What Happened to You? (Part 3)

In our third and final episode in our series on childhood trauma, we take a look at the bigger picture — as in, what the heck are we supposed to do with the knowledge that what happened to us as kids can affect our health in adulthood? How can we help heal our own childhood traumas? Buckle up, folks, because this train makes stops in Rantville, Can You Believe This Burg and OMGtown.

This episode was produced in partnership with: Call to Mind, American Public Media’s initiative to foster new conversations about mental health; St. David’s Center for Child and Family Development, which is building relationships that nurture the development of every child and family; with support from the Sauer Family Foundation, which is committed to improving the lives of disadvantaged children and their families in Minnesota.

Transcripts may not appear in their final version and are subject to change.

I’m Nora McInerny, and this is Terrible, Thanks for Asking.
[MUSIC]
For the past two episodes, we’ve been talking Adverse Childhood Experiences, or ACEs. If you haven’t heard those episodes we STRONGLY recommend that you go back and listen to them. They are episodes 85 and 86. They tell a personal story about Britt and her childhood, framed by a study called ACEs. The study is powered by the ACEs survey… which is a is ten questions that represent abuse, neglect, and household dysfunction that kids experience. And the data shows that the more ACEs a kid experiences… the more toxic stress they have… and the more likely they are to experience behavioral, mental, and physical health risks as adults. Things like depression, heart disease, diabetes, autoimmune diseases, and so much more.
But the good things in your childhood count for something as well. Some of those things can be protective factors that help a kid process and understand their ACEs… and give them the best chance to not live out their most risky futures.
[MUSIC CHANGE]
So why is all this important to know about?
Well… because this isn’t happening to ONE child. But the story of childhood trauma is not about one child. It is a global story, and this episode is about going big.
Because there are currently 2.2 billion children in the world. Actually… my oldest recently turned 18 so I guess now there’s only 2.2 billion people under the age of 18 on our planet.
And most of those 2.2 billion people will experience at least 1 adverse childhood experience. That means that it is… or is going to be… your kid. Or a kid in your family. Or your friends’ kid. Or all of them.
When those billions of children grow up… they are going to shape the health concerns and epidemics of the next 30 years. And what we know from all this research is that what we do right now to protect and empower kids… can have an impact those future health issues.
So what are we doing? How are we addressing the health risks of our kids in 30 years? Of our grandkids in 60 years? What kind of world will we live in when all of these kids are older?
As consumers… as community members… as voters… are we prioritizing things that will help?
In this third and final episode of our series on childhood trauma, we’re going to take a bigger picture view of this issue, and how it affects our bodies and our communities and the world at large It’s a big, big picture. Because this is a big-picture issue. Brian Lynch: [01:05:17] it’s a very unaddressed public health crisis.
[MUSIC OUT]
EPIGENETICS
That is Dr. Brian Lynch. He is a pediatrician at the Mayo Clinic in Rochester, Minnesota. And he is going to help us get started on our big picture journey by getting very very small. Like… fundamentally small.
We know that if you have ACEs… you will tend to raise children that share some of your same health risks. Because when things happen to you…
Brian Lynch: [00:14:45] the way your genes are expressed is changed. Then this not only impacts your health… it changes the health of future generations… because you can pass on these changed genes and a child who’s born who’s never experienced an ACE… can still be at risk for the health outcomes associated with adverse childhood experiences.
This is called epigenetics. Which… really confused our producer Hans for a while because he got it confused with eugenics… which is controlling who gets to reproduce and who doesn’t… and is VERY VERY different. Epigenetics is actually pretty new research.
We used to think that our genes were static and fixed. That they were like a train track. We start the engine up at birth, and just hit go and end up in Yuma or whatever. And all the towns we pass through in between are set and established before we even get into the train in the first place.
But epigenetics tells us that is not how it works. Epigenetics says that our genes are actually a network of tracks… and what HAPPENS along the route can change your route. It can reroute your train of life through other towns, other climates, other ecosystems.
So it means that our genes aren’t dictating what will happen to us from birth. There’s flexibility.
