About the Author
Donna Jackson Nakazawa is an award-winning science journalist and public speaker. She is the author of The Last Best Cure, in which she chronicled her yearlong journey to health, and The Autoimmune Epidemic, an investigation into the reasons behind today's rising rates of autoimmune diseases.
Excerpt. © Reprinted by permission. All rights reserved.
Childhood Disrupted CHAPTER ONE
Every Adult Was Once a Child
If you saw Laura walking down the New York City street where she lives today, you’d see a well-dressed forty-six-year-old woman with auburn hair and green eyes who exudes a sense of “I matter here.” She looks entirely in charge of her life—as long as you don’t see the small ghosts trailing after her.
When Laura was growing up, her mom was bipolar. Laura’s mom had her good moments: she helped Laura with school projects, braided her hair, and taught her the name of every bird at the bird feeder. But when Laura’s mom suffered from depressive bouts, she’d lock herself in her room for hours. At other times she was manic and hypercritical, which took its toll on everyone around her. Laura’s dad, a vascular surgeon, was kind to Laura, but rarely around. He was, she says, “home late, out the door early—and then just plain out the door.”
Laura recalls a family trip to the Grand Canyon when she was ten. In a photo taken that day, Laura and her parents sit on a bench, sporting tourist whites. The sky is blue and cloudless, and behind them the dark, ribboned shadows of the canyon stretch deep and wide. It is a perfect summer day.
“That afternoon my mom was teaching me to identify the ponderosa pines,” Laura recalls. “Anyone looking at us would have assumed we were a normal, loving family.” Then, something seemed to shift, as it sometimes would. Laura’s parents began arguing about where to set up the tripod for their family photo. By the time the three of them sat down, her parents weren’t speaking. As they put on fake smiles for the camera, Laura’s mom suddenly pinched her daughter’s midriff around the back rim of her shorts, and told her to stop “staring off into space.” Then, a second pinch: “no wonder you’re turning into a butterball, you ate so much cheesecake last night you’re hanging over your shorts!”
If you look hard at Laura’s face in the photograph, you can see that she’s not squinting at the Arizona sun, but holding back tears.
When Laura was fifteen, her dad moved three states away with a new wife-to-be. He sent cards and money, but called less and less often. Her mother’s untreated bipolar disorder worsened. Laura’s days were punctuated with put-downs that caught her off guard as she walked across the living room. “My mom would spit out something like, ‘You look like a semiwide from behind. If you’re ever wondering why no boy asks you out, that’s why!’ ” One of Laura’s mother’s recurring lines was, “You were such a pretty baby, I don’t know what happened.” Sometimes Laura recalls, “My mom would go on a vitriolic diatribe about my dad until spittle foamed on her chin. I’d stand there, trying not to hear her as she went on and on, my whole body shaking inside.” Laura never invited friends over, for fear they’d find out her secret: her mom “wasn’t like other moms.”
Some thirty years later, Laura says, “In many ways, no matter where I go or what I do, I’m still in my mother’s house.” Today, “If a car swerves into my lane, a grocery store clerk is rude, my husband and I argue, or my boss calls me in to talk over a problem, I feel something flip over inside. It’s like there’s a match standing inside too near a flame, and with the smallest breeze, it ignites.” Something, she says, “just doesn’t feel right. Things feel bigger than they should be. Some days, I feel as if I’m living my life in an emotional boom box where the volume is turned up too high.”
To see Laura, you would never know that she is “always shaking a little, only invisibly, deep down in my cells.”
Laura’s sense that something is wrong inside is mirrored by her physical health. In her midthirties, she began suffering from migraines that landed her in bed for days at a time. At forty, Laura developed an autoimmune thyroid disease. At forty-four, during a routine exam, Laura’s doctor didn’t like the sound of her heart. An EKG revealed an arrhythmia. An echocardiogram showed that Laura had a condition known as dilated cardiomyopathy. The left ventricle of her heart was weak; the muscle had trouble pumping blood into her heart. Next thing Laura knew, she was a heart disease patient, undergoing surgery. Today, Laura has a cardioverter defibrillator implanted in the left side of her chest to prevent heart failure. The two-inch scar from the implant is deceivingly small.
John’s parents met in Asia when his father was deployed there as an army officer. After a whirlwind romance, his parents married and moved to the United States. For as long as John can remember, he says, “my parents’ marriage was deeply troubled, as was my relationship with my dad. I consider myself to have been raised by my mom and her mom. I longed to feel a deeper connection with my dad, but it just wasn’t there. He couldn’t extend himself in that way.”
