By Dana Bergquist
“Subluxation is a symptom of interference and not a cause”
– Dr. B.J. Palmer –
We learn from the very beginning of chiropractic college that disease is caused by subluxations, and subluxations are caused by the 3 Ts: Thoughts, Traumas & Toxins. As chiropractors, we promote adaptability in the body by adjusting subluxations, and we address the 3 Ts through lifestyle recommendations. “Take care of yourself”-type messaging along with diet, exercise and other lifestyle factors are widely conveyed. Communicating the importance of personal responsibility and healthy lifestyle is wonderful and necessary and…often misses the forest for the trees. I think chiropractors are well positioned to dig a little deeper. As chiropractors we want to care for the cause, not the symptom, right? Working with patients to facilitate the integration of subluxations is a big piece of this, but I’m proposing that to be more wholistic and vitalistic, we need to be better equipped to work with the Thoughts, Traumas and Toxins beyond lifestyle recommendations. If the leading causes of morbidity and mortality in the United States are related to health behaviors and lifestyle factors [1], then why am I saying that lifestyle recommendations aren’t digging deep enough? Well, it appears that without addressing the underlying cause of those ‘unhealthy’ lifestyle factors, then we will never be able to help our patients truly heal.
ADVERSE CHILDHOOD EXPERIENCES:
A GLIMPSE INTO THE CAUSE OF DISEASE
During the 1980’s, a Kaiser preventative medicine clinic in San Diego California, specializing in lifestyle modification for the treatment of obesity, was experiencing high levels of “dropout”, with over 50% of patients ending their treatment early. Interestingly, patients that were dropping out of the program early were those who had been experiencing the greatest success in weight loss, though short of their weight loss goals. Why would people who were 300 pounds overweight lose 100 pounds, and then drop out when they were on a roll? This baffled the clinic’s director and physician, Dr. Vincent Felitti, so he and the clinic staff decided to conduct follow-up interviews with all their patients to better understand why some patients were dropping out early, and others would stick with it. What they found was that a disproportionately high number of patients who had dropped out of the program had experienced childhood abuse. As his patients continued to reveal to him their history of abuse, he felt disturbed and unprepared. He thought, “This can’t be true. People would know if that were true. Someone would have told me in medical school.” It appeared that the patients had developed coping strategies that were connected to their weight gain. As patients had begun implementing strategies to help lose weight, they had inadvertently removed strategies that had helped them cope with their past experiences of abuse; For example, eating to sooth. Without incorporating additional coping strategies, many patients experienced higher rates of anxiety and depression under treatment for their obesity, and subsequently dropped out of the treatment program. Dr. Felitti didn’t know it at the time, but his discovery would help to provide more understanding about the lives of hundreds of millions of people around the world who use biochemical coping methods – such as alcohol, marijuana, food, sex, tobacco, violence, work, thrill sports, checking our phones, etc.
– to escape intense fear, anxiety, depression and anger.
“Time does not heal, time conceals”
– Dr. V. Felitti –
Dr. Felitti approached Dr. Anda, a researcher from the CDC about his preliminary discovery, and together the two orchestrated the first investigation into childhood abuse, neglect and household challenges as they relate to later-life health and well-being; the Adverse Childhood Experiences (ACEs) study [2]; see infographic for examples of ACES [3]. In the ACEs study, nearly 10,000 health members from southern California received physical exams and completed confidential surveys regarding their childhood experiences, current health status and lifestyle behaviors. The study found that ACEs are common: almost 2/3 of study participants reported at least one ACE and more than 1 in 5 participants reported 3 or more ACEs. The study also revealed that the higher the ACE score, the greater the likelihood of:
•Severe and persistent emotional problems,
•Behaviors that risk health (physical inactivity, smoking,high alcohol consumption, etc.),
•Adult disease and disability,
•Shorter life expectancy (an average 20-year difference in life expectancy).
For example, compared to an ACE score of 0, having 4 ACEs was associated: 7x increase in alcoholism, 2x the risk of being diagnosed with cancer. An ACE score above six was associated with a 30x increase in attempted suicide. When I started interning in the Life West Health Clinic, I would commonly hear DCs and other interns say that patients rarely follow their homecare recommendations. Why is that?! It is because our patients will not be able to make sustainable lifestyle changes if they haven’t addressed the underlying reason for that lifestyle choice as a potential coping mechanism.
