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With addiction such a prominent problem, experts say it’s time to use words that don’t carry judgment. Studies show that saying “addiction” instead of “substance abuse,” and “person with substance abuse disorder” instead of “junkie,” affects the treatment patients receive, as well as public policy.

Michael Botticelli was director of the Office of National Drug Control Policy under former President Obama when he issued a memorandum specifying how federal agencies should refer to addiction.

Here & Now‘s Robin Young talks with Botticelli, now executive director of the Grayken Center for Addiction Medicine at Boston Medical Center, about the language of addiction. 

Here are some highlights from the interview:

On the reasons he issued the memorandum on language surrounding addiction

“So, you cited when you started this story that nearly 21 million Americans have a substance use disorder, and unfortunately a very small percentage — about 10 percent of those people — actually get treatment. And when you look at the reasons that people cite of why they don’t seek treatment, the No. 1 answer that comes up for many people is stigma: They don’t their neighbors finding out, they don’t want friends finding out. And one of the contributory factors to that stigma is our language that we use. So, this is not just a polite thing to do. These are issues, and these are words that have a dramatic impact on both clinical care and about how medical professionals actually see and treat people with addiction.

“Often when we call people things like ‘addict’ or ‘junkies,’ not only are they incredibly judgmental words, but they also kind of pigeonhole someone’s entire being to that one single characteristic. And, again, this is where we’re beginning to have much more direct clinical evidence that words matter. And Dr. John Kelly, who’s at the Harvard-MGH Recovery Research Institute, did this really interesting study where he gave trained clinicians nearly identical scenarios about someone with a substance use disorder and the only thing he changed was in one scenario he called the person a ‘substance abuser,’ and in the other scenario, ‘person with a substance abuse disorder.’ And what he found is when you called someone a substance abuser, it elicited, even from trained clinicians, a much more punitive response.”

On why the words are changing

“Now, we have language that comports with our understanding of addiction as a disease. Not as a moral failing, not as a character flaw. A word like ‘abuse,’ it implies volition, it implies intent — and not to say that people with addiction don’t make choices — it negates the fact that they have a disease and they need treatment. And, not only does that impact on an individual level, it impacts on the policy level. So you think about our history of how we treat people with addiction, and largely it’s been with punitive criminal justice responses, not with, you know, robust health responses to this. You know, from my standpoint, this is one of the simple things that we can do, I think, that will have a direct impact on how people perceive themselves and the care that people get.”

On the difficulty of getting a language change to take root

“I think language changes are always hard, initially. That, you know, we’re going through an adaptation period. I make mistakes all the time, you know, and I fall back into kind of habitual language, and so it takes time, but I think that part of it is we need to continue to make conscious effort. You talked about autism, but think about words that we use to describe someone with a mental illness that we don’t use anymore. The ‘R-word’ people don’t say anymore. So we need to be able to do that, and, you know, the other piece, too, which I think is important — I’m also a person in long-term recovery and I realize sometimes what I say is we use our 12-step language in public ways that is probably not beneficial. So what we say to each other or what we say in the context of a meeting is different than what we should be saying in the public, because people in the general public hear those words dramatically different than someone who’s sharing the same journey.”

Learn more and listen to the full interview at WBUR.org

HIV is undetectable in Shana Cozad’s blood, but she says her antiretroviral medication doesn’t deserve all the credit.

“In the Native community, when you’re sick, it isn’t that you just take a pill and you’re better,” says the 46-year-old Cozad, a member of the Kiowa tribe of Oklahoma who lives with her husband and children in Catoosa, a Tulsa suburb.

She recalls seeking help from the tribal elders. “Hey, I’m sick. The white-man doctors say I’m going to die,” she told them. The tribal elders guided Cozad to traditional healing ceremonies, overnight rites that last 12 to 15 hours. “Lots of sitting on the ground or on your knees and praying before a fire,” Cozad explains. The ceremonies helped her release the anger she felt toward HIV.

