Last Friday, two of our team members found the paper version of Vakblad Vroeg on their door mat, and in it the article we wrote. It is always special to see a piece you have worked on with several people in print instead of on a screen. To actually hold a text in your hands, on paper, is really satisfying. It was extra special this time, because the road to the final version had been a long and winding one, with one step forward and two steps back here and there. Together with the Vakblad Vroeg-editors Jan de Graaf and Louise van den Broek, however, we all patiently worked towards a version that they felt would fit their audience and we felt would do justice to the message ACE-awareness has to bring.

Jan and Louise are good at editing and rephrasing, so our first version already got a nice make-over, with the essence very well preserved; great work. After another round, we were happy, the editors were happy and we all felt we were more or less done. Then the article went to the larger Vakblad Vroeg editing team and the text came back with several important questions: ‘What is the added value of ACE Aware NL, seeing that so many people are already working with concepts like the ‘first 1000 days’ and a ‘Promising Start’? What is different in your approach? What is your core message?’ Now things got a bit more tricky. We realised we had a hard time putting into words what has by now become so ingrained in our hearts and souls. We realised the big conceptual distinctions were in the seemingly small verbal differences and we had not been explicit enough in explaining them. We had work to do!

Take these two sentences:

What makes it so hard to let it get through to us that children can also feel unsafe and insecure?
What makes it so hard to let children’s perception of unsafety and insecurity get through to us?

How do you, as a reader feel about what happens here…? Do you sense a difference? In what way?
We elaborated on these two sentences with the following thoughts and arguments. In the first sentence, the adults are the point of reference; this is mainly caused by the word ‘also’. The child is somehow an afterthought. The thinking starts with the adults, who often feel unsafe and insecure, and who build a wall around that feeling. That wall is thick. Oh wait… do children feel like that, too? Hmm… maybe… The children’s perception of a similar experience has a hard time getting through that wall, however. Worse, still… the sentence says that children *can* feel unsafe and insecure, not necessarily that they often do. Somehow, you can almost hear the word ‘sometimes’ being whispered after ‘insecure’. This phrasing clearly represents a power relationship in which the child is the subordinate one. This way, the child is secondary. The child is not the focus of the adults’ reflection on how they impact children’s wellbeing in either direction.

In the second sentence, we have a completely different situation. Here, the perception of unsafety and insecurity in children is a general given. It is the core of the sentence and the question is focussed on the adults: ‘Guys, let’s be humble and rumble with this issue: what makes it so hard? How come we cannot see how miserable they (often) feel? Let’s take a close look at that.’ It punches us in the stomach more or less, ‘perception of unsafety and insecurity’, and we have to let it get through to us. That is pretty uncomfortable, for sure. It asks us to take a step back, to make ourselves vulnerable and to courageously dive into this, to take in children’s feedback on their reality, without becoming defensive. This is truly difficult, because most of us adults do not consciously harm children or consider them unimportant. Nevertheless, many children suffer because of adult decisions that impact their lives, decisions they themselves cannot influence. And it becomes even more difficult when we are aware that many adults who create insecurity for a child, carry an emotionally wounded inner child with them, that itself is still looking for security. How to deal with all that…? That is not easy, but you need to ‘name it to tame it’, as clinical psychiatrist and expert in the field of interpersonal neurobiology Dan Siegel says. If we do not identify the issue, we cannot tackle it, not as individuals and much less as a community or a society.

This could be compared with the discussion on white or male supremacy, where non-white or non-male people no longer put up with whites or males who say that they, too, have all kinds of problems to deal with. That may be true, but it is beside the point, if you want to address the inequity that arises from not taking non-white or non-male people seriously and considering their wellbeing of lesser importance. If you don’t call it out, you won’t call it off. As Brené Brown says in ‘Dare to Lead’: ‘To opt out of conversations about privilege and oppression because they make you uncomfortable is the epitome of privilege.’