What happens in childhood – like a child’s footprints in wet cement – commonly lasts throughout life. “Time does not heal; time conceals” – Dr. V. Felitti. Many of our most stubborn public health problems are the result of compensatory behaviors like smoking, unhealthy eating, alcohol, and drug use, which provide immediate partial relief from the emotional problems caused by traumatic childhood experiences. Those experiences are commonly unrecognized and become lost in a person’s history, where they are protected by shame, secrecy, and social taboos against exploring these areas of the human experience [4].
While ACEs are surprisingly common (even in the earliest years of life), they are generally unrecognized and can start to manifest their damage as ill health during childhood or later. Like distinguishing a true subluxation from a compensation, chiropractors may need to practice recognition of these realities so that we can provide clear opportunity for early intervention. I have heard it being proposed by many who have studied early childhood development and trauma that if doctors took the time to sincerely talk to a patient and dig deeper, they would realize they were diagnosing a patient’s living conditions. Take away toxic stress, remove the fractured family structure, and eliminate abuse and in most cases, one could dismiss the diagnosis. Many physicians are categorically medicating a person’s life circumstances, not the person [5]. My hope is that chiropractors continue to be leaders in health promotion and vitalistic health care. My hope is that we do this by avoiding standing on the soap-box of blaming a person’s lifestyle while prescribing them changes to that lifestyle without first realizing the potential underlying cause for that lifestyle. Like trauma and childhood development expert Dr. Gabor Maté says, “Not, why the addiction…but why the pain?”
“Not, Why the addiction?…
Why the pain?”
– Dr. G. Maté –
WHERE DO WE GO FROM HERE?
When I was 30 years old, I experienced the death of my first child, a still-birth at 38 weeks gestation. Unknowingly, this traumatic life experience manifested as severe back pain months later. After consistent chiropractic care from my father-in-law and seeing several other healthcare practitioners with no relief, my father-in-law suggested that my back pain may be related to my emotional distress and recommended I seek counselling. With the universe conspiring in my best interest, the counsellor my health insurance connected me with happened to specialize in trauma and worked with me on not only processing my recent trauma, but on integrating my adverse childhood experiences, which ultimately resolved my back pain.
To be clear, I’m not saying chiropractic cannot facilitate the integration of trauma. Indeed, some chiropractic approaches work to integrate traumatic experiences more directly. Working with improving the function of the nervous system, for example, is a beautiful component of integrating traumatic experiences. In some cases, however, there may need to be a referral to trauma specific services like trauma-specific counselling. As budding DCs, I think one of our biggest first steps to facilitate this type of healing is to learn about early childhood development and how trauma affects development, including nervous system development. Regardless of whether you want to work with children or not, learning about early childhood development along with the effects of trauma is almost like a superpower. It helps you understand and meet your patients where they are at in that moment, because as you know, all adults were once children! Our second step is to learn how to provide trauma informed care. Being trauma informed means recognizing that the behaviors our patients are engaged in make sense – they may be maladaptive, but they once served the purpose of survival. Providing trauma informed care means providing services in ways that recognize the patient’s need for emotional and physical safety, as well as provide the opportunity for patient choice, control, and collaboration in one’s own care. Trauma-informed services are not designed to treat the symptoms of traumatic experiences but are more of a commitment, made by individuals and organizations, to approach service in a way that recognizes the universal and high prevalence of trauma and that provide services in a way that is welcoming and accessible for everyone.
What does this look like? Many of you are probably engaging in trauma informed care already! It can be simple things like explaining to a new patient what to expect in the upcoming appointment (e.g. where to park, what to do when they walk in, what the appointment will entail, etc.). It can involve telling your patients well in advance when you will be leaving the clinic and involving them in the process of selecting a new intern. It involves asking a baby if you can pick them up or giving a child the choice of which table to sit on. It involves helping your patient get used to what it is like to have their head/neck held before ever putting a force in. It involves making paperwork that uses inclusive language, or at least telling your patients you recognize that the paperwork may not be inclusive. The list goes on and there are much deeper components involved in becoming a trauma informed practitioner and business. If you would like to learn more, please see the credits section for a list of some resources.I’ll leave you with a quote from leading childhood development expert and trauma therapist, Dr. Bruce Perry:
“The more healthy-relationships a [person] has, the more likely they will be able to recover from trauma and thrive. Relationships are the agents of change, and the most powerful therapy is human love”
GIVE. DO. LOVE. SERVE.