Does talent need trauma? Some collapse but others thrive after child adversity
What do musical virtuoso Dizzy Gillespie, the inventor of bebop jazz, Jonah Lomu, arguably the greatest All Blacks rugby star, and pioneering artists like Salvador Dali have in common?
They all suffered considerable Adverse Childhood Experiences or ACES, but their scars drove them to excel.
ACES include suffering physical beatings, sexual abuse, neglect, parental separation or divorce, an imprisoned parent, witnessing domestic violence, or living with a parent with a drink, drug or mental health problem. Bullying by peers, poor quality housing, poverty and the death of a parent don’t figure in the original conception of ACES, despite the risk of mental health problems as a result.
Children at socioeconomic disadvantage are more likely to have multiple adverse experiences and these are often touted as a major causal factor for many bad life outcomes. In Scotland, ACES and other associated psychological problems, especially trauma, are part of the dominant discourse within this field. ACE prevention enthusiasts use dramatic metaphors like “toxic stress” disturbing brain development, causing brain system “damage” or the “body remembering”, but the mind forgetting, embodied distress.
Although the science is yet to prove causal mechanisms between ACES and poor health, there is another side to the story. Vincent Felitti, head of preventive medicine from 1995 to 1997 at a private clinic in San Diego for mostly middleclass patients, found time does not often heal and people just don’t “get over it”. The real breakthrough is the idea that we are wrongly focused far downstream in health on the consequences of ACES.
The chronic stress of adverse childhood experiences “gets under the skin” and changes human developmental processes, and there is a correlation with future mental and physical health problems.
Some ACES purists state that those who grow up in violent homes are “scarred for life”, developing substance abuse and crippling mental health issues and they may
even grow up to become violent themselves, keeping the cycle going.
But those who grow, function or thrive in the face of sometimes considerable trauma are less newsworthy. From depression, alcohol and drug problems to obesity, cardiovascular disease, respiratory problems and cancer, ACES are in the frame. But a correlation between two things like ACES and suicide does not mean one causes the other.
Tucked away in the relevant studies is the all-too-common phrase that researchers were not able to discern “causal inference”, meaning we don’t really know if ACES cause the bad outcome or, if it does, we don’t know by how much..
Scotland has the laudable aim of becoming an Ace-aware nation, but networks of causal factors are hard to disentangle. To infer causal factors, researchers will need to consider a range of issues beyond parenting and family systems, such as the role of poverty, pollution, poly-genetic and epigenetic factors. Nevertheless, we are vaulting ahead without the causal research to back up the primacy of the negative causal role of ACES.
But maybe we don’t need to do the research, given a world with fewer or no ACES would be a better place. Or is this a utopian vision where the stuff of life never happens?
I recall being told authoritatively by a health visitor that ACES always disrupt attachment, if that happens under three years then “that’s it for life”. The danger is in writing children off. ACES don’t take account of subtlety – in the research, a parent with shortlived depression and a parent with chronic psychosis both count as parents with mental health issues.
It is well known that there are problems relying on people’s memories, which is how they are identified in research. Adults suffering mental health problems have memory biases and can amplify the recall of adversity in childhood.
ACES may be associated with disturbance, but that isn’t the same as psychological trauma. Defying all expectations, post-9/11, only 0.6 per cent of Manhattan residents close to the Twin Towers suffered post-traumatic stress disorder after six months, with symptoms rapidly declining for that tiny group. Some people fold in the face of ACES, some survive, many reframe ACES to propel themselves forward in life with grit and determination.
The reason for this is resilience. Under extreme or chronic adversity many of us are forced to grow. Recent studies on performing artists like dancers and singers show that those with high numbers of ACES are more creative. Artists with more ACES have a greater sense of pleasure, power, meaning, and purpose during their imaginative endeavours. Unresolved mourning and higher ACES have been found among actors compared with a control group. Anxiety and vulnerability are closely linked to the creative process.
One study found Olympic athletes had more ACES than non-olympic ones. In another, athletes with higher numbers of negative life events performed better under a test of performance and pressure. The researchers went as far as to say that “prior brushes with adversity should be considered when identifying athletes who are likely to excel during stressful competition”.
The idea that talent needs trauma perhaps overstates the research evidence, but the concept of posttraumatic growth and creativity might be relevant for many with ACES. The danger is that ACES become synonymous with negative life outcomes, eclipsing stories of resilience and growth. The prescription given to reduce ACES comes down to loving each other, relationships and attachments – if we just love everyone, ACES will melt away like the fruits of a blissful commune in a Californian sunset.
I’d like that but, in the real world, flat-out parents have to foster their kids’ emotional and cognitive skills, be aware of their own and their children’s emotions, and use emotions as opportunities for intimacy and instruction.
At the same time, parents have to impose firm but fair rules and limits, contain stress and overbearing emotions, develop and maintain household routines and, of course, provide all-important love – while making ends meet through work.
Love is not enough to be a good parent. Often relationships are an ominous prospect for people with ACES and complex trauma. Developing therapeutic relationships is important in psychotherapy but simply taking this “relationship” approach alone is not likely to lead to clinical change.
Saying that it’s only about relationships is a psychotherapeutic apostasy of our modern age. Asserting sagely that adversity is bad for you is obvious, it is pseudo-profundity, akin to pronouncing that oxygen keeps us alive. What’s more essential, whilst trying to reduce ACES, is to work out what makes some people collapse in the face of childhood adversity and others grow.
Once we work out these answers scientifically, we can make more informed decisions about targeting our resources where they are most likely to be needed.
Dr John J Marshall is a consultant forensic & clinical psychologist.