Shakespeare Can Wait…and So Can My Ego

I’ve been reading The Body Keeps the Score again…by Bessel van der Kolk. I don’t think I got this far last time (p. 167 so far). That’s how I read non-fiction, at intervals. And also I know that things come back into my scope of awareness again for a reason, so I try to pay attention to that…when exposure to something begins to feel like a spiral. Like, Oh, there’s that book again, maybe I should grab it as it comes around this time. It’s a slow cyclone of things that I think my higher consciousness wants me to see or know. There are periods where I am busy, bogged down in the day to day, and I don’t see those things that are circling me in this way. But it’s been a while. 2020 has been a pretty conscious year for me and, I think, for others. It’s a waking up kind of year.

What’s been tugging at my consciousness more than anything else this go ‘round with The Body Keeps the Score is the enormity of the issue of childhood trauma. In New Zealand, the statistics on teen suicide are alarming to say the least. Of course, teen suicide is also a problem in other developed countries, but I found it shocking to learn that the rate of teen suicide (per 100 teens) is actually higher in New Zealand than in the U.S., where on the surface there seems to be a whole lot more to threaten one’s feelings of safety and security. That’s just the thing, though. It’s not about not feeling safe or secure in your community or your society at large. It’s about not feeling safe and secure in your home. Worse yet, it’s about having the people who are meant to provide care for you being the very ones who threaten your safety, who hurt you and who fail to protect you. That’s where childhood trauma comes from, and it affects so many more people than we ever knew.

Plus, it’s cyclical. People who are the victims of child abuse, whether it’s sexual, physical, emotional, or straight neglect, are much more likely to be involved with abuse as adults, either as perpetrators or as victims. Some of the statistics available in Van der Kolk’s book are incredibly eye opening, but the thing that maybe stands out the most to me (so far) is the concept of ACE scores and their broad implications. These are numbers that came out of a monumental investigation of Adverse Childhood Experiences, a collaboration between the CDC and Kaiser Permanente, with Robert Anda, MD, and Vincent Felitti, MD, as co-principal investigators. It was focused on the 17,421 Kaiser patients (out of 25,000 asked) who agreed to provide information about childhood events and whose responses to 10 carefully developed questions were then compared with the detailed medical records Kaiser kept on all patients. This was in 1990.

“The ACE study revealed that traumatic life experiences during childhood and adolescence are far more common than expected. The study respondents were mostly white, middle class, middle-aged, well educated, and financially secure enough to have good medical insurance, and yet only one-third of the respondents reported no adverse childhood experiences” (147). The questions were things like “Did a parent or other adult in the household often or very often swear at you, insult you, or put you down?” (one out of ten responded yes to this one). Also, “Did an adult or person at least 5 years older ever have you touch their body in a sexual way?” and “Did an adult or person at least 5 years older ever attempt oral, anal, or vaginal intercourse with you?” (over 25% said yes to each of these!). For each of ten questions, a positive answer equals one point. So, for example, two “yes” responses out of ten gives you an ACE score of 2. With ten questions in the study, the score is out of 10.

It was a pretty comprehensive study of a pretty homogenous group (imagine the impact of things like poverty, lack of access to education and healthcare, and systemic colonisation on these numbers; based on what I have seen in my classrooms, I’m guessing it would be staggering). What was perhaps most surprising to me was that in this study group, “87 percent scored two or more. One in six people had an ACE score of four or higher.” What was observed was that “when sorrows come, they come not as single spies but in battalions” (that’s Shakespeare, rather than Van der Kolk). Essentially, the sorts of abuse that our youth endure don’t happen in a vacuum. Most kids who experience trauma are experiencing multiple varieties of trauma at once. “And for each additional adverse experience reported, the toll in later damage increases.”

And guess where the effects of this childhood trauma first become evident? At school, of course. “More than half of those with ACE scores of four or higher reported having behavioural problems [at school], compared with 3 percent of those with a score of zero” (148). Of course. It is part and parcel of a trauma-informed approach that one does not start with the question, “What is wrong with this kid?” but rather with, “What has happened to this child?” And yet, in the classroom, where teachers are taxed with too-high rolls and not enough support, how often does this really happen? How often is it considered that the behaviours that are so disruptive to the learning of one’s class are incredibly accurate indicators of trauma? How often do teachers have the opportunity to truly consider this? And by opportunity, I mean the time, the wherewithal, the training, and the simple support of another adult to take over with the other children while s/he addresses the problematic behaviour in a compassionate, meaningful, trauma-informed way.

