I spoke to a patient recently about ACE scores. A veteran. Who has had trouble sleeping since childhood.
"What was your childhood like?" I say. "Was sleeping safe?"
"No, it wasn't. We were in (one of the major cities) in a very bad part of town."
"So not sleeping well may have been appropriate. To keep you safe. To survive."
We both think this veteran has PTSD.
"I think I had PTSD as a child. And then the military made it worse."
I show the veteran the CDC website and ACE pyramid: https://www.cdc.gov/violenceprevention/acestudy/about.html.
Adverse childhood experiences. Leading to disrupted neurodevelopment. Leading to a higher risk of mental health disorders, addiction, high risk behavior, medical disorders and early death.
Ugly, eh? Damaged children.
"But I don't agree with it." I say.
My veteran looks at me.
"Disrupted neurodevelopment." I say. "I don't agree with that. Different neurodevelopment. Crisis neurodevelopment. We have to have it as a species in order to survive. Think of the Syrian children escaping in boats, parents or sibling drowning. We have to have crisis wiring. It isn't wrong, it's different. The problem is really that our culture does not support this wiring."
"You can say that again."
"Our culture wants everyone to be raised by the Waltons. Or Leave it to Beaver. But the reality is that things can happen to any child. So we MUST have crisis wiring. Our culture needs to change to support and heal and not outcast those of us with high ACE Scores."
My Veteran is quiet, thinking that over.
I say, "You may read more about ACE scores but you do not have to. And we can work more on the sleep. And we do believe more and more that the brain can heal and can rewire. But you were wired to survive your childhood and there is no shame in that."