From Childhood to Life Happiness – our questionnaire

For this week’s blog, we would like to have a first ‘dive’ into the initial responses to our ACE Aware NL questionnaire ‘From Childhood to Life Happiness’, that we introduced in this blog and that can be found at any time here. With this occasion, we would also like to reach out to those of you who didn’t have the chance to see it yet, because we think it offers both a very good opportunity to reflect for any of us, as well as a valuable source of interesting data for research around ACEs.

With an average age of 45, our respondents are both from within the Netherlands, and outside, both raised here, and not, and both settled in the region for generations, as well as second generation Dutch citizens or expatriates. In other words, we are in for a treat – a properly mixed participant pool.
Is that so? One interesting detail is that so far in our small sample, 100% of our respondents are women. What might that tell us? Is our audience mostly female, or the ACE-science in general reaching more women? Are women more willing to talk about personal issues? Are the men in today’s society (at least in the Netherlands) taught to play ‘tough’ and avoid disclosing emotional stories that are sometimes deeply rooted in childhood? Or is it just a coincidence, so far? We don’t know yet, and we will have to see along the way as the responses come in, but we find it an interesting element to ponder upon nevertheless.

As we dive in a bit deeper, things start to get…well…messy. A first glance at how people remember their childhoods gives a strikingly troublesome image: neglect, abuse, bullying, loneliness, complicated family relationships, loss of a dear one, problematic sexual experiences, lack of safety, lack of emotional support… and the list goes on. It’s almost like reading a presentation on ACEs, or a description in a trauma-informed manual. Except, these are not book descriptions – they are real life stories that we read first hand. Immediately, the question comes to mind – is this a skewed representation, meaning that people who are interested in our material tend to be more involved in or oriented towards this topic and implicitly tend to have lived more troublesome childhoods? We are aware that painful experiences may be why our respondents participated in the questionnaire in the first place, so that their stories may be heard at last. Or, is this a hint indicating, as others have pointed out, that unhappy, traumatic childhoods are much more common than we dare or can bear to imagine? Again, we don’t know, and we will have to keep analysing more data as more people start to fill out the form and share their narratives with us. This first impression, however, once more feeds our curiosity for the topic; it also strengthens our compassion for all those among us who, often invisibly, carry with them the scars from their early days. What should be a carefree life stage, a happy past nourishing a fruitful future, is clearly still a triggering and often unsettling present for many.

And then, what are the threads, the moments, the experiences that leave the strongest marks, and stick in our memories and bodies forever? What are the defining characteristics of childhood that are formative for the development of a person? What do people point out first, when ‘caught off guard’ and opening up in their vulnerability? Well…it depends. Sometimes, it is a one time event, like the birth of a sibling, the death of a parent, or an illness in the family. Other times, it is a transitional period, like learning how to breastfeed, figuring out how to deal with strong feelings and life challenges, or even the time spent in the mother’s womb. Sometimes these events also play a role in making the perception of our childhoods good or bad, joyful or traumatic, a pleasant dream or a nightmare. Often, a common narrative seems to be, perhaps not surprising at all, the emotional environment in which the child grows up, the quality of parent-child attachment: a toxic relationship, a perceived lack of love, persistent bullying at school without any buffer at home, or, moving to the other side of the spectrum, making a parent enjoy your milestones, feeling emotionally understood and listened to, a good ‘life energy’ being instilled from the start. Whatever the case may be, one thing becomes clear – life stories cannot and should not be considered a mere collection of consecutive events to be treated as numbers in a statistical pool – they are much more than that. It matters how people feel all the way through their life journey, starting in early childhood. These are biopsychosocial processes doing their neurophysiological work: they have the worrying potential to build a road from a lack of feeling safe and secure in childhood to a difficult life in adulthood.

Next week, we are going to address exactly that, the link between childhood and adult life, between the past and the present. These links only come to light because of your insights and stories, that we appreciate deeply. Therefore, until then, if and whenever you see fit, feel free to have a look at our ‘From Childhood to Life Happiness’ survey and know that we welcome you to fill it out. Thank you in advance for doing so or for sharing the link with others who may be interested!

From Childhood to Life Happiness!

