This week, we would like to talk about an important topic, namely the way we use language when we discuss certain themes, especially around health issues.
The importance of language and its influence on how people perceive or understand a topic or a concept was first consciously and piercingly brought home to me by Diane Wiessinger with her article ‘Watch Your Language’. Years later, another beautiful talk on the topic was given by Karleen Gribble. Both women speak about breastfeeding as the biological norm to feed babies and how breastfeeding is instead often described as ‘healthier’ and ‘lowering risks’ and ‘increasing intelligence’. This comparative shows that breastfeeding is compared to something else, which is apparently considered the norm, although not explicitly. The hidden norm in these kinds of wordings is artificial formula. When we speak in terms of ‘breast is best, is the gold standard, gives improved outcomes and enhanced development… we imply that breastfeeding is the ideal, offering all kinds of extra benefits. Because no one is perfect, however, the normal (or the hidden norm) is formula.

Last year, in August 2020, Diane Wiessinger gave a presentation in which she delves even more deeply into the ‘watch your language’-idea. She explains the basic rules of science, such as the difference between the control group and the experimental group. The control group is the group that has the normal biology and has nothing done to it. It is never the focus of the study. The focus is always on the experimental group, the one that gets an intervention, has something done to it, and then shows a variation, a deviation from the norm of the control group. It is in statistically describing this variation that using the wrong norm gets really tricky. Look at the image below.

If we say that healthy practices reduce the risk of something by 50%, we in fact say that unhealthy practices increase the risk of that something by 100%! In other words: the numbers in the message given to the reader or listener, depend on what norm we use. Researchers, policymakers and healthcare providers probably do not intentionally try to give a deceiving picture of certain risks, but that may nevertheless be the result of the way the language is used. This turns informed decision making into a very difficult process. Therefore, the mechanisms of wording in a specific way require some solid philosophical and ethical thinking with regard to what we consider the norm in a specific field and how we, subsequently, speak about it.

In this context, it is interesting to look at how we talk about adversity in childhood and about trauma in general. When we say that secure attachment reduces the risk of problem behaviour, we have insecure attachment as our hidden norm. When we say that proper coregulation lessens chances of having a toxic stress response, we have lack of good coregulation as our hidden norm. When we say that compassion increases empathy and resilience, we have their absence as our hidden norm.

How come, that we often tend to use wordings like these…? It probably has to do with the fact that wording it the other way around can be perceived as very uncomfortable. Saying, for example, that coldness (or lack of compassion) jeopardises the development of empathy and resilience can feel much more confrontational. It points to where we fall short and what the nasty consequences of that shortage can amount to. It has a much bigger potential of holding us accountable, thus revealing our responsibility and likely also shaking up the status quo of cultural practices and power relations.

With regard to childhood adversity (or ACEs), we could do a thinking exercise to come up with a biological norm. Taking insecure attachment, insufficient coregulation and lack of compassion as the (hidden) norm, offers a pretty sad view of normal human characteristics. As the saying goes: ‘Humans are hardwired for connection.’ Human babies come into the world with a prosocial inclination: they actively seek out positive relations with others. It is their innate tendency; only this way can they survive. It is through social connection that they develop from healthy infants into healthy children and adults. All through humanity’s evolutionary history, humans survived because they were able to offer one another security through close connections, meaningful relationships with caring others, and thus a sense of belonging and purpose. Without all this, humans cannot survive, let alone thrive. Reciprocity is society’s ‘social glue’. Based on our mammalian heritage, we can therefore safely say that connection and feeling safe and secure are the norm for survival and healthy social relations within communities.

This means that if we want to convey a message about health risks, we should subsequently mention the risk of *lack* of healthy social relations. And if we notice that different forms of structural violence, such as poverty, racism and other inequalities endanger abundant relationship building, we should label those phenomena as risk factors or social determinants of ill health. As confrontational as this may sound… wording it this way prevents the unfair, unethical hiding of the wrong norm in terms like ‘advantages’ and ‘benefits’ of the opposite. Ethical, scientifically sound wording (focus on impact of intervention/experiment) can bring us, as a society, closer to an understanding of what we should stand up against and what needs to be changed. After all, the primal precept in healthcare is ‘First do no harm’, or, originally: ‘Primum non nocere’. Naming what is harmful, facilitates tackling it. Not naming it, is unethical, deceitful withholding of information. Calling toxic stress or too many work hours or letting babies cry-it-out risk factors, points us in the direction of how to eliminate or reduce the risk. Comparing different practices in scientific research or policy settings is of course necessary to find out where the risks are. Then again, when we have conversations in other social environments with one another, we could also decide to not compare at all. As the visual shows, we can choose to represent a concept by being descriptive in explaining it, not comparative. It might help to become more aware of the fact that life is not a competition, where all is constantly compared to something or someone better or worse. It helps to prevent polarisation and can facilitate placing processes on a continuum instead of in a black-and-white either/or-category.

