I saw this book on Saturday when returning another to the library.

I hemmed and hawed. Many of you know what I mean. Do I need another book on childhood trauma? Shouldn't I be over it already? Is this one going to have something to say that I haven't seen before? Can I stand to have people know that this happened to me, will they blame me for still feeling it? Do I want to log it on goodreads? Maybe I should keep it to myself.

I borrowed it (clearly) and read it on Sunday. I know, from experience, what reading books like this is like for me. The longer I dragged it out the longer the reaction would take. So I crammed the whole thing into a couple of hours, skipping the stuff I already knew, and surfing the inevitable flashbacks. You aren't there. You're here. It isn't happening anymore. Breathe, breathe, breathe.

~~~~~

Let's talk about the book:

Part I is about the science of how Adverse Childhood Events (ACE) affect the mind and also the body, based on research about epigenetics, and the very clear and overwhelming statistics linking childhood trauma to seemingly unrelated adult health outcomes, such as cancer, stroke, autoimmune diseases, heart disease, and so on. It's no mystery anymore to say that a childhood of deprivation or abuse can lead to depression, anxiety, addiction or rage; but the evidence of how it leads to disease and early death, too (as the book says, a person who experienced six out of the ten adverse events listed on the ACE inventory will on average lose 20 years of their lifespan), has gained much less traction.

Part II is about different evidence-based ways that people can reduce the damage that has been caused. Practices that can retrain the brain in ways to react to stress, decrease the body's negative reactions to chronic stress hormones. It is much more pat, much less satisfying, and uses far less evidence. But one thing at a time:

Part I, a brief summary:

1. Two thirds of people who take the ACE have a score of at least one. Forty per cent score two or more. 12.5% score 4 or higher. (I scored 4 or 5, as did approximately--if the statistics are to be believed--1/10 of you.)

2. The higher a person's ACE score, the more doctor's appointments they have had in the past year.

3. People with an ACE score of 4 or higher are twice as likely to develop cancer.

4. For each additional point an individual has, their chance of being hospitalized with an autoimmune disorder increases by 20% in any given year.

5. Those with ACE scores of 7 or higher who did not smoke or drink, were not overweight, not diabetic, and did not have high cholesterol, still had a 360% increased risk of heart disease compared to someone with an ACE score of 0.

6. The important thing, it turns out, is not the severity of the events per se, but their unpredictability. A moderate but unpredictable adverse event has worse health consequences than a horrible but predictable one. When you don't know when the stressor will return, your body stays on alert all the time. The stress hormones don't ever go awyay. You live your life in a state of hypervigilance from which there is no reprieve.

7. Adverse events alter the expression of genes.

Worse, these alterations, through the epigene, can become heritable.

8. Kids raised in orphanages have smaller brains than other children. Early adverse circumstances permanently alter the development, size and function of the brain.

9. Besides chronicness and unpredictability, the other important factor is whether or not children are keeping it a secret. If they can't talk about it, they will suffer more.

10. There are genetic differences, too, in sensitivity levels.

~~~~~

Reading these sections of the books was ... how to put it.

Imagine watching a horror movie. Or The Walking Dead.

You know that feeling of "is there going to be a zombie behind this door?" or "when is the next attack coming?" or "don't go in the basement!"

Your heart is pounding. Your shoulders are tense. Your forehead is furrowed. You feel the tension in your jaw, the back of your skull. Your mouth is dry. Your hands are cold. You have a knot in your stomach.

It felt like that. For me, anyway. It felt like that for about ten hours.

When I was reading, when I put the book down, when my daughter and I went to Chapters, when I browsed shelves of sci-fi and philosophy and art books. Heart pounding, dry mouth, cold hands, hard shoulders.

This would have been worth it, if Part II had offered something meaningful.

~~~~~

There were things I learned in the research section that were genuinely new and helpful. Things like:

1. Chronic stress and trauma in childhood will disrupt a person's ability to figure out if a situation is potentially dangerous or a person is potentially unsafe.

2. Chronic stress and trauma in childhood interferes with a person's ability to feel and name their feelings. The end result is that they go from underreactivity to overreactivity, often at a moment's notice; from not feeling anything when they should be, to feeling way too much, on a dime.

Well that explains a lot.

The recovery section, however, was unsatisfying.

It lists a number of well-known and popular, one might even say "trendy," methods:

1. Journaling
2. Art journaling (but only about the traumatic events)
3. Meditation
4. Tai Chi
5. [b:Mindsight: The New Science of Personal Transformation|6315775|Mindsight The New Science of Personal Transformation|Daniel J. Siegel|https://d.gr-assets.com/books/1320475978s/6315775.jpg|6501014]Mindsight (Yes, I've read it.)
6. Loving-kindness meditation
7. Forgiveness, someday
8. Yoga and massage
9. Nutrition. (Nutrition! Really! Eat clean to reduce your PTSD!)
10. Relationships
11. Somatic experiencing--I couldn't get through this part
12. Guided imagery
13. Neurofeedback
14. EMDR

Is there anything on this list you haven't seen already on a FaceBook meme? Possibly if you're not on FaceBook. Otherwise, you know everything that's in this section already. And if you're dealing with these issues, chances are good that you have tried most or all of these already, and they haven't worked, and that's why you read the damned book.

The book blurb and a good bit of the book's text talk about "getting back to who you would have been." That's a high promise, and her methods won't meet it. She provides no statistics or evidence on the effectiveness of these methods. Is a complete recovery likely? For how many people? How many won't respond at all? How many will respond partially? How many methods are likely required to have a significant impact on the quality of a person's life? She doesn't say.

So let me say: studies on meditation often include no mention of side effects or negative impacts, but these are known to occur for some people--thought more likely to be those suffering from PTSD, who may have flashbacks while meditating.

I looked up a couple of studies on PTSD and meditation, just for curiosity's sake. In one study, 12% of study participants improved in the control group, and 24% improved in the meditation group. To be sure the meditation significantly increased the beneficial impact, but it still left 76% of study participants with no benefit at all. Seventy-six per cent! How does this add up to a guarantee of "getting back to who you would have been"? No mention was made of whether any of those 76% might have been worse off than when they started. And meditation is one of the best studied of the methods she proposes.

Why only yoga--why not running? Are there no other physical activities that could provide similar benefits? Where's the evidence? Why does drawing only count if the drawing is related to the trauma? What about painting, photography, sewing, quilting, knitting, woodworking? What about religious practices from other traditions besides Buddhism? Etc. Too many questions, too few answers, and the answers provided with far too little evidence.