Have you ever wondered why you remember some childhood memories vividly, and others not? Do you ponder about how you grew up into the person you are today? Does it happen to you that you seriously doubt your ability to get something done, despite your qualities and proof to the contrary? Do you ever get annoyed about how annoyed you can get? Are you sometimes struck by a sense of loneliness that seems to come out of nowhere? Do you often engage in negative self-talk?

These are among the types of questions that we, as ACE Aware NL, would like to see addressed more, both in science and society at large, because the processes linked to these questions often may turn out to have a link to childhood experiences. The way you experience the world as a child, the way you are treated, and the relationships you build with those closest to you, are a strong driver for how your worldviews and your behaviours manifest themselves. In several scientific disciplines, a large number of studies have tried to find out how these developmental processes work.

It so happens, however, that much of the literature and population-based research targeted at advancing our understanding of Adverse Childhood Experiences (ACEs) is based on rather dry and numerical research. Questions such as ‘how present are they actually in the general population’, ‘how much do they impact the functioning of adults in the present’ and ‘what are the key insights that we can use to prevent them from happening’, are currently answered largely through quantitative-based surveys and scales. To illustrate, researchers have been correlating scores on an internationally accepted ACE scale or quiz (person X matches the criteria for N number of ACEs) with (longitudinal) measurements or observations for disorders, diseases or risk behavior at a later stage in adulthood.

We feel that this way of studying the importance of early life for human development in general, and ACEs in particular, is missing some more in-depth, personal, narrative insights. We feel that human life trajectories are too colourful, too multi-faceted and too unique to be summarized by checkboxes, pre-defined categories and descriptions researchers come up with, however applicable they may seem here and there. What we would love to learn about, is how you, yourself, would describe the link between your early years and your current self. We therefore invite you to make yourself a soothing drink, sit down at ease in a place where you feel comfy, and take a trip down the memory lane. What was your childhood like for you? How safe and secure did you feel? What barriers did it throw on your path? Who made a difference for you in overcoming the most difficult circumstances? Who was that one person that truly saw you for who you are?

Qualitative methods such as open-ended questionnaires, in-depth interviews and thematic conversations have a history of making these deeper layers more visible. As such, today we join international colleagues who encourage the inclusion of qualitative insights and the use of multiple methods to research this topic, by putting forward an online questionnaire entitled ‘From Childhood to Life Happiness’. The questionnaire is written in both Dutch and English and is meant for both lay persons and professionals. It includes both direct closed questions and exploratory open questions. We think it is short enough not to demand too much of your time, and thorough enough to give you the much needed space to provide a nuanced view of your personal experiences. We emphasise that the questionnaire is fully anonymous and hope that this will support you in writing openly about what was important then for your life now. The aim is to get the questionnaire circulating at a national level in the Netherlands, so that the results will be an honest reflection of as many different people and their insights into the link between their childhood and adulthood.

We look forward to your responses that will make a valuable contribution by giving a more personal insight and unexplored context to the scientific knowledge of how important our early years and our loving relationships truly are. Thank you very much in advance for your honest musings and your trust in our efforts to use them for the benefit of people’s journey ‘from childhood to life happiness’!

A Full Plate: When ACEs Lead to Problematic Self-Reliance

They sat at the dinner table; his wife had cooked something really nice and was filling the plates. She filled their son’s plate, asked their guest Lucy to hand her plate over and then filled her own. She looked at him and said: ‘You will fill your own?’ ‘Yes’, he responded, got up from the table, walked to the kitchen and filled his plate.
Lucy watched the scene in amazement. She had not been at their private dinner table many times yet. On previous occasions, they had often shared meals in a restaurant, where everyone is being served. Lucy looked at him, their eyes locked: ‘What was that all about?’ He paused: ‘What?’ ‘Well, you insisting on filling your own plate…’ He smiled: ‘I’m perfectly able to fill my own plate; there is no need for someone else to do that.’ She let it sink in and then said: ‘Well, I’m totally convinced… or rather I know you can do that, but why would you want to? Isn’t it nice to be taken care of and just lovingly have your plate filled?’ He mumbled and said there was really no need. The whole afternoon had been wonderful, so to maintain the good atmosphere, the topic was dropped.

