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Dec. 23, 2009 - Freedomain Radio - Stefan Molyneux
01:09:57
1539 The Bomb in the Brain - The Effects of Child Abuse Part 2 - The Freedomain Radio Interview with Dr Felitti

An interview with Dr. Felitti, the director of the Adverse Childhood Experiences project.

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Hello, Dr. Felici?
Yes. Oh, hi.
It's Stefan Molyneux from Free Domain Radio.
How are you, Mr. Molyneux?
Oh, I'm just great. Thank you so much for taking the time to have a chat.
Yes, of course. I went over the materials that you sent to me with...
Enormous interest, if not outright fascination, so thank you so much.
We can do this one of two ways, or another way if you'd prefer.
I can either do a short introduction before I publish the show, going over some of the stats and figures, and we can talk more about the conclusions, or I can ask you about the stats and figures, and you can then explain them and the conclusions, whichever is preferable to you.
Well, why don't you go the first way because you know better your audience and what you want to get accomplished.
Okay, fantastic. And I don't want to waste your time with stuff that's in the material that I can easily reproduce for my conclusions and I think the significance of what's being studied I think is where your intellectual capital I think is best applied.
Okay. And is there anything that you'd like to focus on or talk about in particular just before we start?
Well, this has been going on for a long time.
I mean, the origins of the ACE study, you know, in one way began about 1990, but in another way went probably back 20 years prior to that, simply based on counterintuitive patient observations and medical practice,
where we were helping people accomplish things that conventionally were, you know, conceived as Incontestably good and wonderful and finding that patients often fled their own success, were terrified, etc.
It really was dealing with those counterintuitive responses to what we viewed as successful treatment of problems that ultimately led to the ACE study.
Certainly, one of the unusual findings in the ACE study Was that many of the conditions that we view as public health problems are indeed that, but perhaps more importantly are also unconsciously attempted solutions to personal problems that are never raised,
that are never recognized, that are basically buried in time and then further hidden by shame and by secrecy.
and by social taboos against exploring certain areas of human experience.
That's a very, very important idea.
A quick insight into that might be provided by the street drug crystal meth, methamphetamine.
Pretty much everybody understands that crystal meth is a major public health problem.
The demonized drug, crystal meth, Virtually no one seems to remember and this is really a very interesting insight.
Virtually no one seems to remember that the first prescription antidepressant introduced for sale in the United States in 1940 by Ciba Pharmaceuticals was methamphetamine.
Methamphetamine was the major prescription antidepressant in this country for the next 20 years.
Until the advent of the tricyclic antidepressants.
Right, right. I mean, one of the things that really leaps out at me in looking at your work and the work of others is the degree to which health and dysfunction or addiction to negative things like smoking or alcoholism, illicit drug use, bad nutrition, overeating, high-level promiscuity, as you phrase it, the degree to which that can be, I think, quite accurately interpreted as a self-medication for psychological trauma.
Is that an unfair way of putting it?
Absolutely correct, yes.
That's a nice way of putting it.
Yeah, because it really is...
I think there's a quote, I can't remember who it comes from, that you talk about in the article, it's hard to get enough of something that almost works.
I wonder if you could talk a little bit more about that, because I found that fascinating.
In the early years of the obesity program, when we really had no idea what the hell we were doing, I mean, we thought we did, Because we were using this technology of supplemented absolute fasting that allows one to take a person's weight down non-surgically about 300 pounds a year.
It's very, very dramatic to see.
The impressive results perhaps understandably led us to believe that we must know what we're doing.
I mean, my God, look at the results!
And it was people fleeing from that or occasionally doing something dramatic like being uncontrollably suicidal as a result of these enormous weight losses.
It was really the pursuit of why these counterintuitive reactions were happening that led us first to stumble into the issue of childhood sexual abuse and then gradually into related issues of growing up In massively dysfunctional households.
So back in those years, interestingly, when people had achieved a certain level of success with weight loss in the program, we gave away this coffee cup with that sentence on the side.
It's hard to get enough of something that almost works.
And we thought it was kind of a cute saying.
And obviously we're inhibiting ourselves from fully understanding what it meant.
Because it probably took another 10 years for us fully to understand what we were saying there.
And that would be applicable for food, it would be equally applicable for smoking, for street drug use, for alcohol, for promiscuity, etc.
It was a profound idea that obviously at some primitive level we recognized, but certainly the conscious Recognition that it completely escapes us.
Right, right. And of course, one of the great challenges is, I mean, as you mentioned, the average age of people in the study was 57.
And it's not like you're going to...
Your first thought is not to look at what happened when you were five, because it's so much later.