What seems like a small change of wording, can thus represent a completely different worldview.
And hell, yes, that can feel really, really uncomfortable… How on earth can we maintain the status quo, if we become aware that many of our economic, cultural, or socioemotional practices have an impact on children that makes them feel unsafe and insecure, something that often casts long shadows on their life paths? Well, maybe we can’t… which is exactly what makes this topic rough and tough to deal with. What is needed to prevent ACEs is in fact the same as what is needed to create change in the way we as adults (whether we are parents, relatives, professionals, teachers or trainers) approach children and the problems they have to deal with. It requires us to learn to look in a whole new way and to compassionately connect with children at a deep level. It probably also asks us to acknowledge that our own history and our own pain can stand in the way of doing so. We have to learn to understand where difficult or unhealthy behaviours come from. We have to find the ‘why’ of these behaviours and see them for the brave, but taxing coping strategies they actually are. Chances are that we have to learn new things in order to be able to do so. We have to become acquainted with a ‘biopsychosocial’ approach – a word that we as ACE Aware NL really love, because it beautifully illustrates the inextricable coherence between body, mind and environment. There is a word that we almost love even more: psychoneuroimmunoendocrinology, the continuous feedback loop between our psyche, our neurophysiology and our immune system, all influencing our hormonal states, and thus underpinning so much of what we feel, think, do, and how our bodies respond to that.

Next week, we will discuss the importance of approaching difficult situations or a gap of knowledge and insight as an opportunity for a learning process. This allows people to see that it is not about categorising yourself as being (good) enough or not, but about moving along a continuum, an upward growth line.

Last week, we discussed how even subtle differences in wordings can introduce an unwelcome power difference between adults and children. This week, we will discuss the importance of approaching difficult situations as learning opportunities and how that is a hopeful way of looking at knowledge gaps.

Learning requires fierce curiosity, which is more or less the same as courage, because especially in relation to trauma-awareness, you really need to be brave and make yourself vulnerable to be able to courageously and wholeheartedly listen to people’s lived experience in an open, nonjudgmental way. Sitting with people’s tough stories and offering holding space may be something we were not raised to do, so it requires learning. This is also something we brought in for the article. Take a look at these two sentences:

Therefore, it is important that adults can recognise the needs and the pain of a child.
To understand what the other goes through, authentic curiosity is needed, the desire to (learn to) understand the other person’s life story without judgment.

In the first sentence, it is indicated that recognising the needs is important. We agreed on this; it is very important, indeed. Then again, recognising is not necessarily something that you are either capable or incapable of. Most things in life can be learned, if the learner-to-be is inherently motivated and sees the added value of what there is to learn. In the first sentence, however, you either can or cannot recognise it, and this can make someone feel like being in the ‘wrong’ category. It can easily be perceived as implying a judgment: ‘You should be able to do this or you fall short.’
This is why we worded it differently and added the ‘learn to’. Once you acknowledge that something is both important and can be learned, a person is no longer in one of two categories (being able or unable), but on a continuum of less or more advanced learning. This offers hope and kindness. By adding the ‘learn to’, you indicate a process, not a rigid state. It takes away judgment and offers compassion and confidence instead: ‘It’s okay; you’re okay! This is what this child needs and you can learn to provide that, if you are not yet able to offer it now!’ It prevents people from feeling the fear and shame of being a ‘loser’ or ‘not good enough’. Shame is one of the biggest blockers of growth and development. You cannot force someone to learn something; the pressure of performing, the fear of failure and stress of shame are in itself enough to prevent any meaningful learning. All you can do is create an atmosphere that is encouraging (even literally: instilling courage), inviting and engaging for someone to become a learner. For that to happen, someone usually needs to feel connected, to feel seen and heard and respected, all the more so if there is a lot of pain underneath that may be expressed as anger, stubbornness, or resistance, to name a few.

Describing important competencies as something that can be learned throughout life, both privately and in work settings or in society as a whole, is an expression of trust: ‘Go ahead! You can do it!’ If we can have those hard conversations about what children need and often still lack, and we add the trust that as an adult you can learn to offer it, we work on the prevention of (cultural and personal) intergenerationality of unhealthy practices. You are only able to really learn something, however, if you feel safe and secure (there’s that psychoneuroimmunoendocrinology again!) and if you know you are also allowed to fail. Without permission to fail or permission to ask for help, it would almost be foolish to enter a learning adventure. Why risk your life, your image, your social inclusion by trying to achieve something you are very unsure of succeeding in? Who would walk the tightrope while lacking both experience and a safety net? And also, you will usually only enter a conscious learning process when you are conscious of your incompetence. This, again, is why you need to feel secure and supported without judgment, because the stress of insecurity will lead us into a fight-or-flight-modus, that does not allow for effective learning processes, only for surviving.
Therefore, if learning turns out to be difficult, the question that deserves attention is: ‘What makes it difficult to create the connection, between the adult and the child, and also between the adult and their inner child?’ It is all about the big difference between ‘What is wrong with you?’ (judgment, no ‘holding space’, power position) and ‘What happened to you?’ (curiosity, connection compassion, courage, equity), between ‘What’s the problem?’ and ‘What’s the story?’

