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.)

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!