It was not until much later that Lucy returned to it and asked him whether he had an idea where that behaviour came from. He told her that over the years he had gotten used to taking care of himself. Lucy, struck by how much she recognised his explanation and aware that such behaviours might reflect more than what meets the eye, suggested there might be painful experiences underneath. He listened and did not fully dismiss the possibility, but he also wasn’t convinced that such old childhood pain could be the cause of this behaviour, nor of several somehow related behaviours, for that matter, that he had developed: smoking, not responding to phone calls or messages, handwashing his clothes while only away for the weekend, shutting down completely when not feeling well and going stray, despite the grief that the parental divorce had caused him all those years ago. He knew that something was not right, but he had a truly hard time allowing the thoughts around it into his conscious awareness.

The story did not end well. He ended up with an autoimmune disease that seriously affected his health: too many red blood cells thickened his blood so much that it could literally not flow properly anymore. He would have times where he felt better (‘Yeah, I’m better again, climbing back up out of the dark dungeons!’, he would say jokingly, although he would never say he went in), but the grey clouds would always dampen his days again, to the point where his desperate looking for love landed him in a divorce of his own, in disappointing relationships and in sniffing coke to deal with both the health problems and the loneliness. Lucy lost contact; she kept at it, but he moved without telling her his new address. Years later, she still sends a message every now and then, but doesn’t know whether his phone number is still the same. Her compassionate inquiry and understanding had not been enough to maintain the friendship. He could not handle her unconditional emotional closeness; shame and guilt over falling short, not responding and letting her down, were too much for him – he disappeared in utter silence.

As a child, in order to not fully collapse under the responsibilities of taking care of a mother whose husband left and had to work two jobs to pay for the cost involved in taking care of him and his older brother, he had had to develop a survival strategy. In those years, he built up an attitude of rather relying on himself than on others, to make sure he would not have another experience of people letting him down. Nevertheless, nothing could fill up the huge hole that the unmet needs left in him. His dad ran off, his mom was busy… was he worthy of their love, of anyone’s love? Twice, he was on the verge of ending his life. One time, Lucy’s loving messages had prevented him from doing so, although the chaos he had created and had to face was almost too much to bear. Sometimes, she was the only one who could pull him out of his numbness, make him feel again, get his tears flowing again.

When we look at this from an ACEs perspective, we can see a scared boy who, as a child, did not have the emotional connection children need to feel secure. He learned to fend for himself and never lost the habit. As trauma expert Gabor Maté explains: the pain of not feeling seen and heard and loved as a child, lacking the secure attachment with caring and emotionally present adults, will likely make us lose our authenticity. Humans, wired for connection as they are, crave meaningful relationships with others. If their unique personality threatens the attachment to those the child depends upon, the child may give up their authenticity in order to maintain the attachment relationship. In losing our authenticity, however, we lose the connection to ourselves and that will almost always result in losing the connection to others. We close our hearts to prevent more pain coming in, but by doing so we also close towards love and compassion. To open up again requires courage and a secure environment. It also requires curiosity on behalf of those in that environment, their willingness to listen to, sit with, and offer holding space for the one in pain. This shows that healing is not just a personal challenge, a lonely move to make; we need attention and kindness from those around us to reverse the illusions we had to build to survive. Trauma, in essence, is a disconnection from the true self, and through love and compassion we can work towards re-establishing that connection.
That is a hopeful thought, one that everyone can contribute to in someone else through connection, compassion, courage, curiosity, confidence and kindness. That way, we can build resilience in ourselves, in one another and in our society as a whole.

Lucy keeps sending good vibes into space; maybe they somehow reach her friend, she says, and they will reconnect one day… or not, and then at least they may benefit him… and her as well.

Unspoken thoughts

We bumped in to one another on the street near our home and had a chat. He was doing his usual round and asked me how I was. It was warm and sunny; I wore my favourite scarce cotton dress, busy getting the outdoors and indoors ready for the summer holiday. As usual, he was in the mood for a relaxed conversation in which all kinds of topics can come to the surface. He never seems to be in a hurry and before you know it, half an hour has passed. We came to talk about a relative of ours that had died and he told about the child of a friend of a friend, who had committed suicide by jumping in front of a train. “It was the second try! The first time, he did not succeed, but now he did. So sad, for everyone involved… Why, I want to know, why, do we not help these people?!” He looked at me, clearly expecting me to respond to his desperation and indignation and more or less demanding a solution. He knows me just about well enough to know that this is a topic I have both expertise on and a heartfelt interest in. I asked him what his thoughts were, what kind of help, in his opinion, a person in such a state of despair would need, where that help should start and in what life stage the troubles were rooted. He shrugged, held his head tilted and pondered: “Yeah… well… hard to say… Do you have ideas about it?” I said I did.