For us, wording in a way that respects all these underlying physiological and psychological processes is of crucial importance and we feel that as adults, we need to be aware that children do not carry responsibility for such dynamics. They model what their environment shows them. They experience toxic stress as a consequence of the interaction with their environment, that often also provides them with toxic language. The responsibility for all this thus lies with the adults around them, with the recognition that the more childhood trauma the adults suffer from, the harder deep reflection will be for them, and this, in turn, deserves compassion. The more security we experience, the more courage we will have to make ourselves vulnerable, because in a safe and secure environment, we do not have to be alert and on the lookout for danger all the time. Speaking about competencies in terms of learning processes that can be entered, instead of categorising people as ‘capable’ or ‘incapable’, makes everything kinder and will end up reducing the use of deterministic, toxic language. Once we are more aware of the possible pain in others, we can be more compassionate in our approach of any other human being and this contributes to a more caring and peaceful society.

So, let us return to the questions that sparked the editing rounds: What is the added value of ACE Aware NL? What is different in our approach? What is our core message?

Science has shown that we do not leave our childhood behind. For better or worse, it stays with us and colours the way we are in the world, the way we feel, think, and behave around others, and the way we respond to our young ones’ needs and nurture them, which will shape their own start in life. Eventually, a healthy and just society, with attention and compassion for others and the living environment starts with a secure childhood.
This means we are not only focusing on infants and children, but also extensively on supporting adults in healing their own ACEs, in turn making them more sensitive and responsive towards children and preventing further ACEs from being created.
We hope that the article and these two blogs have shown that we aim to create a space of awareness around ACEs within the Netherlands, an awareness that needs and deserves strong reinforcement both at the personal and at the policy level, such as families, communities, child-related healthcare and national institutions.

These were the discussions we had with the Vakblad Vroeg-editors and it was heartwarming to experience that if we all stay in that state of curiosity (‘What do you mean with this?’, ‘What is the reason you edited that in/out?’, ‘How can we stay within the word limit for two pages and make this text as powerful and accessible as possible?’), a lot can be achieved!
We hope the article serves you in your work and we also hope to meet you in the near future for an ACE Aware NL-meeting or film screening. We want to thank Jan especially and Louise for their patience and their open mindedness and we look forward to working together again shortly!

Last week, we dove into the concept of  ‘salutogenesis’, coined by medical sociologist Aaron Antonovsky. In it, the central question is what we need in life to remain healthy. We are all exposed to stress factors of many sorts, which makes it important to have resources that can refresh us, people with whom we feel safe and secure, heard and seen. Antonovsky called these Generalised Resistance Resources (GRR’s), to indicate that they contribute to our ability to cope with life’s challenges.
If we have such resources available, Antonovsky stated, they will support our health through the ‘Sense of Coherence’ (SoC), a sense of consistency in life, also described as psychological resilience. The SoC is the confidence that our internal and external environments are predictable to a certain extent and that all will be well in life. He saw three core elements that together constitute the SoC: comprehensibility, manageability, and meaningfulness. These three mutually influence one another and the physical, psychological, and social are always interwoven. Let us take a closer look at all three.

Clear messages and communication and a certain order and predictability feed comprehensibility in life. This is the cognitive element of the SoC. For comprehensibility, a perception of security in a culture or a specific setting is key. If you are in a war situation, in a violent neighbourhood, somewhere where you do not understand the language, or in the middle of a disaster or a crisis, your sense of security and predictability are seriously affected. You will no longer know what to count on and this can make life feel incomprehensible.
For children, if they cannot count on their primary attachment figures, such situations can lead to forms of insecure attachment.