Cozad is one of nearly 4,000 American Indians and Alaska Natives (AIs/ANs) estimated to be living with HIV. Not all have been as warmly embraced and supported by their respective communities as she has been. Many AIs/ANs have encountered cultural, economic and logistical obstacles to getting tested and receiving the care they need, whether it’s pre-exposure prophylaxis (PrEP) to prevent HIV or antiretroviral treatment to fight the virus.

Although people who identify only as American Indian or Alaska Native make up about 1.2 percent of the U.S. population, they have always been part of the HIV epidemic, notes Alex White Tail Feather, executive director of the National Native American AIDS Prevention Center (NNAAPC).

The Denver-based nonprofit was founded in 1987 because, White Tail Feather says, neither the National Indian Health Board nor the National Congress of American Indians acknowledged the existence of gay Native Americans. Although not all Native Americans living with HIV are gay, the widespread association of the virus with gay men was an impediment. By 2006, however, the National Congress of American Indians approved March 20 as National Native HIV/AIDS Awareness Day, which was first observed in 2007.

The first HIV surveillance report by the Centers for Disease Control and Prevention (CDC), published in July 1982—before the virus had been identified and named—listed one AI/AN among the 452 cases reported to the CDC of Kaposi’s sarcoma, pneumocystis pneumonia and other opportunistic infections that would come to define an AIDS diagnosis. “I find that compelling,” says White Tail Feather, a member of the Kashia Band of Pomo Indians.

Because of the relatively small number of cases diagnosed each year, White Tail Feather worries that some people may brush off the notion that HIV is a problem for AIs/ANs. “Oh, there’s only 200 natives who have been diagnosed with HIV, and that’s really good” is not an uncommon refrain, he says.

“No, that’s not good,” White Tail Feather retorts. “What is not understood is that one individual who is diagnosed with HIV might have historical knowledge of the tribe. They might carry the oral tradition of the tribe.” Or that individual may be his or her family’s breadwinner or one of a dwindling number of people who speak a particular Native language. “You can’t measure that.”

Elton Naswood suspects that the number of AIs/ANs diagnosed with HIV may be higher than the CDC count, owing to misclassification. “A provider would look at them and think they’re Latino or Hawaiian Islander,” says Naswood, a member of the Navajo Nation whose older brother, Eldon, faced stigma on his Arizona reservation as a gay HIV-positive American Indian. Eldon died 20 years ago of AIDS-related illness.

Naswood, who lives in the Washington, DC, area, does capacity building for tribal agencies that deal with HIV. In addition to challenges helping those living with the virus, Naswood has encountered barriers to prevention, such as clinic pharmacists who don’t know how to prescribe PrEP.

According to the CDC, excluding whites and Asians, AIs/ANs have a lower rate of HIV diagnoses than other racial groups, but this could simply be due to the fact that a higher percentage of Native Americans living with HIV don’t know they have the virus. “The time between first diagnosis of HIV/AIDS infection and death is the shortest” among Native Americans compared with the other groups, points out Jessica Leston, an Alaska Native and director of the HIV/STI/HCV clinical programs for the Northwest Portland Area Indian Health Board (NPAIHB).

In 2013, the CDC estimated that 18 percent of AIs/ANs living with HIV didn’t know their status, compared with 13 percent of the entire U.S. population living with HIV. In addition, while annual HIV diagnoses among the general U.S. population declined 19 percent from 2005 to 2014, they rose by the same percentage among AIs/ANs during that decade, according to the CDC.

The reasons for these disparities between Native Americans and other ethnic groups are as complex as the Native American community itself.

Although federal agencies lump American Indians and Alaska Natives together as AIs/ANs, Native Americans are far from being of one mind when it comes to HIV. The federal government currently recognizes 567 tribes in 35 states, and “they are just as different as the 50 states have different policies and norms,” says Leston.

NPAIHB, the nonprofit tribal advisory organization Leston oversees, serves the 43 federally recognized tribes in Oregon, Washington and Idaho. “They operate very autonomously, and the tribes set their own public health priorities. HIV might be high on some tribes’ priority lists, but it might not be high on others’ lists,” she says.