~~~~~

Here is a tree.



This tree has experienced trauma in its life. You can tell, by the burl on the trunk.

A burl is how a tree responds to certain physical stressors. You can read about the biology if you've a mind to--for now, just imagine what would happen if you tried to return the tree to "what it would have been" without the stress, and removed the burl.

YOU'D KILL THE TREE.

Similarly, for those of us who have had less than loving parents, there is no former us to get back to. There is no me before my mother. She's always been there.

A tree can still be beautiful and impressive with a good number of burls, of course. What's a little deformity between friends. Right?

Meanwhile, I've tried nine of the 14 things on the list above, plus therapy. They've all helped, but I am not who I would have been, I never will be, and I haven't "recovered" if by that you mean that I no longer have the extreme stress responses. I still lost a day to what are essentially flashbacks, from reading this book. Last week, I lost three days when an interpersonal conflict echoed what I'd had with my parents; for three days, my hands shook, my heart beat faster. Three days. I couldn't sleep.

It doesn't go away.

And whoever decided that all feelings dissipate in 90 seconds (a fact that was repeated in this book, but I've read it elsewhere too) has clearly never had a flashback. They don't last for 90 seconds. They can eat up a whole year.

Isn't that the whole point of the first section of the book?--that you can exist in a permanent state of anxiety and hypervigilance that can last pretty well forever?

~~~~~

There's a more significant criticism of Part II:

Human development is a funny thing. It only takes place in the context of some kind of relationship that involves some amount of nurturing. Children who receive no care at all, who are never held, never changed, never talked to, do not learn to talk, or walk, or feed themselves, or us the toilet, or even physically grow as they should, even if they are fed. Thus all childhood abuse that results in an adult who is capable of walking, speaking, self-feeding, and bladder control, didn't consist solely of abuse--there must have been moments, days, weeks, months, of an adult responding to the needs of the child.

That is to say, if the bar for "real abuse" is set at total and unrelenting abuse and neglect, the bar is set so low as to prevent survival, really. Abuse and neglect cannot be understood as the total absence of any care ever.

That's often how it's presented, though, in families like these. How can you be angry about x? How can you be upset about y? Don't you remember that nice thing I did for you once? But the nice thing doesn't cancel out the x, or the y. It's a favourite tactic of adult abusers too, isn't it? OK yes, I punched you in the face last week, and one time I broke your arm, but then I brought you flowers and you know I always take you to that restaurant you like.

It makes it worse for the survivor, those nice things. To bring back the Walking Dead, imagine the gang walking around in Alexandria, the zombies circling the walls, and then the zombies start throwing flowers over the gates. There's no apologies. There's no indication that they remember slaughtering and eating the survivors' loved ones. But there are these occasional gifts, these nice things, the flowers thrown over the wall; and then, later on, the demands that the gates be opened. OK yes, I killed your wife, I ate her, I ate your brother too, but then I gave you flowers. Open the gates! How can you still hold a grudge, after all this time?

The nice things end up standing out in one's memory in an aura of fear, rather than enjoyment. It becomes a mystery that begs an answer, where no answer is.

When a functional and healthy person does something hurtful or wrong, they apologize.

The lack of an apology, particularly coupled with a demand for resumption of the relationship and NO process for amends, means that the person is not safe to be around. "Nice things" notwithstanding.

This is something a child who grows up in an abusive home learns on their own, very slowly, if at all; and it is something that is not discussed in this book.

The most basic, fundamental action of healing--removing the source of hurt from one's life and keeping it as far distant as possible--is not even mentioned. Indeed, in the author's rush to assure readers that she is not one of those authors who blames parents, she goes a fair bit in the other direction, all but assuring readers that once healing is done, once you have miraculously recovered the person you would have been, you can be around your parent and the things they do will no longer hurt.

Imagine giving this advice to an abused spouse. Leave, for a while. Get counselling, meditate, do yoga. Feel better. Then go back to him. From now on, when he punches you in the face, you won't mind. If you do, it's your fault, you're "blaming him."

This is a dangerously irresponsible idea.

~~~~~

I can recommend Part I wholeheartedly to anyone interested in this subject. If you are reading "for a friend," just be aware that the preponderance of bad news and tragic anecdotes may make a difficult read. I found it triggering as hell.

I cannot recommend Part II to anyone, really. If you have never ever heard of meditation used therapeutically and are totally unaware of the health claims for yoga, and you can be satisfied with a couple of paragraphs of anecdotal data, then by all means. Otherwise, no. ( )

I learned so much from this book. As I face my 50s and live with a few chronic illnesses, it's been important to understand all kinds of possible causes. The cause of childhood stress is one I wouldn't know about were it not for Donna's books. Beyond the cause or contributing factors information, this book covers solutions. And, of course, putting solutions in place is an important part of healing. Highly recommend this for anyone who lives with chronic illness. ( )