I was reading this excellent diary on Bob Herbert's last NY Times article and it provoked me to search out his first column as an op-ed writer. 18 years ago, Bob Herbert told us to Listen To the Children. He articulated a vision then that he would focus steadily on for nearly two decades.
It reminded me of another article I read this week in The NewYorker (abstract) about the vital lessons we can learn from children. I imagined Bob Herbert may have inspired Dr. Nadine Burke, who has a similar focus which she blends into her medical practice today. Burke looks at the cues in her pediatric patients and their histories to develop new treatments for the clinical manifestations of childhood trauma.
In America; Listen To the Children
By BOB HERBERT
Published: June 27, 1993
The teenager called to ask if he could be excused from classes. Something bad had happened. He had attended a christening and a shootout had erupted.
"I have to go with my mother to visit my brother in jail," the boy told school officials. "He's up for attempted murder. Then I'm going with her to bring my other brother's body home. He was killed in the shootout and I still have to go back to the doctor because I got shot in the pelvis."
Officials at the Bushwick Outreach Center, an alternative high school in Brooklyn, were understanding. They said yes, the boy could be excused.
Herbert proceeds with a litany of childhood traumas that had become common place excuses for missing or being late for school: murder, the death of a sibling, neighbor, uncle, or foster child, their mother’s panic, beatings, rape, TB, evictions...
"It's shocking. It's very upsetting. Students come to school who are cut up or shot up, or we hear from kids who can't come to school because people are after them."
Shocking. Shock is a real physical condition.
Herbert crystallizes:
We have not even begun to confront the enormity of this problem. We have children across America living in neighborhoods as lawless as Mogadishu. We have children who believe that the death of other children is normal.
These stories are on television daily but they are not on our national agenda. We are looking, but we sure aren't seeing.
Had more attention been given then perhaps the ground breaking clinical work being done n 2011 would be further along.
Back to 1993...the data was percolating...
A three-year study of "Adolescents in High-Risk Settings" was released last week by the National Academy of Sciences. It says, "We believe that the problems of America's young people are getting significantly worse, not better."
And, according to the study, the individuals and organizations that should be helping these youngsters -- including parents, child welfare organizations, schools and the juvenile justice system -- are in many cases making the problems worse.
You'll never guess what those in Washington, DC were doing....
The big story in Washington is the struggle over the Federal budget, but that means nothing to the children of the cities. They are nobody's constituents. We hear about them mostly when they are killing somebody, and sometimes when they are dying.
Given a choice, most of the country would like not to hear from them at all.
Same old story.
But we muddle along, making small steps of progress here and there, one forward, three back. We have the potential to harness it all someday but in the meantime we take steps, and leaving behind so many lives. Maybe a great composer. A healer. A singer/song writer who could have pulled at the strings of our hearts. A renewable energy engineer.
Bob Herbert was telling us in 1993, listen to the children…
18 years later, Herbert retires from the NYT the same week The NewYorker prints a story about another visionary, one with a similar message. But she’s a scientist, a doctor doing leading edge work with pediatric patients. And the discoveries she integrates with others in disparate intersecting disciplines make will change the way we all live, from Bushwick, Brooklyn to Beacon Hill and Beverly Hills.
Nadine Burke MD, MPH, FAAP is practicing at the nexus of medicine, public health, parenting, and poverty.
This article tracks the clinical research linking childhood trauma not just to juvenile health risks like ADD and adult addictions but ones appearing later in life such as asthma, obesity, cancer and heart disease. Trauma and poverty have a chicken-and-egg relationship. Racism a multiplier.
The Poverty Clinic - Can a stressful childhood make you a sick adult?.
The NewYorker
March 21, 2011... research on how childhood trauma affects adult health. Monisha Sullivan first visited the Bayview Child Health Center a few days before Christmas, in 2008. Sixteen years old, she was an African-American teen-age mother who had grown up in the poorest and most violent neighborhood in San Francisco, Bayview-Hunters Point. Sullivan had ailments that the staff routinely observed in patients: strep throat, asthma, scabies, and a weight problem. The clinic’s medical director, Nadine Burke, examined Sullivan and prescribed the usual remedies. But Burke, who founded the center in 2007, was having a crisis of confidence regarding her practice. At the clinic, Burke gently interrogated Sullivan until she opened up about her childhood: her mother was a cocaine addict who had abandoned her in the hospital only a few days after she was born. As a child, she lived with her father, who also took drugs, and at the age of ten she and her brother were placed in foster care. Since then, she’s been in nine placements. Sullivan encountered Nadine Burke at a moment when Burke was just beginning to think deeply about the physical effects of anxiety. She was immersing herself in the rapidly evolving sciences of stress physiology and neuroendocrinology. What if Sullivan’s anxiety wasn’t merely an emotional side effect of her difficult life but the central issue affecting her health? According to research that Burke had been reading, the traumatic events that Sullivan experienced in childhood had likely caused significant and long-lasting chemical changes in both her brain and her body, and these changes could well be making her sick, and also increasing her chances of serious medical problems in adulthood. And Sullivan’s case wasn’t unusual. Two years after Sullivan’s first visit, Burke has transformed her practice. She believes that regarding childhood trauma as a medical issue helps her treat more effectively the symptoms of patients like Sullivan. In the view of Burke and the researchers she’s been following, many of the problems that we think of as social issues might be better addressed on the molecular level. If these researchers are right, it could be time to reassess the relationship between poverty, child development, and health, and the Bayview clinic may turn out to be a place where a new kind of pediatric medicine is taking its tentative first steps. Mentions the Adverse Childhood Experience—or ACE—study. The study’s correlations between adverse childhood experiences and negative adult outcomes were so powerful that they stunned Vincent J. Felitti and Robert F. Anda, the researchers who had conducted the study. “In many cases, what looks like a social situation is actually a neurochemical situation,” Burke stated….. Sixty-seven per cent of Burke’s patients have had one or more ACEs, and twelve per cent have had four or more. … Burke’s goal is a treatment protocol, like the one doctors use when they’re dealing with cancer or diabetes.
Read the whole article.
I grew up in Brooklyn, very poor, like the kids in Herbert's article, a victim of childhood trauma. But unlike the kids in Bushwick Outreach Center though, I grew up in another section of Brooklyn without the unbearable street crime, white, with a great primary school education and large extended family. Low class but upwardly mobile with pathologies under wraps.
I got exposed to integrative approaches to childhood trauma as an inquiring foster parent and then to the practice having had the opportunity to be a patient in the Kaiser Permanente clinic highlighted in The NewYorker article (my ACE score is 7) .
The data is stunning. The ACE study done on a white, well off population presented the same unmistakable linkage of trauma and adult sickness as in poor African American neighborhoods. The picture being documented proves that childhood trauma changes brain development in a precise physical way that defines neurological circuitry in charge from early childhood through adulthood, and lasting for generations. Better, now the data linking poverty and childhood trauma are being aggregated as well.
Most importantly, options exist to change the outcomes, even for adults.
Surely someday we'll have pharma protocols that undue some of the brain damage from child neglect or abuse, war, maternal substance abuse, etc.
Dr. Burke is working toward treatment protocols as robust as are used today with diabetes and cancer. That is revolutionary.
Moral or social motivations never seem to be sufficient to tackle humanitarian crises but the scientific data and financial cost benefit will soon drive action that eliminates poverty to some degree and Dr. Burke is the leading edge.
Bob Herbert was right 18 years ago and hopefully he'll go on teaching us plenty. Mr. Herbert is a great man I've enjoyed listening to. And Dr. Burke, she rocks.