Balance between experiencing under- and overload (with regard to obligations and expectations) and between challenges and resources in life (the previously discussed GRR’s) creates manageability, the behavioural component of the SoC. When you do not have enough to do and are not encouraged and challenged, you may lose your lust for life. On the other hand, being constantly overburdened is also problematic, because it may lead to a lurking burn-out.
For children, being overasked on a structural basis can mean that they can hardly be themselves and are continuously trying to meet other people’s expectations. This way, the child’s authenticity may get under (serious) pressure.

The extent to which life feels emotionally valuable and satisfying and to which people consider life worth living and worth dedicating energy to, forms the meaningfulness of one’s existence, the motivational element of the SoC. Antonovsky saw this as the most important element of the SoC. When you get the impression that what you do is useless, you can start feeling useless yourself. It can damage your self-confidence and make you feel depressed. Because humans are intensely social beings, ‘hardwired for connection’, especially the lack of meaningful contact with others can create a sense of meaninglessness – an aspect painfully made visible for many by the present lockdown measures.
For children, the lack of contact with others can have really severe consequences. We know the stories of children in Romanian orphanages, who were fed and clothed, but had hardly any interpersonal contact – they withered away. Harry Harlow’s experiments in the middle of the previous century (with monkeys separated from their mothers) also showed how deep the urge for connection is and how babies perish without loving connection.

How people experience and describe their health, has a lot to do with how they experience their SoC. If one of the elements of the SoC is threatened, the perception of how ‘healthy’ you are, can change very suddenly.
As we discussed last week, Antonovsky mainly looked at factors in life that support health and wellbeing, that help you to adjust to changing circumstances, and that offer social resources. He did not look at life as a river full of dangers that you should not fall into, but as a stream in which all of us inevitably located. What we need to do is learn to swim. We have to learn to acquire resources and use them if necessary, so that we do not feel engulfed and drown. In all of that, Antonovsky saw an important role for the surrounding culture and social environment. Those can either support the SoC or rather throw up barriers. Have a look at the framework above; you see the important place of cultural factors. In his writings, Antonovsky mentioned social position, gender, age, innate characteristics, parenting methods, ethnicity, work situation and good or bad luck as illustrations of these cultural factors influencing the SoC.

What we see is that Antonovsky chose a very holistic approach: health and wellbeing are not individual phenomena, but are embedded in all kinds of physical, mental, and social mechanisms. This is called a biopsychosocial approach. Anything around ACEs is based on such a biopsychosocial approach. The science related to ACEs repeatedly emphasises that disease and social problems have a history with roots in the social environment. It is counterproductive to judge people’s behaviour without paying attention to that environment; shame and guilt are the biggest barriers to growth and development. They do not make us flourish, but nips us in the bud. They push us under water in the river.
A society that dares to courageously, vulnerably and compassionately examine her own history, habits, and institutions, offers her children the most fertile soil for a healthy adult life.

Did these two blogs make you curious about salutogenesis and how you can apply this concept in your own life or work setting? If so, have a look at this wonderful, freely downloadable resource: The Handbook of Salutogenesis, a publication from 2017, written by Mittelmark et al., and a real treasure trove for information and ideas.

A few weeks ago, in the last part of our conversation with Henriëtte Markink, one of the topics we mentioned was salutogenesis. This is what we said about it: “This approach asks about the origins of health, leading to very different follow-up steps than western medicine’s more common ‘pathogenesis’ (the questions about the origins of disease). Salutogenesis is prospective (looking ahead – how can we maintain this?) and proactive (what does one need to stay healthy?) and searching from trust and confidence towards the good things in life. Pathogenesis is more retrospective (looking back – how did this problem arise?) and reactive (what can we do to solve the problem?) and working from avoidance (of risk factors). The founder of the concept, Aaron Antonovsky, described it like this: ‘Pathogenesis sees life as a river full of risks that you should not end up in. This view focuses on prevention (do not fall in) and treatment (do not drown, we will save you). Salutogenesis says that all of us are always in that river, because in life, anything can happen to us at any time. What to do…? Learn to swim!’ ” This week, we will take a closer look at this fascinating view on health.