Priorities are not the only differences that shape a tribe’s approach to HIV. “It’s very important that we work within the constructs of people’s religions and cultures and belief systems,” says Richard Haverkate, national HIV/AIDS and hepatitis C program coordinator at the Rockville, Maryland, headquarters of the Indian Health Service, a federal agency. “We can’t tell a community how they must do something.”

For example, the leaders of some tribes won’t even use the words HIV or AIDS, says Haverkate, a member of the Sault Ste. Marie tribe of Chippewa Indians, the largest federally recognized tribe in Michigan. “If you call the name out, it’s almost like you’re calling that condition forward,” he says. “You’re actually opening up that doorway for that bad thing to come to you.”

The Navajo Nation, second only to the Cherokee Nation in population, is an example of one such tribe whose leaders shun using such terms, Haverkate says. And yet, “they are leaps and bounds ahead of the rest of the country in the way they’re getting the work done,” he says.

#GettingItDone happens to be the hashtag for the Albuquerque Area Indian Health Board’s campaign to encourage HIV testing, and it’s been working. Even though the older tribal leaders avoid using the terms HIV and AIDS, “somehow they were able to get people to know what ‘getting it done’ meant,” Haverkate says. “It creates conversation, but it doesn’t make people feel any kind of stigma.”

Many of AIs/ANs don’t know they’re HIV positive because of that “ever-present stigma still attached to just the idea of testing for HIV,” he says. “It’s taboo in a lot of communities still.”

It’s been nearly a quarter of a century since Cozad learned that she has HIV. Over the years, she’s reached a truce with the virus. She credits her spiritual advisers, who “had to teach me how to approach this disease and approach my body in a positive way.”

HIV’s goal is not to kill her, since then it, too, would die, explains Cozad, one of the first Native American women to speak publicly about living with HIV. “And so it’s life, and you respect life. HIV is a teacher for me. It has transformed my life. It has humbled me. I don’t feel cured, but I feel healed because I’m at peace with this disease.”

Read more on POZ.com

Like mass shootings in general, school shootings have gone from being a rare tragedy to a tragic reality. Already in 2018 there have been at least 17 instances of gun violence in U.S. schools, including the shooting Wednesday at a high school in Parkland, Florida. In one recent attack at a Kentucky middle school, two children were killed and 18 others were wounded when a fellow student opened gunfire.

How can you possibly explain these shootings to your kids and how to do you talk about it?

NBC writer Nicole Spector put these questions to mental health experts who are also parents dealing with these concerns at home. Here are their best strategies to keep the lines of communication open and your own emotions in check.

Have your own support system and self-care rituals

For your own sake and your children’s, it’s critical that you make time to quell your own anxieties before diving into the issue at hand.

“To have these conversations open and honestly you need to take care of yourself as a parent,” says Kristin Wilson, a licensed professional counselor and clinician with a teenage daughter. “Have your own support system in a spouse or friend or another go-to person, so that when you’re talking to your child you’ve already processed through it.”

Wilson adds that she experienced her own scare when her daughter’s school was on lockdown for over six hours due to the possibility of a shooter. She found out on the news, when it was leaked to a local media network.

“I was on the phone with my partner and my friends trying to process everything,” she says. “Having your own support group is important as is indulging in self-care so you’re not so reactionary. Yoga, mindfulness practice, exercise and really anything you can do to better your mental health is essential because sadly, this is a reality now.”

Let your kids take the lead

You may be unsure where to even begin with such a heavy topic. Consider asking your kids what their questions are before you give your two cents.

“It is often best to let your child take the lead in asking questions about difficult situations so that you only share what you feel is necessary to satisfy their inquiries,” says Dr. Allison Agliata, a clinical psychologist, head of an independent middle school in Tampa Bay and the mother of three children ages 12 and younger. “Otherwise, as parents, we tend to either share too little and leave them wondering, or over-explain and freak them out.”