[MUSIC]
The thing about genes, is that we pass them on. That’s why my kids have long, skinny feet. That’s why some of my kids have great eyelashes. And that’s why the trauma that we’re dealing with is not just ours…it’s our grandparents.’ Brian Lynch: [00:56:10] You get your genetic code– and this is what’s really interesting about ACEs is we probably need to be thinking two generations back. Right? So if you think, you know… a mother is born, she has her ova there at birth… her eggs… and… the genes in those eggs are there… from the parents. And so if they’ve experienced stress or they’ve had things that impact that genetic code, that’s going to be passed on… so these are intergenerational concerns.
As if we need another reason to be mad at the boomers, now we can thank them for fucking up our kids! JOKING JOKING — I’m saying, actually, that thinking about your own genes this way might help you even understand why your parents are the way they are, or why their parents are the way they are…not JUST because of what they went through, but because of what has been in their genes. And this isn’t me saying that you’re doomed because of the things that have happened to your grandparents.
Brian Lynch: [00:56:59] the way your DNA can be expressed can be changed and it can be changed by positive experiences and those positive experiences can then decrease your risk. And understanding which specific gene changes do what… we’re a long way from that. But we do know… that you can mitigate or counteract the impact of those ACES… by promoting those positive experiences.
Great news! And to do that, you need some awareness. Of yourself, of where you came from. Of what you’re doing and why you’re doing it. Beyond genes… we pass things along culturally as well. A habit or a tradition was established generations ago to solve a problem or stress or struggle. That problem went away… but we still do those habits or traditions anyways. Therapist Brandon Jones talked to us in the last episode about resilience, and this episode.
Brandon: [00:00:23] I’m kind of a unicorn– black male therapist we barely exist. Born and raised in St. Paul. This time, he’s helping us understand this passing on of trauma with a story. [MUSIC CHANGE]
Brandon: [01:24:26] so during the holiday season there was a family and they always cut their hams in half… and the story goes like this… so one generation asked her Mom “Mom why do you cut the ham in half like that… when you cook it?” And mom says “that’s because Grandma cooked it like that.” And then… she said “you should ask grandma why she cooks like that” so the… girl goes to Grandma… “Grandma why do you cook your hams like that?” And she said “oh that’s how big momma used to cook them. You should ask Big Mama why we cook them like that.” So then she goes and asks her great grandmother… “hey Big Mama why do you cook the hams like that?” and Big Momma says “Well wack– in my day, when we had to cook the hams… we had a small stove so we had to cut it in half to cook it.” But what happened? Big mama taught her daughter to cut the ham… she taught it to her daughter… and now she’s teaching it to her daughter how to cook the Christmas ham. Right? But the thing is what has changed? The stove has changed but the habit and the cultural custom was still there. I think that that ends up happening a lot as well in families who have trauma… is that one generation goes through the trauma… they don’t get an intervention but things start to change around them… they pass that on to their kids… they pass that on their kids and they pass it on their kids. So if we think of it from that point– that transmissions theory point… chances are if you have a high ACE score… you can end up putting your children in situations where they have high ACE scores as well.
It’s awareness — of the fact that you’re even cutting the ham in half — that can help you make different choices, and pursue healing. That can help you re-route that genetic train. But awareness isn’t just about you personally. It takes a systemic awareness to affect change.
[MUSIC CHANGE]
And that’s really hard to accomplish. Because in America at least, we interact with a lot of systems. And they don’t all interact with one another.
So when we come back… we talk about systems.
[MIDROLL 1]
So we’ve talked about childhood trauma on a personal level, a genetic level, and a cultural level.
But there is a part of this on a bigger scale. To really understand what we can do, we have to think on a systems level.
SYSTEMS OF CARE
Brian Lynch: [00:57:34] adverse childhood experiences can’t be solved in a clinic or a hospital. And traditionally, sectors like health care, public health, schools, child care, early childhood organizations have all done great work… but in specific silos. And those silos haven’t… necessarily always communicated or collaborated in the way that they need to… to promote the most efficient and effective outcomes in children.
That’s Dr. Brian Lynch again. If ACEs tell us anything… it’s that things are connected. What happened to you as a kid is connected to how you’re doing as an adult. So to work on an interconnected issue… we need to have an interconnected approach.