The body has completely regrown, in a sense, over that time period, yet the scar tissue of early trauma seems to remain and continue to do its negative work, you know, as you said, 50 years after the abuses may have occurred.
Yes. That's quite shocking.
I have a lot of questions, of course, and whatever time you can give is gratefully accepted.
I mean, the numbers, of course, for those who are not familiar with these kinds of statistics, the numbers of people with significantly adverse childhood experiences is quite shocking.
But I think that a case could be made that, despite the significant amount of the numbers, they may actually be underrepresented.
And two things, I guess three things sort of popped into my mind.
I'm wondering if you could speak to these.
The first is that these are middle-class people who have really good health insurance.
That's the sort of control group of the population that you're limited to by the nature of the study.
And so, in a sense, the people who've had more significant problems Because of high ACEs would not be represented as greatly in that population because they may not have even made it to the life of the middle class with health insurance and all the other things.
So the people who are more functional are in your study than less functional, I would say.
The second, of course, is there's under-representation in general with people talking about trauma because people don't like to talk about it.
And I guess third, there is the problem of amnesia, right?
Of people who really can't remember stuff.
So I was wondering if you could speak to that.
Well, the issue of amnesia is potentially an important one and an interesting one.
I had never really given it much credence in terms of everyday practice, thinking of it mainly with the theatrical device of Hollywood movies of the early 40s.
About 1985, I was talking with a woman.
In the weight program, and we're going through her life year by year, you know, where'd you weight when you were born, in kindergarten, sixth grade, et cetera, and if you can't remember, we were the fattest kid in class, the skinniest kid, ordinary size, and so on.
We got to age 23, and she tells me that at 23 she was raped and in the year subsequent gained 105 pounds, whereupon she looks down at the carpet and mutters out loud, Overweight is overlooked and that's the way I need to be.
I didn't know how to respond and I said nothing.
We finished our conversation and several weeks later when she had lost 35 pounds, she abruptly disappears for two and a half years, comes back obviously having regained the weight.
The interesting thing was she had no recollection of our conversation and here I, 24 years later, Remember the pattern on the carpet that she was looking at when she muttered that memorable statement.
That prompted me to look into the issue of amnesia.
So the interesting thing is two and a half years later she has no recollection of our conversation and that prompts me to look into the issue of amnesia and so we looked I believe it was into 300 consecutive patients in the weight program Lo and behold,
12% of them have no recollection of some period in their life, typically the few years right before weight gain began.
I don't mean absolute amnesia, but I just don't remember anything from 10 to 13, doctor.
I don't know why. It's just not there.
That kind of thing.
And that was a real surprise.
And that, of course, supports the point that you're raising.
That the data probably are worse than what we're showing.
Certainly no one would expect them to be better if you're looking at people living on the street or in prison or from some destroyed culture or coming out of some war zone and so on.
Right, right. Because the majority of people have at least one negative ACE and I think if you would expand that to a wider population than is available to you, it would probably be higher because you would be dipping further down the economic chain.
And that's not to say it's an absolute correlation between family dysfunction and economic poverty, but I think the two would have some relationship for sure.
You're raising a very important and interesting point.
And it may not be universally applicable in the world because one notes that in other countries poverty is associated with starvation.
Here it's associated with obesity.
But in the United States, poverty is commonly viewed as a causal factor.
I'm sure it's hell not arguing that poverty is good for anybody.
But what we've seen is that very often it's clearly an outcome.
Yeah, and one of the things that struck me is the degree to which an increase in ACEs is correlated with an increase in negative appraisal of job performance problems with employment, all of which would be associated with impairment to income potential.
Exactly. I was also very interested in the fact that you said women are 50% more likely than men to have experienced, was it five or more categories?
Five or more, yeah. Right.
Now, do you think that's self-reporting or do you think that's like it's more honest self-reporting in a sense or less amnesia or do you think it's an actual increase in the abuses?
I believe it's an actual increase in the abuses.
I mean, women are in general more vulnerable.
They're, to some degree, brought up to be more vulnerable.
They're more likely to be the object of sexual molestation, etc.
Right, yeah. And that's, of course, particularly tragic when it comes time for them to be mothers, right?
That's how some of the cycle came. Absolutely.
Now, you also had a sentence in your paper, the one that you sent me, which gave me pause, because we like to think that there is a general increase in the quality of parenting over time, and something that you pointed out, I'd like to get a little more information on to make sure I understand it correctly.
You wrote, we find no evidence that there has been changes in the frequency of overall adverse childhood experiences in various age cohorts spanning the 20th century.