Set a time to talk daily or weekly with no screens

Most of the mental health experts NBC spoke with strongly recommended having screen-free routine family time, and using that time to talk one-on-one with your kids about school shootings and any other issues that may be top of mind. For Wilson, this means a daily check-in at the dinner table.

“Sometimes my check-in is as simple as, ‘How was school today?’ And other times it’s a more uncomfortable topic about drugs and alcohol or school violence,” says Wilson, adding that this longstanding ritual has enabled her daughter to always count on this time to talk, trusting that it’s a space to discuss both the good and the bad. “If you set the groundwork early, they will naturally come to you with concerns as well as really awesome things.”

And it doesn’t have to be at the dinner table. Christopher Gerhart, a licensed and certified substance abuse counselor finds that he and his preteen daughter have their best talks about serious matters such as gun violence while he walks her to school. Kelley Kitley, a licensed clinical social worker talks with her four kids ages 11 and under individually at bedtime.

“For us it’s a lot calmer. Our household is chaotic [during the day], but at that time lights are dim. It’s usually about 15 minutes each and they really look forward to it,” Kitley says. Dr. Agliata has found bedtime works best for her family as well adding, “we reflect on the day and they have some one on one time with me to share their thoughts.”

Teach them how to de-stress with breath-work and gratitude

The choice to talk deeply to kids at bedtime could have parents asking, “Can’t that create anxious thoughts?” Not if your kids are equipped with de-stressing mechanisms such as deep breathing exercises.

“They lay on the bed, hands on tummy inhaling through their nose, then blowing out like they’re putting out a candle,” says Kitley of the technique she teaches. “And they take five long deep breaths.”

After talking, Kitley also has her kids focus on the stuff they enjoy rather than the stuff they fear.

“I say, ‘think of five things you really loved about your day.’ It’s a way of acknowledging that, yes, bad things happen to good people but let’s be grateful for where we are. It’s not avoiding, but rather validating how they’re feeling and understanding what is our reality right now.”

Encourage your kids to feel their feelings

If your child is really upset about this or other issues, that’s okay too. Allow them to experience those feelings rather than to suppress them.

“[My son] is inundated with violent videos being shared on Snapchat of fights at school,” says Lynn Zakeri, a licensed clinical social worker and the mother of two adolescents. “I talked with him recently about allowing himself to have feelings about these videos: be overwhelmed; be worried; be sad; be scared, and then, more importantly, have empathy. These are natural responses. Allow them to happen.”

Don’t make promises you can’t keep – but do assure them

Perhaps the most troubling issue for parents is that part of their job is to help their children feel safe in a world that can turn deadly in an instant.

“The truth is, they trust me to keep them safe,” says Zakeri. “I can’t succumb to what if’s because they are not practical and they perpetuate anxiety. Instead, I focus on what we have control over. I don’t make promises I can’t keep.”  Zakeri likens this to the sort of talks they have when getting on an airplane. “[Saying] ‘I promise you will be safe’ is very different than, ‘We can only trust what we know for sure which is [X,Y,Z].’”

But perhaps the most important thing you can do in all of this, is what you’re already doing: loving your kids and putting care and time into how you address these frightful facts of life.

“As long as parents are putting thought, energy and love into their conversations, it is unlikely you are going to really mess things up,” says Dr. Agliata, adding that even she wishes she had more definitive answers for her children about why violent situations occur and how we could stop them. But she doesn’t. “Humanity is complicated and so rather than concentrating on the fear of what could happen, my main objective is to instill a sense of power in my children so that they don’t let random, single incidents impede their love of life and quest for adventure. There is so much to experience in life that I never want them to take the safe route out of fear.”

Read more on NBCNews.com

The Ventura County Board of Supervisors has approved moving forward on a novel job training program. The program will create a drought tolerant plant nursery called “Growing Works” that will act as a training ground and jobs program for people with mental illness. The combination of horticultural therapy, which provides a healing environment, along with job training and jobs, has been shown to be an effective form of treatment towards recovery and independence.

