Stressful traumas from childhood such as failure and abuse settle in the body and can cause physical illnesses. In the book "How abused children become sick adults", Norwegian doctors and researchers document how doctors' treatment should, to a much greater extent, take account of the harmful health consequences of trauma.
Instead of exclusively examining what is wrong with the patient, healthcare professionals should ask what has happened to the patient from childhood, they argue.
Neglecting Children is Very Costly by Anna Luise Kirkengen, professor in general medicine. Anna clearly demonstrates how violated children become sick adults.
Nothing is as deadly as the contempt of others: we human beings can feel shame without knowing that it stems from experiences in our childhood which have had a deep impact on our bodies. A broad range of professionals have documented how long-term burdening, especially in childhood, drains central systems in our body of vitality and health.
Dr. Kirkengen describes actual case histories and clarifies the high prices we pay for these kinds of experiences, both as individuals and as a society.
The text below is translated from Norwegian/Danish interview the researchers had with Anne Anthon Andersen from socialtindblik.dk in November 16, 2023.
It began with Anna Luise Kirkengen's doctoral thesis.
It was back in the 1990s, and she had decided to investigate how being exposed to incest as a child affects a person's health.
She interviewed and followed 34 adult women and men who received help at two different incest centres in Norway and concluded with the thesis that the sexual abuse from childhood settled physically in the body and triggered a number of diseases.
The dissertation was to prove to be the foundation for the landmark research results she has since produced with the help of research colleagues - documentation that trauma from childhood affects not only people's mental health, but also their physical health. That trauma can settle in the body's cells as chronic inflammation and trigger a wide range of chronic diseases such as cardiovascular diseases, dementia, depression and autoimmune diseases.
Even then, in 1998, the thesis attracted attention. In 2001 it was published as a book with the title "Inscribed bodies – Health Impact of Childhood Sexual Abuse" by the international publisher Springer.
"That was the essence of what I had established in my research - that incestuous violations were inscribed in the body. The thesis clearly pointed out that it was no coincidence that the health problems people who had been exposed to sexual abuse in childhood developed later in life," she states.
The thesis came to lay out the main track in the research she has carried out ever since.
At the time, Anna Luise Kirkengen's conclusions stood relatively alone. Since then, a large number of studies have confirmed the findings she made. In 2005, there were so many different studies that supported the message in their own way that Anna Luise Kirkengen together with her research colleagues in Trondheim decided to collect them all in book form in one long coherent documentation.
“We found so much solid research that we could put it together for the bigger picture, which strengthened the observations I had made in 1998 about how abuse inscribes itself on the body. The book unfolded the problem and presented documentation of how much influence abuse in childhood has on later health in general," she says.
The book "How abused children become sick adults" was first published in Norway in 2005. It has since sparked debate about the organisation of the Norwegian healthcare system, has sold more than 11,000 copies, and has been updated four times. The latest two editions in 2015 and 2021 in close collaboration with doctor Ane Brandtzæg Næss, who is training to become a specialist in psychiatry at St. Olav hospital in Trondheim.
The Body Remember
In August, a Danish translation of the book was published with the title "How abused children become sick adults". In the book, the two authors document how traumatizing experiences are stored in the body and can develop into disease.
Among other things, you can read about studies documenting how elevated levels of stress in the body affect the rate at which the body's cells age and shorten the so-called telomeres, which form the ends of each chromosome and protect it.
Most researchers agree that telomere shortening is one way to measure cell aging. And that shorter telomeres are associated with more diseases and increased mortality. Telomeres naturally shorten with age, but inflammation, cortisol, and oxidative stress (waste products in cells), all of which are associated with chronic childhood stress, appear to promote the process.
For example, a long-term study measured the telomere length in children aged five and ten. The children who during this period were exposed to two or more types of violence, either witnessing violence between parents in the home, frequent bullying, or physical violence by an adult, had a faster shortening of telomeres than those children , who were less exposed to violence.
Chronic systemic inflammation, i.e. inflammation, which stays in the body for a long time and therefore eats away at the body and wears out the organs, is one of the most consistent findings in people with an unpleasant and difficult childhood, you can read in the book. A wide range of chronic diseases such as cardiovascular disease, dementia, depression and autoimmune diseases are associated with increased inflammation.
"Inflammation-related diseases are responsible for more than half of the causes of death worldwide. Therefore, a growing number of researchers and medical experts now consider harmful childhood experiences and harmful living conditions to be a public health problem," the authors write in the book.
Backed by brain research
What exactly is happening in the body that causes toxic stress, triggered by, for example, various forms of abuse, to lead to illness?
"The body reacts to all challenges by adapting so that it can meet what it has to master. For example, the fact that the body produces saliva when you have to eat. If you have been particularly exposed to threats, loneliness and do not get the support you need, the body adapts to perceive the world as threatening. Among other things, it increases the cortisol level and can lead to an elevated cortisol level over time," says Ane Brandtzæg Næss and explains that an elevated cortisol level can have a number of negative consequences, for example that you eat more and unhealthily, get too high blood sugar, just as too much cortisol affects the hormonal system and a lot of other central functions of the body.
"Elevated cortisol seems to contribute to chronic inflammation and thus more wear and tear on the body. The body uses energy to prepare for danger instead of other things – this leads to chronic overload," explains Ane Brandtzæg Næss.
At group level, research has shown that this dis regulation in the stress system contributes to unhealthy lifestyles.
A population survey from the Norwegian North-Trøndelag region showed a significant correlation between a very difficult childhood and chronic disorders. Respondents who categorised their childhood as 'difficult' and 'very difficult' were five times more likely to have two or more chronic conditions compared to respondents who chose the categories 'very good', 'good' or 'normal'.