I said that oftentimes, suicide is not a sudden event, even if it seems so to outsiders, but the tragic finale of a long and difficult life trajectory. Regularly, something went wrong early on, as with a house lacking a solid foundation, even if standing for decades and looking like a secure shelter from the storm.
I spoke about inner working models, the image that gets built up in the early years by the parental reflection of love and sensitivity for the child’s needs. A positive model sustains and supports us when we have challenges to deal with. It will cheer us on and we experience that cheer as love and trust in our abilities. It gives us courage and wings to fly. A negative model shakes and subverts us even when we only have to deal with the daily duties. It will talk us down and we experience that talk as a blow to our true selves, to the point where we lose connection with that self altogether and wither away on the inside. It feeds our anxiety and urge to lie low, not soar high.
I explained that humans are wired for connection and if they feel it, they can move mountains. If they don’t, life may seem to consist of mountains only, ones that cannot be conquered, regardless of their size. You can build stamina to keep trying, but sooner or later you’ll feel exhausted.
I asked how, if the parental reflection appears to say: “You are not lovable, you are not worth our effort, you’re up to no good, you’re tiring, you disturb the life I had before you came”… how, then, can a child build up an image of itself as lovable, worthy, good, delightful and enriching for close others? It is easy to say that you simply have to love yourself, but if it feels like no one else does, how can you keep that image alive and kicking?
And I added that if that is what a child experiences, it is often a handed-down inheritance from a previous generation that was struggling itself and did not manage to heal its wounds.

He had been listening closely and looked me in the eye: “Yes. I see what you’re getting at. I know a story like that, of a boy who was taken in by his grandparents, because the parents wanted to keep leading a wild life, as if there were no kid around. The grandparents did really well, but the boy had to see a psychiatrist later on anyway, because so much had been missing at the start.” I nodded. “You see…? That’s how it goes. It’s really sad, and changing it is really hard, because we all tend to say we are okay, even when we are not. Suppose I asked you how you were and you would not be well… what would you say?” He smiled; he clearly got a hunch of what I was heading towards. He shrugged again and smiled. “Well, you know… I can’t simply say I’m not okay, can I? I can’t bother you with that, can I?” I smiled back: “There you go… if I don’t know you are not well, how can I come up with ideas for things that might help you feel better again? How can I be there for you in whichever way, with proper holding space, if you don’t tell me you need that closeness, so that you won’t jump in front of a train?” His eyes lit up and widened: “That thought has never crossed my mind, fortunately!” “Aah, that’s good, but do you see it is only a gradual difference, not a fundamental one?” He slowly shook his head from left to right and his friendly smile returned: “I guess you have to continue with what you are doing, or it won’t get done in time, because I feel that this is going to be a very long conversation, if we get to the bottom of it!” I laughed out loud and agreed with him: “Yes, there is a lot to say about this, indeed! Your question about why we don’t help people who are so lonely that suicide appears to be the only escape , is not an easy one to answer, but we can begin by listening carefully when people say they are not so okay. That is a start to that answer you are looking for and an answer that could change our whole society!”

He walked away a few metres in the direction that would bring him back to his own place. He is such a friendly, well-meaning man and I know he has his own burden to take care of these days. He raised his hand to greet me and wish me a beautiful holiday and I thanked him. I realised that this is what Felitti and Anda meant when they were talking about the commonality of ACEs. I realised as well that shame and fear of vulnerability are ubiquitous, too. Why is it so hard for us to speak our minds, to open our souls, to express how we feel, to admit we are scared? If it all comes down to shame, then each of us can do something about this societal issue: don’t shame other people. Say what you like. Say whom you love. Acknowledge good being done to you. Be kind, be compassionate, be gentle. Try to imagine how challenging something may be for someone else, how their heart pounds while they try to do what is expected or needed, how dearly they miss a dearly loved one, how they wish they were not ashamed of past practices. Try to think of how they maybe just dried their tears and had to take a very deep breath before leaving home and facing the world. If we all do that, we will all be treated with much more grace, patience and humanity. As Scottish ACE Aware-colleague James Docherty says in the article below: “I have never seen a long term positive outcome from shame.” Well said, James; I hope we can meet shortly and you have time for a talk together, as it is the human story, the personal narrative, that can help us understand how we are shaped by what goes on between our entrance into this world and the day we draw and exhale our last breath. May there be a lot of understanding, connection and compassion in between, to create awesome childhood and adult experiences!

