Many of you are familiar with the Stress Index or Holmes and Rahe Stress Scale, which psychiatrists Thomas Holmes and Richard Rahe developed in 1967. Curious about the link between stressful life events and illness, they researched the medical records of more than 5,000 medical patients whom they asked to look at a list of 43 life events to which the researchers had assigned a score. For example, they gave a weight of 100 points for death of a spouse; 73 points for divorce, 65 points for marital separation, etc.
Finding a positive correlation between stressful life events and illness, they published their work as the Social Readjustment Rating Scale (SRRS) or the scale that bears their name. I use this scale with my students in a business communication course at North Carolina Wesleyan College, many of whom are working parents. Add a move, a pregnancy, an exam, a disagreement with a professor, changes in schedules and time management and you have a predictor of illness. We then do exercises to reduce stress — massage, neck twists, shoulder shrugs, facial massage — concentrating on the body from shoulders to face where 90 percent of stress manifests itself.
If one scores 300 plus on the 43 life events, one is at risk of illness. Fewer than 150 points scored means only a slight risk of illness. To check validity, Holmes and Rahe tested 2,500 U.S. sailors, various ethnicities in the U.S. (African, Mexican, Caucasian), and cross-culturally, comparing Japanese and Malaysian groups with U.S. populations. The correlation was proven true in every case study. Holmes and Rahe also developed a non-adult version wherein the greatest Life Change Units were assigned to death of a parent at 100 points; failure of a grade in school carries 56 points, while being a senior in high school has 42 points, or Life Change Units. Again, an accumulation of 300 points means the risk of illness.
Then in 1995, Vincent Felitti became curious when 50 percent of patients at an obesity clinic which Kaiser Permanente (a health care company) sponsored began dropping out of the weight loss program despite their success. As head of the Department of Preventive Medicine at Kaiser Permanente, Felitti interviewed the participants, discovering that the majority of the 286 interviewees were victims of childhood sexual abuse. He joined forces with Robert Anda from the Centers for Disease Control and Prevention (CDC) to survey 17,337 Kaiser Permanente patient volunteers: 50 percent were female; 74.8 percent, Caucasian; 75.2 percent, college-educated; and the average age was 57.
These volunteers were asked about these types of childhood trauma: physical, sexual, or emotional abuse; physical and/or emotional neglect; exposure to domestic violence; household substance abuse; household mental illness, parental separation or divorce, and incarcerated household member.
They called this study Adverse Childhood Experiences (ACEs), which yielded these results: 87 percent reported at least one ACE while 28 percent of the study participants reported physical abuse; 21 percent experienced sexual abuse. Each type was assigned one point; the total number of points predicts adult high-risk health behaviors such as smoking, alcohol and drug abuse, promiscuity, severe obesity, depression, heart disease, cancer, chronic lung disease, and shortened life span. An ACE score above 6 was associated with a 3,000 percent increase in attempted suicide. The study was first published in the American Journal of Preventive Medicine.
I learned about ACEs during a workshop which the Guardian ad Litem Program sponsored as many of the children GALs represent are experiencing these traumas. All of us participants took the ACEs Test, assigning one point for each item that applied to our experience:
1. Did a parent or other adult in the household often swear at you, insult you, put you down, or humiliate you? OR act in a way that made you afraid you might be physically hurt?
2. Did a parent or other adult in the household often push, grab, slap, or throw something at you? OR ever hit you so hard you had marks or were injured?
3. Did an adult or person at least 5 years older than you ever touch or fondle you or have you touch their body in a sexual way? OR try to have oral, anal, or vaginal sex with you?
4. Did you often feel that no one in your family loved you or thought you important or special? OR your family didn’t look out for each other, feel close to each other, or support each other?
5. Did you often feel that you didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you? OR your parents were too drunk or high to take care of you or take you to the doctor if you needed it?
6. Were your parents ever separated or divorced?
7. Was your mother or stepmother often pushed, grabbed, slapped, or had something thrown at her? OR sometimes or often kicked, bitten, hit with a fist, or something else hard? OR ever repeatedly hit over a few minutes or threatened with a gun or knife?
8. Did you live with anyone who was a problem drinker, alcoholic, or who used street drugs?
9. Was a household member depressed or mentally ill or did a household member attempt suicide?
10. Did a household member go to prison?
Those of us reading Tara Westover’s memoir “Educated” relive with her the traumas of her childhood and adolescence. We marvel at the resilience she showed that led to self-discovery and self-invention. What is resilience? According to one source, “it involves behaviors, thoughts, and actions that can be learned and developed. It is the ability to adapt in the face of adversity, tragedy, threats or significant stress — family and relationship problems, health and financial worries.”
Next week’s column will look at the goals of the North Carolina Resilience and Learning Project established in 2017, growing out of the Public School Forum. Other states are passing laws that address traumatic stress in children. Join Wayne County Reads on March 12, 7 p.m., at Wayne Community College to learn more about ACEs and resilience.