So what does that look like?
Over the past decade, Dr. Lynch has been heading up a group that works in Olmsted County , MN to connect and coordinate care for children. That group is called the Communities Coordinating for Healthy Development.
Brian Lynch: [01:01:26] It involves members of public health… Rochester Public Schools… Head Start… early intervention… different providers at Mayo Clinic… and volunteers in the community.
One of the people who works on this project is Margene Gunderson. She’s works with the Olmsted County Public Health Department. Margene: [00:00:07] I am Margene Gunderson. I am a registered nurse… and a public health nurse. I have worked in… public health field my entire career. So like Dr. Lynch said earlier… most of our healthcare exists in silos. Think about it – does your dentist know what you talk about with your therapist? Does your ophthalmologist know what issues you’re working on with your gynecologist? Do any of those people even know that the others exist? And if they do, do they all sit around talking about you? GOSH I WISH.
But is your neck bone connected to your shoulder bone? And is your shoulder bone connected to your arm bone? And is your arm bone connected to your… other arm bone? I don’t know… I’m not a doctor.
But all these other people you see are!!!
And when all the doctors are each treating just one part of you without talking to each other it’s like that old parable about the blind men and the elephant. Where three blind men are each trying to describe an elephant by touching it but they’re all touching different parts of it. The man who has hold of the elephant’s ear insists that an elephant must be skinny and very flexible. The man who has hold of the elephant’s leg says that first guys is a dum dum who clearly can’t understand that an elephant is super solid and wrinkly. And the man who has hold of the tusk says that both these idiots don’t understand that an elephant is perfectly smooth and strangely pointy.
MY pointy… (get it??)… is that our healthcare is like an elephant in a lot of ways. It’s huge and grey and is very confusing when you just try to interact with one part at a time.
And that comes with big challenges.
And that’s exactly where the Communities for Coordinating Healthy Development started from about ten years ago. Looking at some of the reasons that doctors weren’t communicating with each other.
First, there’s the time factor. Doctors are people, and people only have 24 hours in a day.
Brian Lynch: [01:03:41] Right, it takes a lot of time to not only… deliver direct patient care, but then to… take that time to communicate with another entity.
And then, these people are working at different places that have different tools.
Brian Lynch: [01:04:29] different cultures and different approaches. And certainly if… home visiting services using one screening tool and the medical homes using a different screening tool… and they’re telling families different things about their child’s development… then that leads to… ineffective care.
And a lot of folks didn’t know… and maybe still don’t know… what even ACEs is. Even MARGENE! Margene: [00:34:42] this ACE study has been out for 20 years… where have I been? I’ve been in public health for 35 and a half years. So I’m that person. And there are some who are… yet to come. But maybe one of the biggest hurdles to getting doctors to communicate are some of the legalities around it.
Brian Lynch: [01:03:52] Certainly HIPPA or the rules that protect medical information… certainly provide some limitations.
HIPAA is the Health Insurance Portability and Accountability Act. Which is not what I expected that acronym to stand for. Basically, it was a law passed in 1996 to protect your medical information from being shared without your permission. Which ensures that you can have confidential conversations with your doctors without risking it getting shared with your family or your job or your insurance or whatever.
Yes! Hard yes. That is true. 100% agree. HIPAA is an incredibly important thing that protects all of us.
But…
Margene: [00:35:54] Because of HIPAA… we are not able to share information just arbitrarily with whomever we would like because we think it’s gonna be good for them. Doctors are not easily able to share important medical data about you with each other. Which reinforces the silos in which caregivers operate. And can be a problem when you’re dealing with something… like adverse childhood experiences… that span across nearly every part of medical care.
The U.S. Department of Health and Human Services… who enacted HIPAA…are aware of what this silo’ing does, and they don’t WANT it to hold up good care. They want this act to have some flexibility to it.
And Dr. Lynch and Margene and the team have been working with that flexibility to get the systems of care to a better place. To increase communication, break down the silos, and redesign the system. Which for them, in an ideal situation, looks like this:
Brian Lynch: [00:59:21] to put the child at the center hub of the wheel with spokes then connecting to these supportive community resources… and those resources communicating together. And I think that’s the way that we’re gonna be able to best address… the current health epidemics in children in our country, including mental health problems… obesity… and adverse childhood experiences.
