The Long Tail of Adverse Childhood Experiences

My dad was DIY before DIY was trending.

If you grew up in the Washington, DC, area in the 1980s, you may remember a store called Hechinger, a precursor to Home Depot. Hechinger was also ahead of its time and sold graphic tees. My dad wore one that said “Do It Yourself,” with a big finger pointing at me.

This was his ethos. When we left rooms, we were to turn off the lights. We weren’t supposed to stand in front of the open refrigerator, looking around for something to eat—we had to pick something and close the door. (My dad was also an environmentalist before that was trending, but more so, he was a thrifty guy responsible for paying the electric bill.)

My dad was a young man who built a career, a family, an extra room on our house, and a small business, but who suffered so deeply from bipolar illness that he felt it the best course of action to take his own life.

It is devastatingly ironic that my dad, who would be 75 years old now, died at age 41 by suicide. He was a man who did everything himself, truly until the end.

Now older than my dad was at the time of his death, I can hold the irony. I write this post as an exhausted working mother who does things as passionately as my dad did. I’m all in, all the time, unless I’m napping, but truly, I’m all in there as well.

I often wonder about this trait, this unrelenting DIY nature that I seem to not be able to push away. This year, as I reflect on my dad’s death, as I do each year around the anniversary of his passing, I get it. And I can see that it’s not going anywhere any time soon.

Today, living with a parent with mental illness and losing a parent to suicide at a young age are called adverse childhood experiences (ACE). ACEs are a category of traumatic events that those in the mental health and public health fields use to quantify the chances of an individual going on to experience physical illness, psychological distress, or victimization in later life. Later life can be adolescence, young adulthood, or later adulthood.

ACEs can sneak up on us; for me, I was in pretty good shape from age 9, right after my father died, through age 35, because of social and family support as well as therapy. I also had many, many protective factors: I grew up in an otherwise stable home with financial means, high-bar schooling, places to safely play and learn and grow, and a high level of internal motivation directed at traditionally-defined measures of success.

At age 35, as I built my own family and began to face some of the stresses that my father had faced at the same age, I found that it was as if time collapsed. All of a sudden, I was not as functional. The coping mechanisms I had relied on for just about my entire life were failing me, left and right. It was like I was a traumatized child, unable to ask for help or even know what help I needed.

I had to be able to recognize that I was having a trauma response to be able to climb out of the place I’d landed, my ACEs piling up on top of me like a landslide. If I’m being completely honest, that process has taken years and is far from being “done.”

Now, we have evidence to support that when people experience trauma as children, we hold on to that trauma in our bodies (see: The Body Keeps the Score and Polyvagal Theory). But, when I was a child in the 1980s, we were very DIY; we didn’t look at things from the perspective of what else could be going on other than that we had caused our problems ourselves. We didn’t know the long-term impact of trauma, the ways it could affect us long after a traumatic event had resolved, or the ways that we would continue to experience and re-experience it throughout life.

When I began writing about my dad in 2009, I didn’t fully understand all of this either. I thought my dad would have gotten better if there had been a better diagnosis, better treatment, and better medications. We, as a nation, were at a different place in our understanding of mental illness even just 13 years ago, and we have made tremendous progress over that time. (See Healing by Tom Insel for an incredible history of the progress and pitfalls related to mental health in America.)

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Now, having gratefully lived through a global pandemic and approaching yet another birthday that my dad did not, I enter this next phase of life with a very different perspective on what we need to recover from the long-term impacts of adverse childhood experiences and other trauma. Some of my refreshed perspective comes from Dr. Insel’s book, which takes a detailed look at what people really need for mental wellness, and some of it comes from reading Dr. Nicole LePera, known as “The Holistic Psychologist.” (A great complement to Dr. Insel, who was known as “The Nation’s Psychiatrist” while leading the National Institute of Mental Health.)

To recover, according to Insel (who is actually quoting another psychiatrist he met while working on Skid Row in Los Angeles), we need people, place, and purpose. People equals social support. Place is “a sanctuary where [we] have a reasonable environment with reasonable nutrition, and a place that [we] know is home.” And purpose differs for every individual.

LePera teaches, among other things, mindfulness skills as well as strategies for developing better boundaries, two of the areas most impacted by trauma. When trauma is experienced, we cope by dissociating, which is the opposite of being mindful. We also develop ways of living that may not allow us to have healthy or safe boundaries, but that seem to help us through a difficult situation in the moment. LePera shows us that we need to undo some of this initial conditioning to move into recovery.

We need better systems and better skills—not just better diagnosis, better treatment, and better medications. It’s a lot, but I believe it is possible.

Copyright 2022 Elana Premack Sandler, All Rights Reserved