And then, how much opportunity is there for follow up? And how effective can that follow-up be? Our teachers are not trained therapists or clinicians. With these statistics, one teacher would be looking at having at least four kids (in a classroom of 24) who are experiencing FOUR OR MORE varieties of abuse. Take it to the middle and high school levels, where rolls are upwards of 30 to 35 kids in a classroom, we’re talking more like 5 or 6 individuals. Will she have the time and wherewithal to follow up on each one (remember, she has 5 classes, so make that 25 to 30 kids and their families)? And maybe most importantly, will she have the courage? How exactly does a teacher, trained to manage students and to teach specific curriculum, say English or Science, approach a family about the potential that their child is experiencing abuse? It’s daunting, to say the least, and at the risk of sounding repetitious, I don’t think it’s quite fair to simply relegate this responsibility to the teachers of the world. And yet, if it’s in the home that these abuses are being perpetrated, but time and again, research has shown that children do better left in their homes than taken out of them, even in cases of abuse…. Do you see what’s keeping me up at night?

And here’s what four or more varieties of abuse in childhood (an ACE score of 4 or higher) looks like in that child’s adulthood: a 66% prevalence of chronic depression for women (35% for men); a 7 times greater likelihood of becoming an alcoholic; a 33% percent likelihood of being the victim of rape (as opposed to 5 percent for those with an ACE score of zero). How about an ACE score of 6? For those with an ACE score of 6 or more, “the likelihood of IV drug use was 4,600% greater than for those with an ACE score of zero; they were also 5,000% more likely to attempt suicide than those who scored zero. And the list of high-risk behaviours associated with a high ACE score—you know, ones that can actually be predicted by the experience of a high level of trauma during childhood and adolescence?—it’s shocking: smoking, obesity, unintended pregnancies, multiple sexual partners, and STDs. And there are crazy correlations between high (6 or higher) ACE scores and straight-up health problems in adulthood (things like chronic obstructive pulmonary disease (COPD), ischemic heart disease , and liver disease): over 15% more than for those with an ACE score of zero. No pressure to identify and treat childhood abuse, but—-PRESSURE!

It’s overwhelming, really. Dr. Anda, in presenting the results of this study, declared that “the gravest and most costly public health issue in the U.S. is child abuse. He…calculated that its overall costs exceeded those of cancer or heart disease and that eradicating child abuse in America would reduce the overall rate of depression by more than half, alcoholism by two-thirds, and suicide, IV drug use, and domestic violence by three-quarters” (150). And here’s the kicker (that’s right, we haven’t even gotten to the kicker yet): there is NO DIAGNOSIS in the DSM-V ( The Diagnostic and Statistical Manual of Mental Disorders) for childhood trauma. Such a diagnosis is what allows a patient to receive effective treatment, not to mention have their condition recognised and paid for by their health insurance, if they are lucky enough to have it.

This is why when I look at the referrals for my students on remand (caught up in the youth justice system and in the custody of the State) I see a laundry list of diagnoses that are really more explanations for (“surface phenomena" describing) the many behaviours that scream childhood trauma: ADHD, oppositional defiant disorder (ODD), intermittent explosive disorder, disruptive mood dysregulation disorder, and on and on and on. No child is born this way. Adults create this. And these are labels that the youth themselves have absorbed, and the language of these diagnoses punctuates the dialogue I have with them about their behaviours. Rather than address their victimisation, the best the mental health profession has been able to do (through no fault of individual practitioners but of the pervasive systems of which they are a part) is give these youth some labels that categorise their behaviours and indeed themselves. I would say these are band-aids, but it’s worse than that. They are obfuscations, veils laid over the fact of real hurt and real suffering that, if not addressed, will likely transmute itself into more violence in the world. It’s not their fault, but the risk is real.