John occasionally runs his hands through his short blond hair, as he carefully chooses his words. “My dad would get so worked up and pissed off about trivial things. He’d throw out opinions that we all knew were factually incorrect, and just keep arguing.” If John’s dad said the capital of New York was New York City, it didn’t matter if John showed him it was Albany. “He’d ask me to help in the garage and I’d be doing everything right, and then a half hour into it I’d put the screwdriver down in the wrong spot and he’d start yelling and not let up. There was never any praise. Even when he was the one who’d made a mistake, it somehow became my fault. He could not be wrong about anything.”
As John got older, it seemed wrong to him that “my dad was constantly pointing out all the mistakes that my brother and I made, without acknowledging any of his own.” His dad chronically criticized his mother, who was, John says, “kinder and more confident.”
When John was twelve, he interjected himself into the fights between his parents. One Christmas Eve, when he was fifteen, John awoke to the sound of “a scream and a commotion. I realized it was my mother screaming. I jumped out of bed and ran into my parents’ room, shouting, ‘What the hell is going on here?’ My mother sputtered, ‘He’s choking me!’ My father had his hands around my mother’s neck. I yelled at him: ‘You stay right here! Don’t you dare move! Mom is coming with me!’ I took my mother downstairs. She was sobbing. I was trying to understand what was happening, trying to be the adult between them.”
Later that Christmas morning, John’s father came down the steps to the living room where John and his mom were sleeping. “No one explained,” he says. “My little brother came downstairs and we had Christmas morning as if nothing had happened.”
Not long after, John’s grandmother, “who’d been an enormous source of love for my mom and me,” died suddenly. John says, “It was a terrible shock and loss for both of us. My father couldn’t support my mom or me in our grieving. He told my mom, ‘You just need to get over it!’ He was the quintessential narcissist. If it wasn’t about him, it wasn’t important, it wasn’t happening.”
Today, John is a boyish forty. He has warm hazel eyes and a wide, affable grin that would be hard not to warm up to. But beneath his easy, open demeanor, John struggles with an array of chronic illnesses.
By the time John was thirty-three, his blood pressure was shockingly high for a young man. He began to experience bouts of stabbing stomach pain and diarrhea and often had blood in his stool. These episodes grew more frequent. He had a headache every day of his life. By thirty-four, he’d developed chronic fatigue, and was so wiped out that sometimes he struggled to make it through an entire day at work.
For years, John had loved to go hiking to relieve stress, but by the time he was thirty-five, he couldn’t muster the physical stamina. “One day it hit me, ‘I’m still a young man and I’ll never go hiking again.’ ”
John’s relationships, like his physical body, were never quite healthy. John remembers falling deeply in love in his early thirties. After dating his girlfriend for a year, she invited him to meet her family. During his stay with them, John says, “I became acutely aware of how different I was from kids who grew up without the kind of shame and blame I endured.” One night, his girlfriend, her sisters, and their boyfriends all decided to go out dancing. “Everyone was sitting around the dinner table planning this great night out and I remember looking around at her family and the only thing going through my mind were these words: ‘I do not belong here.’ Everyone seemed so normal and happy. I was horrified suddenly at the idea of trying to play along and pretend that I knew how to be part of a happy family.”
So John faked “being really tired. My girlfriend was sweet and stayed with me and we didn’t go. She kept asking what was wrong and at some point I just started crying and I couldn’t stop. She wanted to help, but instead of telling her how insecure I was, or asking for her reassurance, I told her I was crying because I wasn’t in love with her.”
John’s girlfriend was, he says, “completely devastated.” She drove John to a hotel that night. “She and her family were shocked. No one could understand what had happened.” Even though John had been deeply in love, his fear won out. “I couldn’t let her find out how crippled I was by the shame and grief I carried inside.”
Bleeding from his inflamed intestines, exhausted by chronic fatigue, debilitated and distracted by pounding headaches, often struggling with work, and unable to feel comfortable in a relationship, John was stuck in a universe of pain and solitude, and he couldn’t get out.
Georgia’s childhood seems far better than the norm: she had two living parents who stayed married through thick and thin, and they lived in a stunning home with walls displaying Ivy League diplomas; Georgia’s father was a well-respected, Yale-educated investment banker. Her mom stayed at home with Georgia and two younger sisters. The five of them appear, in photos, to be the perfect family.
