One of my friends sent me this video last year, but unfortunately I never got around to actually writing about it. But I put it on my list of things to write about, and coincidentally, we were assigned to watch this Ted Talk for one of my Public Health Seminar discussions!
My friend and watched this more through the lens of how South Asians experience emotional abuse without really realizing it or its impact on our overall health and well-being.
In class, our discussion was more revolved around whether Adverse Childhood Experiences (ACEs) (discussed below) are an accurate measure to follow in health care.
Regardless of the angle you take in approaching this video, I think it’s a great conversation starter on how childhood trauma may (or may not) affect other aspects of our health in the longterm.
What Are ACEs?
Adverse Childhood Experiences (ACEs) have become a critical public health issue that have not truly been given the attention they deserve. Individuals may experience several types of adversity; however, the original ACE Study identified 10 such categories.
Each of the following contributes to 1 point on an individual’s ACE score: (1) Physical Abuse, (2) Emotional Abuse, (3) Sexual Abuse, (4) Physical Neglect, (5) Emotional Neglect, (6) Parental Mental Illness, (7) Incarcerated Relative, (8) Mother Treated Violently, (9) Household Substance Abuse, and (10) Parental Divorce or Separation/ Not Being Raised by Both Biological Parents.
Studies have shown that 60-67% of all adults have experienced at least one ACE during their lifetime, illustrating how these experiences affect people from all types of backgrounds. According to the National Public Radio, disparities do exist as members of low income, low-education, racial minority, and LGBTQ communities have a significantly higher chance of experiencing more adversity during their childhood.
Association Between ACEs and Long-Term Health
The studies have also found an alarming association between higher ACE scores and worsening future health outcomes. There is a sort of dose-response relationship between ACEs and health outcomes, where as the number of ACEs increases, so does the risk for Injury, Mental Health, Maternal Health, Infectious Diseases, Chronic Diseases, Risky Behavior and lower life opportunity potential.
Our stress response is believed to explain this association. When we are faced with stressful or traumatic experiences, our Fight or Flight response becomes activated. Adrenaline is released, our blood sugar increases, and our blood pressure increases–all to help us respond to “danger.” However, this system can go from being adaptive and life-saving to becoming maladaptive or health damaging if it is activated over and over again.
For example, the more blood sugar and blood pressure that’s released for longer periods of time, the more risk one may have for chronic diseases like diabetes and cardiovascular disease. As children are still developing, their brains and bodies are more sensitive to the repetitive activation and are more prone to facing these neurological and other physiological changes.
Public Health Discussions
More states are now collecting and analyzing ACE data to further understand susceptibility and develop the earliest and most effective interventions. It is essential to develop policies that tie together the improvement of relationships, quality care, support of parents, and implementation of interventions. These are examples of the holistic approaches needed to teach healthy coping mechanisms and prevent future risks with protective and positive experiences. Additionally, healthcare providers who incorporate screening techniques and use multidisciplinary treatments would be proactively stepping in and implementing measures to help protect against the potential adverse consequences of ACEs.
The consequences of ACEs cannot be tackled with one time treatments alone. It is essential to study the risk factors and implement targeted solutions that also prevent the problems. With many public health issues, people tend to: (1) be unaware of their own risks; or (2) not want to admit their reality. In this case, as Dr. Burke mentions, some believe that we are marginalizing the ACEs issue because it actually does apply to us.
Since these conditions are preventable and treatable, it is critical to disseminate information and increase awareness regarding ACEs, the association with worsening health outcomes, and shutting down stigmas while accepting our own realities within this public health crisis.
At the same time, it can be harmful to rely too strongly on ACEs scores. In countries like the United States, we like to rely too heavily on numbers. Although the ACEs score can be a good indicator of past trauma, it cannot be the only measure that is relied on. Across countries and even across communities in the same physical areas, the definition of trauma varies.
What we consider “physical abuse” in America, may be considered “good parenting” in another country. What we see as traumatic childhoods may just be seen as normal childhoods in other nations.
Therefore, applying a one scaled measure that may be appropriate in one culture, can be dangerous if applied cross-culturally.
South Asian Perspective
As I initially watched the video and wrote my discussion for class, I was under the impression that all of this makes sense. I do believe that relying heavily on this scaled measure in varying cultural settings is not appropriate. However, I think the discussions on the impact of childhood trauma and other adverse events are important to have.
In communities like our South Asian ones, we tend to ignore or push aside topics like trauma. Because it may have seemed “normal” for some parents in other countries to slap their children, because it was “normal” for teachers to “discipline” their students, or because it may have been “normal” for families to be there financially but not emotionally for their children, and because of so many other hypotheticals–members of our communities have been led to believe that they have never been traumatized.
It may be “normal” (common) for certain communities to experience certain situations–but that does not mean that they cannot be traumatic.
Even if someone is used to being slapped or getting yelled at, most people are still scared. Many people still dread in anticipation of when they will be “disciplined” next. And when it does happen, many people’s Fight or Flight response becomes activated. I get that it may not be the case for some individuals–but for most of us, that’s just how our physiological systems work.
Emotional abuse is typically not a part of our South Asian vocabulary because if we are not physically or sexually abused, we don’t think of ourselves as being abused in any other way.
However, all abuse–physical, sexual, and emotional–is a part of our communities from childhood onwards. And a lot of people in our communities just don’t speak about it–because they may not see what’s wrong about it or because log kya kahenge?
I’m not saying everyone needs to come together and talk about the abuse they have experienced–I truly believe people should only speak about their stories if and when they’re comfortable doing so.
But, we as a community need to recognize the impact it is making on our lives. The abuse and trauma themselves are topics that warrant their own discussion. However, the impact this trauma makes on our life in the long-term is something we don’t always think about.
Chronic diseases (like obesity, diabetes, and heart diseases) are disproportionately high in South Asian populations. We are also some of the least likely to seek help for mental health concerns.
Ignoring traumatic events can worsen mental health conditions like PTSD or depression, which can go undiagnosed. And these conditions are associated with the chronic diseases that are so prevalent in our communities.
So it’s my hope that we start these conversations in our communities. Talk about how experiencing or witnessing abuse is not a normal part of life. Talk about how past adverse experiences have shaped our upbringings. Talk about how trauma may have impacted your mental health. And talk about how our adverse childhood experiences may be negatively impacting our overall health and well-being.
Although there is no definite causation, there is a fair association between the two. The causes of the health conditions we experience are multifactorial. And ACEs may be one of those factors–especially if they have gone unaddressed in order to fit into the ideal South Asian vocabulary.
Adversity is real. Trauma is Real. And the impact they make are real. So let’s stop ignoring their existence and instead accept them as part of our lives. Let’s start those conversations so we can take the right next steps in addressing the health of our communities!