[MUSIC]
So how do you get systems to talk with one another?
Meetings. Lots of meetings. Sharing tools. Collaborating on screenings. And plenty of adjusting paperwork. Brian Lynch: [01:03:58] And it’s taken a long time in Olmsted County… to create… authorization forms… that all the organizations agree… can qualify for communication of medical information between those organizations.
Everyone had to chime in with what would work for them to share, and in what format, to still comply with HIPAA but to help put that child at the center of the wheel. They’ve had to change forms and paperwork. Decide on how to effectively communicate with patients and each other.
Margene: [00:26:39] if we knew our family was going to go see… say, Dr. Brian Lynch on Tuesday and something had happened in the home… on Monday, where we could just quickly send this this communiqué to him… Brian Lynch: [01:00:51] I will know what organizations they’re connected with in the community that are also aiding the parents and child… and I’ll know what they’re finding, how often they’re going… if there’s any problems… because that could make a big difference.
A system like that gives a lot of power to the patients as well. If you’re working on a parenting issue or a health issue with a public health nurse, they can update your pediatrician on the progress you’re making. As a parent, oh my GOD when doctors ask you about your kids and you’re like, uh, I don’t know, I don’t really remember??? Having more professionals know what’s up on your life, and giving you support? Sign me up.
Margene: To sort of say, nice job that, you know, because… before this is how this worked for you and now that you are working on this… this is how this is working… and your child… is going to have a different experience than you had as a parent. Right? So it’s just connecting the whole thing and making it more fluid.
The system isn’t perfect yet, but they have had some really interesting successes.
One example is in Olmsted County schools dealing with stress and bad behavior in classrooms.
Margene: [00:16:07] The teachers have been frustrated, students have been frustrated, parents have been frustrated.
To work on this, public health nurses and school social workers are collaborating to teach a social emotional learning curriculum.
Margene: [00:15:21] we’re teaching… you know second graders how to… recognize when their brain… their amygdala… is getting fired and these students… know… the big words… and they use the big words… they can recognize stress and then they practice these… these… meditative or… relaxation sort of techniques that take just minutes to do… so that they can help themselves… self regulate.
Remember Brandon’s story about cutting the ham? This is second-graders looking at themselves and their behavior and being like, wait, why are we doing this? And as an adult woman who just learned about the amygdala and struggles with mindfulness, I know it has value for me as an adult. And Olmstead county knows it has value for kids, too. Margene: [00:18:31] the results are… are very clear… that there is a… definite improvement in the way people are able to self regulate… and calmness in the classroom.
[MUSIC]
Not everyone is doing this sort of work. Not every community CAN do this sort of work at the moment. The Mayo Clinic is one of the top hospitals in the country, and it’s taken them ten years and enormous effort just to get this far. And there’s farther that they need to go. Because Olmstead County is just a little county in Minnesota.
Brian Lynch: [01:02:31] Every community is different. For strengths and weaknesses in terms of how it can help families who’ve experienced adverse experiences. So we need to develop local systems. And that local systems need communication and collaboration between the medical home… and these community agencies.
Margene: [00:05:28] each community is unique in terms of the issues that its self-identifies… and so then the solutions then become… more independently driven… within communities– despite the fact that there may be some similarities… you know, across the nation.
Brian Lynch: [01:04:15] You know because every… school district, every public health organization, every health care organization… has different things they need… to authorize sharing of medical information.
ECONOMICS
So far, we’ve talked about how to do our best for kids who have experienced ACEs, and how the systems can be adapted to better help those kids. But when we’re talking about systems of care, we need to expand even farther and talk about the systems that give people access to systems of care. We need to talk about how we can use these social systems to help prevent ACES in the first place. Because for all the people thinking, “well, doesn’t this come down to people just needing to take personal responsibility for their children? Isn’t this all a matter of someone’s PERSONAL ACTIONS AND CHOICES?” No.
