Chapter 9: Diagnosing PPD Part III: Adverse Childhood Experiences (ACEs)
Learning that ACEs could cause pain or illness in adults was the biggest shock of my medical education. It comes as a surprise to most patients, too, even those who suffered abuse, neglect, loss of a parent, parental alcohol or drug abuse, or other trauma.
The situation is even more difficult for patients who don’t recognize their ACEs. Since none of us has a parallel life to compare ourselves with, many of my patients who survived less obvious (but still impactful) ACEs just don’t see them. However, it is fundamental to recovery from PPD linked to ACEs to have a realistic and accurate assessment of what you endured in childhood. Fortunately, there are several techniques that can help.
“Imagine you are a butterfly on the wall of your childhood home… Do you feel sad or angry about anything you are observing?”
Imagine you are a butterfly on the wall of your childhood home. You are watching a child you care about coping with what is going on. Do you feel sad or angry about anything you are observing? If so, make a list of those issues. To understand these issues even more clearly, consider writing an unmailed letter to the person(s) who caused the adversity, expressing all your thoughts and feelings good and bad.
Think about a childhood event that was traumatic, bad, difficult or a significant challenge for you. Then take 5-10 minutes to rapidly write down words or phrases that come to mind related to this event. Don’t overthink this and don’t worry about spelling or grammar. After you have written as much as comes to mind, take another 10-15 minutes to write complete sentences about what the words and phrases mean. (This exercise was created by Howard Schubiner MD).
Look again at the Personality Traits listed in Chapter 3. No one is born with those traits. They must be learned which means someone must have taught them to the child. If you have one or more of those traits, how might you have learned them? I will discuss this in more detail in Chapter 10.
The most difficult of the ACEs to recognize are those that negatively impact the child’s self-esteem even when the intent seems positive. For example, many parents who want the best for their children take more time pointing out how their child could do better than they do appreciating and expressing how well their child has done. One extreme example was a patient who grew up in a home where the acceptable standard of behavior was Jesus Christ. That child failed much more often than they succeeded. It is no surprise that as an adult this patient was a perfectionist with low self-esteem.
After accurately assessing your ACEs, the next steps are to address the major categories of long-term impact of ACEs. These are the Personality Traits from Chapter 3, repressed emotions, and triggers. We will look at each of these in the following chapters.