Salutogenesis is a concept introduced by Aaron Antonovsky (1923-1994), a medical sociologist for whom two things were as plain as day: first, humans are always in interaction with the larger social context, and second, continuous change, disturbance, and deterioration are not the exception, but the rule. For that last process, he used the term ‘entropy’, which in sociology terms refers to ‘inevitable disintegration’. Humans are mortal. The road to the end of life is longer, healthier, and happier for one than for the other, but sooner or later we all take our last breath. That may sound like a pretty dramatic, pessimistic approach: is there nothing but misery, and are we all inherently flawed? What is the purpose of all our efforts? Strangely enough, the idea of inevitable disintegration is somehow full of compassion, full of softness and optimism: nobody is perfect; we are all vulnerable; each and everyone of us can fall prey to adversity; we all go through ups and downs and highs and lows on a daily basis. This, in full truth, is a realistic view on life that opens up a new perspective. It does not assume a smooth, linear life trajectory as the status quo. It leaves room to, without shame, be allowed to make mistakes, to experience things as difficult. This awareness connects us as humans with one another. To slow down the entropy, we can look for factors and processes that actively counteract the decline. We can, then, proactively strive for the things by which health (‘saluto-‘) is being created (‘genesis’), instead of nervously, incessantly preventing all that is dangerous and might threaten our health and wellbeing. The challenge, Antonovsky said, lies in learning to deal as well as possible with what life brings and make sure we can weather the storm… or the swell and surges, to stick with the image of the river.

In all of that, he did not view health as a dichotomy, a divide by which you can only be in one of two categories, in this case ‘healthy’ or ‘not healthy’. Antonovsky saw a continuum, a line on which people move back and forth: there are times they feel better and healthier than at other moments. Even if they go through tough times, however, they can still work towards maximizing wellbeing, given the circumstances. Even if everything seems to be working against them, people can tap into resources that bring light to the darkness. Even if you are really ill or heavily traumatised, comfort and reassurance can ease your fate.

Looking at health this way, the core question becomes: what do we need? How can we enjoy as long as possible the years we are given? What makes us feel happy and healthy and consider life as meaningful, even if there is disease or adversity? The interesting thing is that Antonovsky did not give a really concrete answer to these questions; he recognised that this can differ greatly per person, per context, and per life stage. He did develop a number of important ideas that do have a quite general validity and that are mentioned in the image above. We see, for example, above the upper blue arrow, the words ‘Generalised resistance resources’ (GRRs), resources and tools that can help you handle stress factors. Antonovsky described them as follows.

This means that these resources are effective to avoid or combat the stressors that life may bring to a person. What does that amount to? It can mean that you can breathe, relax, ease your mind and feel better again because you are physically able to go and do sports or take a long walk, because you have a sweet neighbour whom you can have a cup of tea with, because you live in a community where the atmosphere is good and safe. Those who have such resources available (and there are many others), will be better able to keep the faith and the courage when life hits hard, to pick up where they left off when things got rough.
Antonovsky’s work specifically asks us to pay attention to the positive things in life and go look for them very consciously, because they help us to swim through the river of life – or, put differently… to develop resilience.
When we translate all this to ACEs, we can see beautiful connections. We know, based on neurophysiological research, that the human brain is built and develops in response to the environment – the larger social context that Antonovsky took as his starting point. We can make an effort to organise society in such a way that we can optimally safeguard the positive influences on that development. Examples? Well-attuned, responsive adults are vital GRRs for a child. Teachers who see the child’s potential and support and encourage the child, create cognitive and emotional GRRs. A social environment that acknowledges children’s interests, forms a precious interpersonal and macrosociocultural GRR. A natural environment where people co-live with nature peacefully, stimulates (among others) physical, material and attitudinal GRRs.

Next week, we will look at the core of Antonovsky’s work: the Sense of Coherence, the confidence that your internal and external environment are predictable and reliable, and that somehow all will be well.

Last week, we discussed how the child’s interest is often not given the same weight as the adult interest and how that influences the child’s status quo and various forms of policy, which, in turn, influence the child’s life. For the time being, this situation continues despite the knowledge we have regarding the impact of childhood on adult health and wellbeing. We also addressed the fact that it may seem as if Adult Supremacy (AS) as a concept is more or less meant to label adults as ‘guilty’ for everything that troubles the child. This week, we will say a bit more about this aspect.

Consciously or unconsciously?

The statement that adults often fall short in satisfying the child’s needs deserves a closer look, as there is much more to this than mere unwillingness or ignorance.