Brian Lynch: [01:00:03] we have good evidence that high level policy changes like supporting… programs for– that aid expectant mothers and parents of young children like home visiting or parental support programs… or quality… child care and preschool for all. These are things that can both prevent adverse experiences… and counteract… their impact.
All of the “good choices” and “personal responsibility” in the world can’t prevent ACEs when there are so many larger things at play. To prevent ACEs, you need to have a family that is supported by a community larger than yourself. And the US can be a really hard place for some people to find family support. And don’t just take my socialist word for it. It’s actually the CENTER FOR DISEASE CONTROL that lists 21 concrete ways we can be preventing ACEs right now. They say – support our families. We should have a ribbon color for that – support our families. Put it on bumper stickers. What would it be? Puce? Gross. Not puce. I mean… lovely color. TERRIBLE name. Who branded that? If you branded puce and are listening, DM me. We have some things to talk about.
Anyways… there are a lot of things the CDC says we can do…. from increasing economic opportunities… to changing social norms to make bystander intervention more common.
[MUSIC]
But the one I want to focus on is childcare subsidies and tax credits. Kids are expensive, and so is quality care. NOT having childcare is not an option if you want and NEED to keep your job.
The US doesn’t have universal paid parental leave. In 2017, only 15% of U.S. workers got any form of paid parental leave. For many people with full-time jobs, this “paid leave” includes two weeks of full-time pay and then 6 weeks of unpaid leave…or being paid at 60% if they have short-term disability insurance. Which means they leave their NEWBORN BABY when their baby is still tiny and helpless, when their own body is not done healing. Basically, we don’t respect women and we make it very hard to be a parent, especially a mother. FIFTEEN PERCENT of people got paid time to spend with their newborn baby or newly adopted baby or child. FIFTEEN. PERCENT. Which means 85 percent of people didn’t. They had to leave their job or their baby. That is a stressful choice. To say the least. THIS PODCASTER BROUGHT HER BABY TO WORK AFTER 48 HOURS!
The Family Medical Leave act is a law that requires most companies to give new parents 12 weeks of unpaid leave to care for a baby. Wow, thanks for NOT PAYING ME FOR THREE MONTHS. THAT IS SO HELPFUL! WHO CAN AFFORD TO NOT WORK FOR THREE MONTHS?!
Paid parental can increase the likelihood that mothers keep their jobs after giving birth. Stressful choice averted. Which… by the way… can also reduce things like depression and even instances of intimate partner violence.
This is just one area where there is a larger social system in place… or not in place… that keeps certain people at risk of ACEs. And keeps people from helping develop protective factors.
These are some things we can already be doing to prevent ACEs. They’re nothing new or fancy, they are solutions that are proven to help reduce the stress of raising a family. Anytime we take steps to decrease parental stress, we are decreasing the risk of abuse and dysfunction in the home. Which decreases the number of ACEs a kid might experience. Because the estimates are that the effects of abuse and neglect cost the US economy 401 billion dollars…ANNUALLY. In criminal justice, child welfare, special education, healthcare, and productivity loss.
So if we choose not to look at how these systems work, kids are just going to keep getting hurt. And those hurt kids will grow into hurt adults, adults we share a community and a society with. And when people are like, uhhhh, we can’t afford that! We can’t AFFORD to help people learn how to raise their kids, or take time off work, or overhaul all these systems of support!
Well, I don’t see how we can afford NOT to. I’m gonna take a quick step down off my soapbox, and we are going to read some ads to you.
[MIDROLL 2]
WHO IS INCLUDED? (PHILLY –BRANDON)
And we’re back.
And we are NOT DONE WITH OUR TRIP TO TRAUMA TOWN. It’s time to go from systems, to populations. And ask the question – who are we talking about? Who is included in all this data?
[MUSIC]
So Brandon Jones… who we met earlier with the story about Christmas ham… Brandon works with traumatized kids. He studied under Dr. Felitti, who conducted that first ACEs survey. And Brandon knows ACEs as a professional with TWO master’s degrees. But he also knows ACEs personally. From his own experiences growing up. As he says… trauma and drama.