(More on the James’ important remark about how some brains never had a chance in a next blog.)


New insights

For years and years, I had been captivated by literature on secure attachment, by the workings of the HPA-axis (the stress regulation system consisting of a cascade through the hypothalamus, pituitary and adrenal glands) and by the role of the ‘cuddle hormone’ oxytocin, that also happened to be a neurotransmitter. I had ended up there through my work as a breastfeeding volunteer and later lactation consultant IBCLC, that fully revolves around oxytocin and its effects on contractions during and homeostasis straight after birth, on the milk ejection reflex in breastfeeding, and on bonding between mother and baby. Secure attachment, I was taught, was the basis of one’s sense of security and sense of wellbeing. Time and again, I listened to these big names in our field, those world-renowned ‘hot shots’, and over the years, their message sank in more and more deeply, more or less until I became unaware of how much it shaped my view on many things. I was also not really aware that to some extent, although these processes are universal and as old as humanity, I was still working in a niche, in a profession that was fairly new in the healthcare landscape and that seemed to use this knowledge more intensively than some other fields did.

I remember listening to the famous Swedish specialist in perinatal neuroscience Nils Bergman some ten years ago. He is one of the founders of the Kangaroo Mother Care movement and a promoter of skin-to-skin contact between a mother and her newborn baby. He introduced me to the concept of toxic stress, coined by Harvard paediatrician Jack Shonkoff and defined as ‘strong and prolonged activation of the body’s stress management systems in the absence of the buffering protection of adult support’. Toxic stress, Nils Bergman explained, disrupts brain architecture and leads to stress management systems that respond at relatively lower thresholds, thereby increasing the risk of stress-related physical and mental illness.

All in their own way, these passionate professionals added elements to what for me became a stronger and clearer and ever more logical framework of where illness and disease originate. It had always felt intuitively obvious that childhood has a huge impact on how we develop from a fully dependent child into an adult with their own characteristics, strengths and weaknesses, vulnerabilities and shining capacities… but how? Which internal processes combine all those influences, all those experiences, all those curses and blessings into the person we become? There is actually a word that describes them as one big fascinating, internally communicating signalling system: psychoneuroimmunoendocrinology! As Nils Bergman would say, quoting neuropsychologist Donald Hebb: ‘Cells that fire together, wire together!’ The more the mind, nervous system, immune apparatus, and hormone-secreting glands talk with one another, the more pathways are built, the closer and tighter all these organ systems become connected, and the more efficiently they can inform one another of what is needed to maintain the organism’s balance.

As beautiful as this is… it also works vice versa. If certain pathways are trodden over and over again, others become neglected and get pruned. Part of the nuance disappears from the (neural) communication and as most of us know all too well: if conversations overlook important details, their quality can rapidly decline, become defensive, and turn into fight or flight (both neurologically and between people). The conversation loses colour differentials and becomes black and white, good or bad, for or against, complicating the stress response.

This, sadly enough, is exactly what happens to many infants and young children when they have to endure a lot of toxic stress without the buffering protection of a supportive adult. They have a hard time maintaining their sense of security as their whole system is in survival mode. It is this what researchers Vincent Felitti and Robert Anda called ‘Adverse Childhood Experiences’ (or ACEs) in their 1998 study on this topic. You can find their study here to get an impression of what ACEs are about. They are not only about psychoneuroimmunoendocrinological processes inside the individual body, as a ‘life-style’ issue; importantly, they are also very much about the sociocultural, political and economic circumstances that impact them.

Jack Shonkoff says in the film ‘Resilience’ that the child may not remember all that happened early on, but the body remembers. He says that what we thought of as ‘intractable and unsolvable problems’ should, seen through the lens of ACEs science, be approached with a non-defeatist attitude. ‘We should be going after it like a bear!’, Shonkoff smilingly says. Let’s join him in the hunt!