Yes. To me, that sounds like it hasn't particularly improved the number of ACEs over the 20th century, but I'm just wondering if you could speak a little bit more to that.
That's literally what we found.
Now, to go back to your original point, we like to think that parenting has improved.
I think that's true.
I think if you were to compare current practices With the 14th century, change is obviously a lot slower than one would hope.
The one thing that clearly is different is media attention to items now that 50 years ago or 100 years ago never would have appeared in the media.
Well, yeah, I mean, I certainly would agree with that, although there tends to be a sensationalization of child abuse in the media where the most egregious cases are put forward, which in a sense, like looking at something on the other side of the sun, obscures the more common and destructive forms of childhood trauma that are revealed in your study because people say, well, you know, there's this terrible case where they locked a child in the cupboard for 14 years and so on.
But I think what you're pointing out, which is enormously underreported in the media, and of course I'm trying to do my little bit through my show to change that, is Is that we really can't understand society unless we understand the effects of this kind of abuse.
I mean, we hear, you know, oh, there's BPA in baby bubbles or whatever, lead in children's toys, and that's harmful to children.
But, of course, that completely pales in prevalence and significance to the kind of stuff that you guys are detailing in these kinds of studies.
Certainly so.
Make a note, write down the name Einar Helander, first name E-I-N-A-R, last name H-E-L-A-N-D-E-R. Einar Helander is an unusual man.
He is a Swede, a cardiologist, who spent his life working with the World Health Organization.
Basically, in some of the most ravaged countries of the world, studying the issue of child abuse.
He has two books out.
You can read about one of them on Amazon, or I think perhaps you could get other information just sticking his name in Google and seeing what's on the Internet.
He was for many years chief physician of the World Health Organization.
And his writings on the subject of child abuse around the world are really extraordinary.
I'll see if I can snag him on this show.
I'm really trying to get his information to as many people as possible.
Okay, he lives in Portugal, but he speaks quite good English.
Maybe I'll go on-site and visit him during the summer months.
That could be very, very important.
Fascinating in this report, the reduction in healthcare costs.
So what I got, and just correct me where I've gone astray if you don't mind, was that this was not formal counseling.
This was not psychotherapy or psychiatry that was being applied to the people who were in this study, but there was some form of group work.
I know that that was in the obesity program, but also I think in some of the other programs that you were working with.
Which had, to me, extraordinary reductions in things like doctor office visits and emergency room visits and even hospitalizations to a smaller degree.
Could you tell me a little bit about the kind of group work or conversations that people had that did result in the alleviation of these?
In the first place, I should say that most people had nothing done beyond talking about these experiences once in the course of a complete medical evaluation.
Oh, and what was the question?
Sorry, you noted the question.
Was it what happened and how do you think it's affected you in the years?
That was our generally most useful response.
In other words, we'd be in the examining room with a patient and say something like, I see on the questionnaire that you were raped as a young woman.
Can you tell me how that has affected you later in your life?
Or, so I see on the questionnaire that you were the one who discovered your father's body when he hanged himself.
Tell me how that has affected you later in your life.
The answers are really quite extraordinary and surprisingly concise.
So basically, that was the nature of the kind of conversation.
And it would last, you know, two, three minutes, etc.
Only a very small number, I mean a really small number of people were ever referred to psychiatry.
Certainly a minority of people, a small minority of people went into the weight program or into the smoking program where the group activity occurred for two hours every week for a minimum of 20 weeks.
That was enormously important and one of the things that we saw Was the importance of simply providing people a support system to be part of a group of a dozen or so individuals, men and women, with similar problems.
Because most of them really had no functional support systems at home.
That was a surprise all the way around.
So we did this simply because it seemed the right thing to do.
And then an outside firm in the data mining business, about two or three years after we had radically changed our questionnaire, came along and hoping to use me as the vehicle for snaring Kaiser Permanente as a customer, did this big survey as a gift.
A survey of over two years' work, which involved for us, I mean this was a very unusual high volume setting, Involved the comprehensive medical evaluation of somewhere over 120,000 individuals.
To my absolute amazement, they come back with a report.
They were using the interesting technique of neural net analysis, a rather sophisticated data mining approach.
They come back with the information that there's a 35% drop in doctor offices over the subsequent year.
Then a smaller drop in ER and even smaller in hospitalization.
Now the next piece of that was that two years later everything reverted back to the prior baseline.
So there was a one year improvement after this few minutes of conversation about these traumas and effects.
And then it disappeared. And so the question that I'm always asked is, you know, what did you do and how come the effect disappeared?