Brandon: [00:00:29] Personally I grew up in a household full of trauma and drama that’s how I explained it to people. Born to a teenage mother. She had me a couple weeks after graduating from high school… ended up with a stepfather who was abusive seeing a lot of domestic violence as a kid. Thought he was my real dad till a… a couple weeks before my 12th birthday– family secret came out– Grandma let me know… “hey that’s not your dad– your dad’s this person you’re going to go meet him on your birthday.” Yeah. Woah trauma trauma trauma. Right? And… did meet my dad really didn’t develop a relationship with him… and kind of struggled with being a male. Being a bl– a young black man… trying to figure out what life is like. But I was a nerd at the same time so being able to put my head in books and learn and… get to aspirations of college and actually make it to the University of Minnesota all those things were huge for me. Brandon eventually realized that he wanted to be a therapist. And it’s as a therapist that he was first introduced to the ACEs study that measures adverse childhood experiences. As a part of his training, he was given the ten question test by the two men who wrote it. Ten questions about abuse, neglect and dysfunction that would give him a score that would tell him his health risks as an adult.
Brandon: [00:07:40] and the first question… I just kind of chuckled at and I was like hmm. The first question is “Has an adult ever yelled at you cursed at you shoved you… know something in that nature?” And I laugh because I’m like all adults in my life have cursed at me and shoved me… and told me these things culturally. That’s just how we discipline and rear our children… is by doing those things– not from a traumatic way even though it can cause trauma… but just a cultural custom of you need to keep your kids in line to protect them. So I was kind of thrown off by the ACE study to be honest with you at the beginning because I’m like this is going to be a long questionnaire for me if I’ve already got one point… for something that I’ve seen all the time in my life.
Nora: And that you didn’t consider…
Brandon: Trauma.
Nora: Right.
Brandon: Not at all. Brandon had… a lot of questions after taking the ACEs questionnaire. Like… the people who were the subjects of the original study…
Brandon: [00:10:32] Who are they? And why were these the questions that were picked? Because there were other things that happened in my childhood that were not asked on that questionnaire… that I do consider traumatic.
—–
Brandon: [00:10:49] Growing up in poverty… growing up in a neighborhood… with a lot of commotion. What I mean by that is like sirens people talking living an apartment buildings where there’s a lot of people up and down stairs just live in an urban environment. Myself I did not grow up in foster care but I knew a lot of kids who did and I think that that’s a traumatic marker for a lot of kids as well. Being bullied was not listed on there. —–
Brandon: [00:11:43] Those things happen to me. Those things are not on the ACE questionnaire at all. I grew up poor. I grew up on WIC, food stamps and Section 8. None of those questions were asked. That has a huge significant marker on… my psychological state… how I view myself my self concept and my self-esteem.
So who was ACEs normalized on? Who did make up that group of 17,000 people that got us all this data? Who was included?
Brandon: [00:50:09] The ACE Study was normed on middle class… white folks… The average age on that study… was 57 years old.
Brandon: all these folks had a premium insurance… Kaiser Permanente… Those folks were white. Seventy five percent of people in the study were white.
—
Brandon: [00:49:58] Unfortunately we live in a system where white folks… have become the standard. To the point where they don’t even see themselves as a culture it’s like I’m just white, right? And no you have issues. The study was designed around the population it was studying. So the questions reflect that. Which means… that there aren’t questions about things that affect other groups of people.
These limitations of the ACE study are real. And acknowledged by the original authors. We spoke with Dr. Vincent Felitti, who ran the study, and he agreed – there need to be more studies that include more questions and ask questions of different populations. And while nothing that has been done is as big as the original study… there have been some things that have expanded the scope.
In 2013 a study was released from a coalition in Philadelphia that was looking at what ACEs look like for an urban population. And they expanded on the ten questions in the original study.
Brandon: Have you ever been bullied? Were you in foster care? Do you feel like you live in a war zone? That’s what they called it. They had several questions that were designed to be answered from someone who has come from an urban environment. And what they noticed was the ACE scores ended up being higher than the original scores… due to the fact… that these folks… experienced trauma different. Adding these questions adds important cultural context to the original ACES study. It expands on that work and gives us more context. About what is affecting people without them even realizing it. About where our systems could intervene, or change.