The Growing Works nursery – which will operate as a wholesale, non-profit nursery – will be located on County-owned land on Lewis Road, one mile from a partner in the project, California State University Channel Islands.

“Horticultural therapy provides a path for people to heal, providing immense mental health and even physical health benefits.” said Jason Meek, Executive Director of the non-profit Turning Point Foundation that will oversee the program. “Growing Works offers people suffering from anxiety, depression, and other mental illnesses, including veterans with combat stress, opportunities to become contributing members of society.”

Growing Works, which is looking for contributions towards its start-up, has already received offers from farmers, including David Martinez with Marz Farms who has offered fencing for the nursery. The Seabees from Naval Base Ventura County have offered to clear the land for the nursery, and the Ventura County Community Foundation is assisting with finding grants for soil, pots and irrigation.

California State University at Channel Islands and California Lutheran University are also Growing Works supporters with students in their psychology, biology, engineering and business schools available to assist the program. The County’s Behavioral Health Department is anticipating contracting with Turning Point to send their clients to receive job training at Growing Works, and the County looks forward to purchasing plants from the nursery for use at the Government Center. The California Conservation Corps has already removed tumbleweeds from the vacant parcel to prepare for Demonstration Gardens that will also make the location a more welcoming place for those who live and work there, including nearby Casa Pacifica foster services, another partner in the Growing Works project. Once completed, the Demonstration Gardens will be open to the public.

The Board of Supervisors voted unanimously in support of Growing Works, leasing the land to Turning Point Foundation. The lease included County funds to repair an unoccupied building on the land that can be used for office and classroom space for Growing Works, and funds for plants for the Demonstration Gardens.

Supervisor Parks, who has been organizing the Growing Works project after seeing a similar successful program in San Luis Obispo County, said there will be many opportunities for the public to become involved, including an upcoming community planting day.

Learn more at VCNewsChannel.com

Public health research has documented racial disparities in health and health care for decades. When looking at the 10 leading causes of death in the U.S. ― including cancer, stroke and heart disease ― mortality rates among black Americans are higher than among white Americans, even after controlling for socioeconomic status factors. Compelling evidence suggests both individual- and institutional-level discrimination cause this disparity. For example, black Americans experience high levels of residential segregation, which limits their access to health resources and exposes them to poor housing quality and environmental toxins.

In contrast, Latino Americans ― and recent immigrants in particular ― appear to experience better health than non-Hispanic white Americans. This occurs despite lower education and income and reduced access to health care services. Researchers call this the Hispanic paradox (or Latino paradox). The exact cause of this phenomenon is not yet well-understood, but some experts speculate healthier diet, strong family ties and lower smoking rates among Latino Americans may be contributing factors.

But what Americans who identify as both Latino and black? Researchers in the U.S. have a tendency to focus on the traditional black-white American binary and forget about individuals at different racial and ethnic intersections. Because of this, we’ve been ignoring how race further impacts the lives of Latinos in the U.S. 

Afro-Latino Americans (also sometimes referred to as black Hispanics) are often left out of social equity discussions entirely and out of discussions about health equity in particular. A 2016 study found health disparities between Afro-Latinos and white Latinos that closely resembled those between non-Latino black and white Americans. For example, Latinos who identified as black were more likely to report poor health compared to Latinos who identified as white. Black Latinos have also reported higher rates of hypertension compared to their white Latino counterparts, and in a 2003 study, Afro-Latina girls reported experiencing higher levels of depressive symptoms than white Latina girls. A Latina woman’s ethnic and racial self-identification may even go so far as to predict her fertility.

In the same way it’s not entirely clear why health disparities exist between non-Hispanic white Americans and the general Latino-American community. It’s also not entirely clear why health disparities exist between Afro-Latino Americans and white Latino Americans in particular. However, opportunity differences may help explain. Afro-Latinos share similar sociodemographic characteristics with that of non-Hispanic black Americans, including high poverty rates, disproportionately low incomes and highly segregated neighborhoods. All of these factors are strong determinants of health; recent studies have shown Latin-American immigrants who identify as black report lower educational achievement (11.64 vs. 12.77 years of education) and weekly earnings ($718.38 vs. $760.95) compared to black Americans.