"The latest brain research based on radio technology, which shows changes in the brain, has also documented that stressful experiences in childhood leave clear traces in the brain. Just like all other learning and experience shapes the brain," explains Anna Luise Kirkengen.
When the book was last published in Norway in 2015, the reactions were generally very positive, especially in the social sector, says Ane Brandtzæg Næss.
"Many nurses and psychologists have missed the doctors' insight into how experiences affect the body. There were also doctors in somatic medicine who were positive. But in general, those who work with somatic, i.e. bodily diseases, were more skeptical. Perhaps because the way of thinking is more foreign to the doctors, and because they see the consequences of how much the health systems must change if we are to take this new knowledge about the connection between social and psychological abuse and disease seriously and act on it. This can make it more difficult for them to absorb this knowledge. But I think there will be more and more acceptance," she says.
Fragments blur the image
The knowledge presented in the book calls for a fundamental revolution in the way we have chosen to organise the healthcare system, the two authors believe.
The division of the healthcare system into somatic and psychiatry alone is inappropriate. Because it means that many patients fall between two chairs, and that there is no common conceptual apparatus for understanding and solving health problems in collaboration between psychiatry and somatic.
The problem is that we have separated body from mind, argue the authors and explain in the book's analyses, why it is crucial to understand, also from a healthcare perspective, that we are present in the world as bodies, and that everything we do and experience happens bodily. From evolution, we are equipped with the sensory apparatus - to be able to see, know, feel, sense, so that the body's preparedness can react to what we experience. Is it threatening or dangerous? or safe?
"Maintaining the distinction we have today between mental and somatic illness can contribute to the fact that patients with chronic pain and mental problems are not treated as they should be. When specialists only want to take responsibility for 'their' area of expertise, a person's problems and life are split up into parts that do not make sense individually," says Ane Brandtzæg Næss.
“When we only look at fragments, we cut ourselves off from understanding how things are connected. We have to study the connections - also between experiences that have been stored in both body and mind in order to understand and treat the fragments - the individual ailments," adds Anna Louise Kirkengen.
How should we use this knowledge?
"Everyone who works in the healthcare system must have a wider view of what incidents may be the reason why the person they meet during treatment has developed a disorder," says Ane Brandtzæg Næss. She herself, after helping to update the book, has begun to ask more about her patients' lives when she meets them in her work in psychiatry at St. Olav's hospital in Trondheim.
"I have begun to think about the fact that the people I work with on a daily basis have experiences in their baggage that predispose them to both mental and physical illness. And I have also started to ask more about their lives," she explains.
Help remove the shame
A team of brain researchers at Harvard University led by Martin Teicher and Jacqueline Samson has been documenting changes in the brain as a result of traumatic experiences for more than ten years. A few years ago, they wrote a research article arguing that every employee in the healthcare system should ask about both physical and psychological trauma as part of the treatment, precisely because such experience is of medical importance, explains Anna Luise Kirkengen.
"I think that perspective is crucial. This is brain research, perhaps the most weighty and prestigious within medical research. A trauma history should be an essential part of any medical history, because difficult and traumatising experiences are the basis of so many disorders, physical as well as psychological. Overload, also in the form of neglect, and indifference in childhood, is a major and overlooked risk factor in the healthcare system today," she says.
How can this knowledge improve the medical approach?
"If we didn't just ask, but asked in a good way, and if everyone in the healthcare system showed their patients that this was important information - if we asked with an acknowledgment that it's not just because you smoke, you are fell ill - it's not your fault - then I think we would help to remove shame from the patients," says Ane Brandtzæg Næss.
Precisely because shame lies in deep layers in patients, and because shame is harmful, it would help patients if healthcare staff became better at freeing patients from shame.
"Shame, linked to living an unhealthy life, is placed on top of the shame that you have experienced something shameful. That shame is one of the driving mechanisms during long-term health-damaging stress. If we in the healthcare system could make it clear that it was not shameful to share one's traumatic experiences with the healthcare staff, we would be able to create a valve for stress. By legitimising and insisting that it is important and good to talk about it, we will be able to lower the patients' stress level, and this is medically important," explains Anna Luise Kirkengen.
The earlier the better
The two doctors recognise that a culture change is needed in the healthcare system.
That the staff must get used to asking about patients' personal history, even if this is still perceived as crossing a line. The patients are routinely asked in advance about intimate relationships when they are deemed relevant. This is exactly why it should be part of regular professional practice to do so, the doctors argue.
"You could start by telling the patient what the research shows about the importance of trauma. Then it will be easier to ask empathetically and not just ask; what is wrong with this patient, but ask; what happened to you?” says Anna Luise Kirkengen.
Who do you hope will enjoy reading the book?
The book is aimed at everyone who works in the social and health sector – from SOSU assistants and nurses to doctors, psychiatrists, surgeons, etc., but also to the highest degree to others who work with the socially disadvantaged and pedagogues who work with children , and which can help prevent and detect children's traumatic experiences early.
“The earlier, the better. I hope that we create a more nuanced picture of what health is. And that we cannot understand physical and mental health as separate dimensions," says Ane Brandtzæg Næss.
"It would be a huge advance if the entire healthcare system recognised this approach to health and illness and made it the basis of treatment. We should understand that we cannot relate to the body without knowing the experiences – both should be weighted with equal medical relevance," says Anna Luise Kirkengen and continues:
"I wish the politicians recognised how much they could save by channeling more funds to ensure children a safe childhood."
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