In any case, the point clearly seems to be this: whenever we use a comparative in our language, we have consciously or unconsciously decided what our norm is, our reference point, the default value. Which situation or behaviour do we consider the norm? What do we see as the essence of human interpersonal connection? It can be very revealing to reflect on this and if we need to choose a norm, to do so consciously and carefully. As Diane says: ‘Everything changes when we change the norm’, including how the media reports on health risks. To consistently use a valid norm in our language can be a challenge, but it can definitely be learned. Why try? Because, as we learned from Diane Wiessinger, our language matters and we honestly need to watch it!

In last week’s blog, we made a reminder note and started to look at the first insights from our questionnaire – ‘From Childhood to Life Happiness’. After dedicating some thought to certain interesting demographics, we talked about how people tend to perceive and remember their childhoods, what makes childhood a favourable or rather a more sad experience overall, as well as which specific events or periods of time seem to weigh most heavily in the long-term. This week, we are following on that thought, asking ourselves what links do people identify between their childhoods and current selves, between their past and present. 

To begin with, all but one of the respondents identified a clear connection between their childhoods and the main current themes of their lives. The picture seems clear and powerful. Loneliness and a lack of connection in childhood seems to be linked to a burning desire of belonging and integrating into the surrounding social circle. Constant insecurity and lack of safety seems to lead to a persistent feeling of doubting one’s actions, immature reactions to daily stressors and seeking safety in the presence of others. Sometimes, people become painfully aware that their childhood trauma somehow leads them to recreating around their children the exact same sense of insecurity that was so difficult for themselves. A lack of recognition and space to show themselves might lead people to feel a lower state of energy in life, and a sense of ‘being too much’ around others, hence a tendency to close inside more often than not. 

Consistently, these themes are reflected in the daily life difficulties that people find themselves in. What our respondents mentioned with regard to this, is: not having faith in oneself or others and finding it hard to let go of people; experiencing fear of failure, insecurity and trouble in setting one’s boundaries in relation to others; having a generalized lack of confidence and not feeling good enough; or feeling a sense of depression. Sometimes, such difficulties either turn into or are accompanied by their first-grade cousins: bad habits. So far, it seems that bad habits can be put into two categories: socio-emotional habits; and substance-related habits. From the first category, people tend to ‘draw a wall around’ them and ‘play nice weather’, avoid hard situations in the workplace by quitting and fleeing ‘out of the blue’, panic easily, act too defensively, or are not able to handle critical feedback well. From the second category, ‘same old, same old’ – a lot of smoking, alcohol or drugs, used either recreationally or abusively, often starting at a young age and later on falling back into old patterns. A common thread across all of these? A reminiscent echo of insecure attachment.

Still, as we move towards the end of our questionnaire, the air in the room seems to change a bit. It becomes more fresh, more light, more positive; it brings hope to the table. It reminds us of a central pillar across all of our work and other ACE-related work: resilience. People often find unexpected sources of strength to survive, and hope is hard to beat. Despite the difficulties and life stories described in a nutshell above and last week, people generally report a state of ‘okay’ health, some better, some worse. It is true that chronic illness seems to have often settled in (once again strengthening the reported link between ACEs and chronic conditions), and feeling ‘ok’ is not really an ideal scenario of how we would hope someone to rate their health. Even so, people find sources of happiness and meaning, whether it is one’s children and grandchildren, dogs and other pets, the process of creation, being in nature, reading, enjoying music, cooking, volunteering or other forms of helping others and sharing one’s knowledge, connecting with people and sharing their stories, or the realisation that one has the power to break a ‘destructive family chain’. People go through (often long, complex and difficult) processes of healing. In one form or another, whether it involves therapy of any sort or not, people learn to develop strategies to live with chronic conditions. They find peace of mind somehow, and use their abilities to reach a fulfilling life. It does not always work and the road is tough, but these stories brighten our day and mind greatly. 

As one of our respondents put it, by managing to “break the cycle of trauma (and go through) a lot of work on myself, I am finally being able to understand my past and accept it”. Understanding, accepting, healing – not a bad way to put it.
Let us end on that note, with the awareness that we can all facilitate our fellow humans going through these stages if need be, by nurturing connection, by showing compassion, and by building the courage to listen to those life stories, as hard to hear as they may be. Noone is ‘beyond repair’, beyond any degree of healing. Our sincere, non-judgmental curiosity and understanding can create exactly that space for personal authenticity that people felt was lacking in their childhoods. If, through connecting with compassionate others, they can finally reconnect to themselves, if we can stimulate people’s perception that they do belong, they can finally grow towards feeling that deep sense of belonging in their own lives. 

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!

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’!

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.