And yet those who are not trauma-informed in their approach (which is simply a matter of a lack of training—everyone can learn this) insist that these youth are “getting away with something,” “not being held accountable for their actions,” or (and this is my favourite), “laughing at us.” I have to say, no one is laughing. And if there is laughter in this scenario, it is devoid of mirth. So I have come to realise, over my many years of working with kids in an educational setting, that what has to go is EGO. It just has no place in education, especially the education of at-risk youth. In my tiny educational space at the moment, progress is incremental. I am patient. I see some of the other adults in that space inwardly disagree and question my approach, which is one of infinite patience. It’s gentle. Compassionate. Soft. Could it be (and will it likely at first be) perceived as weakness by my students? Yes. Probably. But I can’t care about that. My job is to provide a corrective emotional experience (let’s call it a CEE). If such an experience, one of healing, comes, at least in the short term, with the cost of “respect”—the kind that silences a child or makes them behave a certain way—then so be it. Real respect, the kind that develops out of gratitude and understanding of one’s character—that comes in time. And if it happens that I never see it, So. Be. It. That’s not why I’m here.

I can’t erase what for some of my students are years of hurt and suffering. I can’t even provide therapy or direct mental health treatment. But I can acknowledge them. I can SEE them. For the individuals that they are (ones who sometimes lash out, sure, or who sometimes have trouble focusing, but as ones who are creative and sentient beings with infinite potential, too? Absolutely). Moment by moment, I can replace those experiences that have involved an adult who didn’t see them, who punished instead of investigated, who yelled instead of soothed, with experiences that build trust and ultimately confidence in a system that has largely failed them. Am I completely overwhelmed by the task? Of course I am. I’d be a fool if I wasn’t. But I have to keep trying. And this is the thing: I am undoing damage. What if this approach were taken (and supported) across the board in schools everywhere? I don’t know that it would be possible to eradicate the need for a role like the one I currently occupy (educating kids who have committed criminal acts and are now in the custody of the State), but it seems worth trying. I’d find another job. Seriously. We should try.

And in trying, I have to be honest. I don’t even know exactly where to start. The problem with the American Psychiatric Association rejecting a clear and well-supported proposal to include “Developmental Trauma Disorder” in its manual of legitimate diagnoses is one that is well beyond my scope of influence, and yet I know that “if you pay attention only to faulty biology and defective genes as a cause of mental problems and ignore abandonment, abuse, and deprivation, you are likely to run into as many dead ends as previous generations did blaming it all on terrible mothers” (167). So I don’t have control over the fact that young people are going to continue to arrive at my little school with multiple diagnoses that amount to a limiting set of observations about their behaviours and don’t allow the larger issue of their childhood trauma to be addressed. I have to, for now, let that go. What I do have control over is the inflection in my voice. My response to impulsive or even outrageous behaviour. My patience in moving toward more academic material. If I’m patient, we’ll get there. Shakespeare can wait. What is needed is slow progress facilitated by one corrective emotional experience at a time. What’s my rush? These are human lives we’re talking about. Someone’s babies. And quite frankly, someone’s future parents, too.

If I can help even one of them heal themselves enough to function “normally” in the world—that is, without hurting anyone else, including their own eventual offspring, who is to say how many people I can impact? Potential victims no longer potential recipients of behaviours that have grown out of abuse and neglect. Their families. The families of the youth themselves. It’s kind of endless. I always say in the classroom that we can’t know a shadow history. The strand of history that would have unfolded had one single thing (one act, one decision or word) been different. We can only know the history that is, the one that unwinds out of our actual actions and words. And yet, those shadows exist. We have to keep dragging each other out into the light. Away from the shadows of ignominy and suffering. This is one way to do it. Midwives and doulas who help babies to be birthed peacefully…they do it. Teachers who see their students as full of infinite possibility and who address “misbehaviour” with compassion and inquiry…they do it. Bosses who seek to understand undesirable behaviours rather than punish them…even they do it.

Every time we take a trauma-informed approach, whether it’s with a child or with an adult, we heal something in the universe. There is so much pain out there. People, youth, are taking their own lives. It’s a crazy time. We just have to do what we can. For each other. In the classroom, Shakespeare can wait. And so can my ego.

I recommend Van der Kolk’s book, for sure. I have learned so much by reading it. You could also start by checking out this Ted Talk by Dr. Nadine Burke Harris. It’s a good one. We just have to keep sharing these things, right? As they come into our scope of awareness. Pluck the things out of the air that seem to keep circling back on you. It could be it’s time to listen.