And the work continues. Most states in the U.S. are doing their own ACEs research, and new findings continue to emerge as we include more people and learn more about how this affects all of us.
But more work needs to be done.
Because this isn’t just a problem for one demographic of people. Or the people in one geographic area. This is a problem that spans the globe.
ACEs don’t care about language or geography or religion. Kids are everywhere. ACEs happen everywhere. And the effects can be felt everywhere.
When we talk about a global health crisis and a survey that was normalized in the US, what does that mean for all these many communities outside of that original ACEs study? How are we making space for any ACEs that those children are experiencing?
Especially children who are experiencing the things we view as systems when we see them on the news – mass migration, war, famine, and genocide.
[MUSIC OUT]
IMMIGRANTS
We can’t speak for all children, and all countries, and all populations. But we can ask our neighbors. Here in Minnesota we have the largest Somali population in the United States. Some of this population includes refugees who were re-settled here after the Somali civil war around 1991. Some have immigrated here, or been born here. The somali population is a huge part of Minnesota, a backbone of Minnesotan life.
So how does a refugee and immigrant community like the Somali experience ACEs and childhood trauma?
We talked to Dr. Ahmed Kah-REE.
Dr. Karie: [00:00:04] My name is Ahmed Karie. I am from Somalia. And I have been practicing as a mental health practitioner for– for the last… 13 years… I have a– advanced degree, doctoral degree in psychology it’s called Psy D. And… I’m also licensed as clinical mental health. I have been working with the community for the past 10 years and providing psychotherapy assessment… and also consultations.
The majority of patients Dr. Karie sees are Somali, with some patients from other communities. And he mostly works with adults, some adolescents and a few children. Dr. Karie: [00:01:54] I see… trauma. I see oppositional defiance, I see ADHD. And I also see conduct disorder… when I’m working with adolescents and children. Sometimes I would see depression. For adults is mostly if I’m working with immigrant communities– It would be PTSD, post-traumatic stress disorder… depression, psychosis. And here and there of substance abuse.
—————————————-
Dr. Karie: [00:03:13] The trauma I see in the immigrant children or adolescents… is the one that has been transferred from their parents to them. Most parents that are from Somalia have had– exposed to the… life threatening situations in Somalia… like the civil war… famine, you know… immigrating to another country. So they have been exposed to a lot of hardship. So and that– they carried that with them when they settled in the refugee camps in the neighboring countries. So these kids have… inherited… that… stressful situation from their parents, even if they were born here… they carry that with them. It manifests in a way behavioral… dysregulation in a classroom setting… isolation… a lack of identity issues. All of those signs can be traced back to trauma, Imagine the epigenetics within a kid whose parents and grandparents have experienced extreme poverty, civil war, and fleeing their country of origin. The US government DOES require domestic medical evaluations to screen the health of people who immigrate from other countries. But the results of the mental health portion of that screening aren’t always comprehensive. If someone points out that you’re cutting a ham and you don’t need to…and you’re not even from a culture that eats ham…you don’t have the context for this situation.
Dr. Karie: [00:10:46] We perceive mental health in a different way in my community. And that’s because we don’t have a lot of terms in our language. We used to and we still do, I think, call it like possession of demons. Dr. Karie: [00:12:05] So in our community… the way we treated is through traditional healing. So we go see the imams in the mosque and… who would read Quran… Dr. Karie: [00:13:57] The idea of talk therapy helps you… you know, it’s new… to them and they don’t really they don’t buy it so easily. And we know that when we’re talking about mental illness… really, you cannot operate on it. You cannot bandage on it. Dr. Karie: [00:14:35] if somebody has a stroke and you tell them you need to go to physical therapy or, you know, teach them again how to lift a pen, that’s fine with them because that’s a physical illness, you know, but… it is the same thing in the mental… health– Mental illness is like you need to do that kind of therapy to be able to learn skills, to understand, have an insight of what’s going on. That’s once you GET to America, and someone points out that you’re cutting the ham in half for no reason. But refugees and immigrants arrive here to a whole new language and context around mental health, which can be totally different … or non existent… in their country of origin.