The number of Latino-Americans who also identify as black has rapidly increased over the past few decades. In 1980, approximately 389,000 Latino-Americans identified as black. Fast forward 30 years, and by 2010, the Afro-Latino population in the U.S. had risen to approximately 1.2 million. The highest percentage of Afro-Latino individuals who self-identify as black are Dominican, followed by Puerto Rican, but it’s crucial to note many Latinos, particularly recent immigrants, tend to reject our racial categories here in the U.S. In one Pew Research study, for example, 24 percent of Latino respondents identified themselves specifically as Afro-Latino. However, when asked about their race, only 18 percent of these same Afro-Latino respondents identified as being black. This shows just how complicated self-identification and socially assigned race can be ― and how discrimination, internalized oppression and self-preservation further affects them. All of this influences a person’s overall health and well-being.

It’s important people recognize the racial diversity that exists within the Latino community. We are not a monolithic group. Our national origins, ethnic backgrounds and indigenous histories are distinct and varied. Social scientists and public health researchers are beginning to recognize this and have identified drastic health inequities within this group. Without question, the Latino-American population as a whole faces economic and social barriers that the average non-Hispanic white American doesn’t. But the heaviest health burden of all seems to fall on Latinos who have darker skin or who identify as black.

Where do we go from here? Public health researchers must identify which health inequities disproportionately affect Afro-Latino Americans, figure out their causes and come up with ways to appropriately address them. This community will continue to suffer if we do not take these inequities seriously and come up with viable policy solutions. The racial diversity that exists within the Latino-American community also gives the rest of us an opportunity to expand beyond the traditional binary black-white discourse when we talk about race-related issues here in the U.S; anti-black discrimination affects members of Latino communities, too.

Finally, we must be self-reflective and take a look at how our actions contribute to these social and health inequities. We are not independent of the system that created these issues. We all contribute to today’s injustices. We must check our own biases and speak up when we feel certain issues are not being adequately addressed.

To understand the Latino-American experience, we ultimately have to acknowledge race plays an important role. Historically, race has been a strong determinant of education, income and health. As we continue to undo the effects of past injustice and build policies to prevent further discrimination, we must make sure marginalized groups are not being forgotten. Race and ethnicity are not just black and white. They’re not even just black, white and Latino. The answers lie at the intersections.

Read more on HuffingtonPost.com

Dr. Nadine Burke Harris had one of those rare and amazing “aha!” moments a decade ago when reading a scientific paper. Researchers from the Centers for Disease Control and Prevention had found that the more traumatic events a person suffered in childhood — things like physical, emotional or sexual abuse, mental illness in a parent, divorce, neglect and domestic violence — the more likely he or she was to also suffer from chronic stress-related health problems like heart disease, obesity and premature death decades later.

For weeks after reading that paper, she says she was not getting a lot of sleep as she pored over the research on these so-called adverse childhood events, or ACEs. Suddenly, what she had been seeing in her patients all day made sense. There was the 7-year-old with persistent asthma, for instance, whose body she realized was overwhelmed by the cumulative trauma from his mother’s depression, his father’s heavy drinking and a sexual assault three years earlier. Asthma medication wasn’t enough to help this young patient; she needed also to recognize and treat the chronic stress that was making it impossible for him to recover.

Dr. Burke Harris, who founded and runs the Center for Youth Wellness in San Francisco, has dedicated the years since to treating chronic stress and raising awareness about the link between traumatic life events and our health.

After a 2011 article in The New Yorker and a 2015 TED Talk, Dr. Burke Harris was flooded with questions from people who wanted to know more. She’s just published a book, “The Deepest Well: Healing the Long-Term Effects of Childhood Adversity,” outlining her experiences and what she’s learned. She spoke with the New York Times about the cumulative effects of trauma, how her work led her to her husband, and what ACEs can teach us about the recent gymnastics sex abuse scandal. The interview has been edited and condensed.