All seemed fine, growing up, practically perfect.
“But I felt, very early on, that something wasn’t quite right in our home, and that no one was talking about it,” Georgia says. “Our house was saturated by a kind of unease all the time. You could never put your finger on what it was, but it was there.”
Georgia’s mom was “emotionally distant and controlling,” Georgia recalls. “If you said or did something she didn’t like, she had a way of going stone cold right in front of you—she’d become what I used to think of as a moving statue that looked like my mother, only she wouldn’t look at you or speak to you.” The hardest part was that Georgia never knew what she’d done wrong. “I just knew that I was shut out of her world until whenever she decided I was worth speaking to again.”
For instance, her mother would “give my sisters and me a tiny little tablespoon of ice cream and then say, ‘You three will just have to share that.’ We knew better than to complain. If we did, she’d tell us how ungrateful we were, and suddenly she wouldn’t speak to us.”
Georgia’s father was a borderline alcoholic and “would occasionally just blow up over nothing,” she says. “One time he was changing a light-bulb and he just started cursing and screaming because it broke. He had these unpredictable eruptions of rage. They were rare but unforgettable.” Georgia was so frightened at times that “I’d run like a dog with my tail between my legs to hide until it was safe to come out again.”
Georgia was “so sensitive to the shifting vibe in our house that I could tell when my father was about to erupt before even he knew. The air would get so tight and I’d know—it’s going to happen again.” The worst part was that “We had to pretend my father’s outbursts weren’t happening. He’d scream about something minor, and then he’d go take a nap. Or you’d hear him strumming his guitar in his den.”
Between her mother’s silent treatments and her dad’s tirades, Georgia spent much of her childhood trying to anticipate and move out of the way of her parents’ anger. She had the sense, even when she was nine or ten, “that their anger was directed at each other. They didn’t fight, but there was a constant low hum of animosity between them. At times it seemed they vehemently hated each other.” Once, fearing that her inebriated father would crash his car after an argument with her mother, Georgia stole his car keys and refused to give them back.
Today, at age forty-nine, Georgia is reflective about her childhood. “I internalized all the emotions that were storming around me in my house, and in some ways it’s as if I’ve carried all that external angst inside me all my life.” Over the decades, carrying that pain has exacted a high toll. At first, Georgia says, “My physical pain began as a low whisper in my body.” But by the time she entered Columbia graduate school to pursue a PhD in classics, “I’d started having severe back problems. I was in so much physical pain, I could not sit in a chair. I had to study lying down.” At twenty-six, Georgia was diagnosed with degenerative disc disease. “My body just started screaming with its pain.”
Over the next few years, in addition to degenerative disc disease, Georgia was diagnosed with severe depression, adrenal fatigue—and finally, fibromyalgia. “I’ve spent my adult life in doctors’ clinics and trying various medications to relieve my pain,” she says. “But there is no relief in sight.”
Laura’s, John’s, and Georgia’s life stories illustrate the physical price we pay, as adults, for childhood adversity. New findings in neuroscience, psychology, and medicine have recently unveiled the exact ways in which childhood adversity biologically alters us for life. This groundbreaking research tells us that the emotional trauma we face when we are young has farther-reaching consequences than we might have imagined. Adverse Childhood Experiences change the architecture of our brains and the health of our immune systems, they trigger and sustain inflammation in both body and brain, and they influence our overall physical health and longevity long into adulthood. These physical changes, in turn, prewrite the story of how we will react to the world around us, and how well we will work, and parent, befriend, and love other people throughout the course of our adult lives.
This is true whether our childhood wounds are deeply traumatic, such as witnessing violence in our family, as John did; or more chronic living-room variety humiliations, such as those Laura endured; or more private but pervasive familial dysfunctions, such as Georgia’s.
All of these Adverse Childhood Experiences can lead to deep biophysical changes in a child that profoundly alter the developing brain and immunology in ways that also change the health of the adult he or she will become.
Scientists have come to this startling understanding of the link between Adverse Childhood Experiences and later physical illness in adulthood thanks, in large part, to the work of two individuals: a dedicated physician in San Diego, and a determined medical epidemiologist from the Centers for Disease Control (CDC). Together, during the 1980s and 1990s—the same years when Laura, John, and Georgia were growing up—these two researchers slowly uncovered the stunning scientific link between Adverse Childhood Experiences and later physical and neurological inflammation and life-changing adult health outcomes.
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