And if they DO know they’re cutting a ham, maybe they’re not comfortable acknowledging that. Maybe ham is not a comfortable topic in their culture. Dr. Karie: [00:16:03] Stigma is huge in the community. That’s another barrier. You know it’s like… people going to know me– I’m crazy now. I’m going to see a doctor who who’s a brain doctor or who is, you know, a therapist. And I’m seeing because my family or me too myself, I think I’m crazy, you know? So… what do we know about the crazy people? You know, we just sort of like… degrade them. We call them names. You know, we call them you– you’re retarded. You know what I mean? So stuff like that hurts the community and therefore prevents them so you can help that they need.
We said in the last episode, having a solid cultural identity IS a protective factor. Living in a place that denies or criticizes or criminalizes your cultural identity takes away some of your protection from the trauma you experience.
The Philadelphia ACEs study asks about racism and feelings of safety. So think about that in bigger terms — for immigrant and refugee communities hearing anti-immigration and refugee rhetoric on the news — or seeing people from their country of origin being banned from the united states.
That instills a serious sense of fear, which can lead to toxic stress. This is a fear that Dr. Kah-REE sees in his community here in Minnesota. He sees a fear of ICE, even for community members that are naturalized citizens. He sees kids who are afraid that ICE will take them from their parents.
Dr. Karie: One of the key things we look at is the separation when we look at trauma, parents being separated from their children. So… that is really, really huge thing for any child out there that they see the same age of the children or different age being separated from their child… without their consent. So it will be difficult to sit down with your children and tell them that, you know, this is happening in this country. And the government is doing this. So the question is, there is either going to come after us? So you can’t normalize it because it’s not a normal thing. You just have to support your children and make them understand… and invited them to ask questions. And also to… validate their concerns and just be there for them. You can’t say “it’s ok it’s ok we’ll move on” it’s not an ok thing. So…. it’s really difficult.
[MUSIC]
At TTFA, we have said before that this isn’t about comparison. Nobody can actually win the Trauma Cup. This is about context.
Dr. Karie: [00:43:07] Childhood trauma is relative to the community you living in. No matter where you live in the world.. so we’re looking at a systematic… trauma systems.
These systems of trauma are…SYSTEMIC. WOW WHAT A SENTENCE. But they’re huge. And they’re normalized on people who look like me and live where I live. I couldn’t count them as an ACE because they would never happen to me, or my kids. They didn’t happen to my grandparents or my parents.
Expanding on that ACEs study — recognizing the adverse experiences outside of our own — is a way of helping us build more empathy. And more humanity. We started this series by looking at one childhood, and now we’ve successfully bummed you out by making you think about the millions of traumatic childhoods taking place all around the world. So our work here is done.
We started this series by suggesting a small shift in attitude towards the people around us — from asking the question “what’s wrong with you” to “what happened to you” and now, we leave you with a whole NEW pile of questions.
Because the more aware you are of ACEs, the more you see them all around you. At the grocery store and on the news, at your kids’ school. On the news. Everywhere you go you can start to see the suffering of other people, and imagine the ways it has affected them. It’s not fun, but empathy rarely is. We here at TTFA are wrestling with the same questions you might be asking. Questions like…okay, what now? What happens to a world where 50 million children — the largest number since WWII — have been forcibly uprooted, and the wealthiest country in the world is snapping shut our borders?
What about the 271 million people in 2019 who migrated borders? Migration isn’t an ACE, but what is the migrant experience along the route? Or when they arrive in their new country?
Like what about the nearly 3,000 children who have been separated at the US/Mexico border from their families by ICE?
And what about forced migration from war, famine, and genocide?
What about refugee camps in Kenya, Jordan, South Sudan, Pakistan?
What about refugee populations in Colombia, Greece, Bangladesh, or Nepal?
What about resettled refugee populations in Turkey, Germany, and here… in the United States?
What about the fact that we have the largest global refugee crisis in the past 75 years?
What happens when these children grow up? And have children of their own? What will they be passing down — emotionally, behaviorally, and genetically? When they are old enough to ask questions, what will they ask? And what answers will we give them?