

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Comfortable with monsters

I am comfortable with the monsters in my dreams.

I dream of monsters howling and I go to them. They could be sick or hurt or need help! I must go to them! And the monsters are very noisy but they are babies. Abandoned and dirty and dark and hungry and cold.

This has nothing to do with my childhood. Do you believe me?

I have a pack and supplies in the dream. I carry the monsters up up into the light. I feed them and bathe them and diaper them and wrap each one in a blanket and hold them. They howl until they are too tired to howl and then they sulk. At first they do not know how to respond to kindness and love. But they learn and grow and are beautiful.

I am not comfortable with the angels.

I dream that all the stars start falling and then I see that they are angels. I am so frightened, why must they fall? I don’t want to be an angel and then I am falling and crying. The angels are at perfect peace with falling but I am not. I don’t understand, Beloved. Why do the angels fall?

I ask the Beloved over and over. My poems are questions. Why, Beloved, why?

The angels fall down and up, over and over. They are good then bad, or labeled bad, then labeled good.

Just like people.

The angels are seen as black or white. But I see them as black on white heaven or white on black heaven, it doesn’t matter. Do not let the color be a label. And after someone falls, they are burnt in the sky. They are seen as a devil or a monster!

Angels falling, fallen, monsters.

And I am here for the monsters. Who are angels, in disguise.

_______________________

For the Ragtag Daily Prompt: disguise.

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Shame and anger in overuse illnesses

“amongst those who treat addicts of any kind generally agree that anger and shame help no one and is actively counter-productive.”*

Wait.

I have to think about that statement.

I do not agree at all.

Ok, for the physician/ARNP/PAC, anger at the patient and shaming the patient are not good practice, don’t work, and could make them worse. BUT anger and shame come up.

In many patients.

Sometimes it goes like this with opioid overuse: the person shows up, gets on buprenorphine, and is clean.

It may be a long time since they have been “clean”.

One young man wants to know WHY I am treating him as an opioid overuse patient. “Why are you treating me like an addict?”

I try to be patient. I recommended that he go inpatient, because I don’t think we will cut through the denial outpatient. Very high risk of relapse. “You have been buying oxycodone on the street for more than ten years.”

“I’ve been buying it for back pain, not to party.”

“Did you ever see a doctor about the back pain?”

“Well, no.”

“Buying it illegally is one of the criteria of opiate overuse.”

“But I’m not an addict! I’ve never tried heroin! I have never used needles!”

“We can go through the criteria again.”

He shakes his head.

He is in denial. He is fine. He doesn’t need inpatient. He is super confident, gets work again, is super proud.

And then angry. “My family still won’t talk to me!”

“Um, yes.”

“I’m clean. I’m going to the stupid AA/NA groups! Though I don’t need to. I’m fine!”

“What have you noticed at the groups?”

“What a bunch of liars!” he says, angry. “There are people court ordered there and they are still using! I can tell. They are lying through their teeth!”

“Obvious, huh?”

“Yeah!”

“Did you ever lie while you were taking the oxycodone?”

Now he ducks his head and looks down. “Well, maybe. A little.”

“Do you think your family and friends could tell?”

He glances up at me and away. “Maybe.”

“Your family may be angry and may have trouble trusting you for a while.”

“But I’ve been clean for four months!”

“How many years did you tell untruths?”

“Well.”

Shame and anger. Anger from the family and old friends, who have heard the story before, who are not inclined to trust, who are hurt and sad. The first hurdle is getting clean, but that is only the first one. Repairing relationships takes time and some people may refuse and they have that right! Sometimes patients are shocked that now that they are clean, a relationship can’t be repaired. Or that it may take years to repair. My overuse folks are not exactly used to being patient. And sometimes as they realize how upset the family and friends are, they are very ashamed. And some are very sad, at years lost, and friendships, and loved ones. I have had at least one person disappear, to relapse, after describing introducing someone else to heroin. He died about two years later, in his forties.

Shame and anger definitely come up in overuse illness.

The above is not a single patient, but cobbled together from more than one.

______________________

*from an essay titled “F—ing yes, I’m a fatphobe” on everything2.com. Today there are two with that title. The quotation is from the second essay.

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Qia and the monsters

Qia is three. She is scared.

“Don’t be scared or go to your room.”

Qia wants help. She is scared of the monster, FEAR, the giant monster, but her father won’t listen. She sniffles and tries, but she can’t stop crying. She goes to her room, because her father has turned his back. Her mother is drawing. They are busy. They don’t like it when she is scared.

FEAR is enormous and pushes into the room with her. She cries harder in her room with the door closed. No one can hear her now except FEAR. FEAR is large and has horrible drippy teeth and too many arms and keeps swatting at her. Qia gives up and lets FEAR swat her. She sits on the bed with her knees up and puts her head on her arms.

FEAR rages around her room.

After a while Qia is tired of crying. She lifts her head off her arms.

FEAR is smaller. Still bigger than her father, bigger than her mother, but just standing and looking at her. FEAR looks tired too.

Qia pats the bed beside her. FEAR hesitates and looks scared. Qia waits. FEAR shuffles over and sits beside her on the bed.

The room is very quiet. Qia finds a scrap of tissue and blows her nose. She looks sideways at FEAR.

FEAR’s head is down and FEAR seems to be crying. Qia reaches out and takes FEAR’s paw. One of the paws. There are a lot.

FEAR holds her hand tightly and then leans against her. Qia wiggles over a bit more to give FEAR room. FEAR sighs and then snuggles down onto the bed, massive drippy toothy head in Qia’s lap.

Qia strokes FEAR’s fur. It is very soft and dark purple.

FEAR is the first monster that Qia makes friends with. There are many more.

_________________

I was thinking about this story even before the Ragtag Daily Prompt: bugbear.

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Negotiating peace

I spend a long day wrestling with love
arguing with myself back and forth
I am no angel descended from above
Those undeserving of my love make me wroth
yet my core argues that it still loves them
and agrees their cruelty’s beyond the pale
I snarl and cough and choke on bitter phlegm
Defend my self staying far away and hale
My core agrees I shall not tolerate abuse
Forgive yet we despair we’ll ever reconcile
They show no guilt nor shame for their misuse
My core says let them be: she is so mild
Negotiation done: Agreed. I may love those who I love
But I leave contact with them to the angels and Beloved.

_____________________

Sonnet 10

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Walk with rabbits

Some days I can’t chuckle
when the news rolls in
my heart could buckle
shootings again

US gun habits
What’s up doc? Dagnabbit.

Shootings on the year of the rabbit
dancers dead as they celebrate
Why are guns such a habit?
I refuse to fill my heart with hate

Gun sales stab it
Year of the rabbit

Forgive but do not reconcile
let my resolve not buckle
mental health takes a while
let no demented chuckle

Fearful gun habits
online snared like rabbits

They argue they must defend their homes
daughter teacher on the line
fearful males online alone
think that guns will make them fine

Fear is a habit
Stop being rabbits

Leave your basement
Help another
Walk the pavement
Earth as mother

Make it a habit
To walk out with rabbits

_______________________

For the Ragtag Daily Prompt: chuckle.

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Petty lie

What old deep wound causes you
to hurt me and other friends you’ve had
in past. What terrors hidden in that brew
make you glory in making others sad?
You boast to me of throwing people out
of your life forever, never friend
again. You don’t explain what crimes reroute
your heart to where you never speak again
to him or me. How many people discarded
from your heart and at what interval?
How many “friendships” have you departed?
And yet you boast that others call you spiritual.
“Friends forever,” you said. I wonder why
you tell yourself and me that petty lie.

______________________

Sonnet 8