The term ‘consciously or unconsciously’ is a well-considered aspect in the definition of AS and received a place in it after a brainstorm with Robin Grille, an author and professional with an impressively holistic vision, who, time and again, emphasises that we should not overlook obstacles on the multigenerational path. It is important to explicitly acknowledge that adults do not generally consciously ignore the child’s interest. They usually do not simply run over and flatten what is crucial to the child. Mostly and unfortunately, due to a host of factors, they are just not trained or able to consciously recognise or serve the child’s interest. Mentioning those limitations prevents an atmosphere in which empathy and compassion for the parent are lacking, in which the parent is considered a ‘perpetrator’, the one who is to blame for all that goes wrong in the child’s life. It is clearly not that straightforward. Many adults were harmed themselves in their childhood and the pain of the past hinders a clear view of needs and problems in the present, often both their own and their child’s. The tragedy of ACEs and AS is exactly that intergenerational aspect: adults who, as children, were confronted with many ACEs, who grew up in an environment where their interests were not sufficiently paid attention to, run a bigger risk of exposing their own children to such situations. What caused them so much misery in their early days, they often partially hand down. This means that there is a long and sad, intergenerational chain of causes and consequences, which is something very different from a long chain of guilty ones. Such a process is hard to break. In what way might we be able to work on that?

Tough questions on responsibility

That we view the behaviour of parents and other adults with the necessary meekness, does obviously not mean that it does not have to be up for discussion. It does not mean that, to the benefit of our children or the children for whom we care or draw up policies, we do not have to reflect on the influence of the choices, cultural practices, and social traditions that our society and we as adults continue to support. After all, an important part of being an adult is to take responsibility for your behaviour and its consequences. Many choices that we make as parents, however, are made under the pressure of sociocultural conventions. The whole idea of AS, therefore, is not to touch on what might simply seem to be a family issue, but to lift the taboo and discuss what is a multifaceted, societal issue. With all the knowledge available, it is about time to take responsibility for that as a community. That can be quite a confrontation, especially in the personal sphere:

‘Does my child not listen to me because I do not listen to her?’,

‘Is my child bullying classmates because it does not feel safe here at home?’,

‘Is my child so reticent because I am always in a hurry and do not take time to get the conversation going in an easy manner?’,

‘Does my baby want to nurse with me all night because I am not available during the day?’,

‘Does my child not lay problems before me because I instantly look for a solution instead of first listening to them, with empathy and compassion and without judgment?’

Institutionalised issues

Aside from personal ones, there are of course also many institutionalised practices that can lead to difficult questions and possibly uncomfortable answers.

– If we know how important skin-to-skin contact is for the newborn, then how come that on NICUs and similar hospital departments there is not much more often continuously one parent present for the prematurely born baby?

– If we know how important breastfeeding and mother’s milk are for the infant’s immunological, neurological, emotional and motor development, then how come that maternity leave is not much more generous?
– If we know that children’s perception of security and safety is so important for their stress regulation and thus for the prevention of toxic stress, then how come that certain forms of cosleeping by parents and children are often so actively (and sometimes almost aggressively) discouraged in youth healthcare?

– If we know how drastic and disruptive it is for children when their parents separate, causing the children to lose the undivided unity of the family, then how come that many regulations have rather made divorce easier instead of more effectively dealing with, facilitating and financing problem solution and support, so that everyone can heal and grow?

This list can easily be extended with other matters that deserve more social indignation. Think of anonymous sperm donation, circumcision without medical indication, behavioristic parenting strategies, oppressive school systems, problematic youth healthcare cases, and poignant child poverty. In all of this, next to the general health of the adult who takes care of the child, socioeconomic, societal and political tendencies play a role. Infants have a need for security and physical proximity of loved ones; at an existential level, children want to be seen and loved for who they are. By now, there is a lot of research showing how important all of this is for psychic, neurological and hormonal health; nevertheless, much of it still remains underexposed in institutions and systems. That those needs can often not be easily expressed in economical concepts, probably plays a role that delays implementation in policies. Love and emotional security cannot be calculated for the GDP and thus parents and children often have to muddle through with one another and make the best of it, despite difficult circumstances, with all due consequences.

Conclusion

The child’s interest is often inferior to adult interests and in many cases, this is partly the effect of insufficient knowledge and insight and insufficient sociocultural options to give the needs of children the attention they deserve. This requires reflection from adults on uncomfortable questions and answers to find starting points for where societal change is needed.

Next week, we will dig more deeply into social change and the link with physiology.