Q. You talk a lot about adverse childhood experiences, or ACES, the early traumatic events that can impact our health. Is it simply an additive problem, that is, the more adverse events you have, the more affected your health is likely to be?

A. “What the science is showing, No. 1, is that the greatest risk is with the cumulative dose of adversity — your total exposure, how they pile up. The other piece is the absence of that caregiver who is able to buffer the effect of that chronic stress.“

Q. As anyone with a sibling or more than one child knows, people will respond differently to the same situation. How much do individual traits change or mitigate the effect of ACEs?

A. “If you take a population of 1,000 people or 10,000 people or 100,000 people and they all have one ACE versus two ACEs versus seven ACEs — what you’re going to see is this substantially increased risk of health problems. Are there still going to be folks who by virtue of their biology or circumstance or environment are able to be resilient in the face of adversity? There are. Just like there’s the guy who smoked two packs a day and drank whiskey every day and lived to be 100. The takeaway for me is how we’re trying to reduce the exposure on a population level.“

Q. You’ve said that your work on ACEs led you to your husband. What do you mean by that?

A. “I won’t comment on any of my ex-boyfriends, but I was like — whoa — the type of relationship that I have has a profound impact on my life span and my health. Not just how I feel, but this could seriously shorten my life expectancy. My husband is a person who I feel heals me from the inside out. He’s been really instrumental in what I’ve been able to accomplish in terms of starting my organization and galvanizing this movement, because it’s super stressful and he is such a buffer to my stress. Even if I come home and have had a really rough day in clinic, and had a patient with a really awful story that’s really heartbreaking, he just helps. He helps me to metabolize it and displaces those stress hormones with lovely nurturing, bonding hormones.“

Q. So, should we all be checking our prospective spouses for ACEs?

A. “It’s not that my husband doesn’t have any ACEs. Sometimes experiences of adversity do augment this empathic response. It’s really about how they’re responding to it, how they’re dealing with it on a day to day, and whether they are able to recognize and have healthy habits around their stress response, as opposed to having unhealthy coping habits.“

Q. In your book, it was striking how hard you had to fight to get people to recognize that ACEs aren’t limited to poor neighborhoods — that children of all socioeconomic classes suffer adverse events.

A. “I’ve said only half joking that the difference between Bayview [a low-income, diverse neighborhood] and Pacific Heights [an affluent, largely white community] is in Bayview, everybody knows who the molesting uncle is and in Pacific Heights they don’t. It’s really true. In low-income communities, they’re so under-resourced that it’s really difficult to hide this stuff, but in affluent communities people feel so much like reputations are at risk that they hide it and it just festers.“

Q. Would the Dr. Larry Nassar case be an example of that? He apparently molested generations of female gymnasts, most of whom weren’t financially disadvantaged. And no one stopped it for years.

A. “That’s the point. It happens to Olympic gold medal-winning women in the middle of Michigan. The tendency when it comes to trauma is to want to shy away from it. That’s part of the cycle of how trauma works, that we don’t like the way it feels to talk about it so we try to push it away. But I hope we’re at a different moment.“

Q. Do you think the trial made a difference for the women who testified? Was it the kind of social buffering event that you’ve talked about as helping to counter adverse experiences?

A. “We can’t protect every child from bad things happening to them, but we can change the way we respond as a society. That judge gave those women a platform to name what happened to them and then connect with each other and bond over this experience.

To so many of them, they have been suffering in silence, and to see that their voices were powerful and they helped to take this person off the street and protect other women — that helps to transform the narrative in a way that helps to break the cycle.

Right now, I think there are a tremendous number of people in our country who are recognizing that trauma lives in the body. Recognizing childhood adversity as a risk factor for how we’re going to deal with stress in the present is really important. I think there is a lot of prevention that can happen when people just have this information.“

Read more at NYTimes.com