Well, what we did was simply talk about things, talk about things overwhelmingly for the first time, doing it comfortably so that people were able to leave without having the feeling that, oh God, even the doctors are uncomfortable with this, how awful this has been, etc.
Slowly, I came to realize, you know, it's kind of interesting.
This is not too different from what's done in the Catholic Church and called confession.
And that technique has been around for about 1,800 years.
You know, it's a brief conversation with an important person about things that one doesn't ordinarily talk about.
You know, there's the pronouncement made that, you know, you're still a decent person.
You know, this can be fixed.
There's no psychologist outside the confessional door.
There's no referral to elsewhere.
The whole process is remarkably brief.
And yet its persistence for 1800 years suggests obviously that there must be some social benefit out of it if it's lasted that long.
It is really chilling to think that the people who are in these people's lives, the husbands, the fathers, the mothers, and so on, that such relief could be provided to people from just a few minutes of concerns and, I guess, neutral, in a sense, questioning, that such relief could be provided, but it's not, and that's so incredibly tragic to think about.
Certainly so. I mean, there's an enormously high price That is being paid for secrecy.
It's certainly comforting to other people which is really its function.
Right, right. Yeah, because the costs, I mean, it's hard to even imagine the dollar figure that would be associated with a 35% reduction in doctor office visits, an 11% reduction in emergency department visits, and a 3% reduction in hospitalizations that would run into the billions and billions of dollars, I would imagine. Without question.
Without question. And that's a two-edged sword.
I mean, there are two sides to that.
If you're a physician in solo practice in the community, If someone comes wildly enthusiastically, speaking about a 35% reduction in doctor offices as well, it may not be greeted with wild enthusiasm.
If, like me, you're someone working in a closed system on salary, well, that's potentially of great interest because the outpatient budget for Kaiser Permanente in Southern California It's $14 billion a year.
So if this is replicable, and I believe it is, you're talking potentially then a $4 billion savings.
Now, there's a two-edged piece to that too.
The naive outside view is, oh my God, people at Kaiser are going to be thrilled about that.
Well, on more careful viewing, what one sees is That there are not many administrators who would be eager to step up to the plate to take a swing at a $4 billion pitch, correctly perceiving that if they screw that up, people are going to remember them.
And equally correctly perceiving that they were hired to keep the ship on course, not to make a right angle turn looking for the Northwest Passage.
So, you know, there are There are counterintuitive aspects to all of this often in the most unexpected places.
Then additionally, where did I want to go?
Oh yes, the reversion back to prior baseline to two years.
That was fairly easy to understand because we use a unified medical record.
Everything that happens is in this one chart.
And so there are our notes literally printed with laser-like clarity, okay, about what has happened in the past and so on and our thoughts as to how that relates to what's going on now.
They might just as well have been printed with invisible ink because almost never did anyone pay any attention to those and integrate that into ongoing care.
I mean, that was just, you know, So when they would go back to their doctor, the issue that came up in the Kaiser Permanente survey was not addressed in any way going forward, is that right?
Yes. No one would imagine that a three to five minute conversation cures decades of long-lasting and physiological, by this point, trauma.
I wouldn't say that it cures decades, but produces a significant and measurable improvement in things.
Yeah, it would be interesting too if there was a way of subdividing those who went into, say, personal therapy or psychotherapy as a result of this conversation, but of course I'm sure that would be very hard data to get, but it would be interesting to see whether the effects turned out to be more permanent or even increased over time.
Without question. Now, you say, of course, that doctors in some ways would be resistant to a 35% drop in patient visits, but if I got the emotional undercurrents of something that you were talking about in both the obesity and the childhood trauma studies that you sent me,
There seems to be among physicians, if I understood what you were writing correctly, a kind of nervousness around, I think you phrase it, patients who present with illness but no disease.
People who have problems, physiological problems that are to them very real, with no physiological basis, and I would imagine That if doctors didn't have to deal with that, which must be enormously stressful and time-consuming and difficult, that they may actually prefer to have patients not come in with stuff that can't be cured by medicine but needs a different kind of approach.
All of that's true.
But what you're leaving out is the fact that it's uncomfortable thematic material to deal with.
Here's a good insight into this.
Remembering that the speaker At meetings is the only person typically who can see the faces of everyone in the audience.
In presenting this to large medical audiences, several hundred physicians, what's striking is that reliably by eight or ten minutes, the level of anguish on people's faces in the audience clearly exceeds anything that you would sensibly attribute to empathic responses.
It looks pretty clearly like personal ghosts are being awakened.
And often times people will come up afterwards and make that explicit.
It's tough for me to deal with this stuff because I have some ACEs that I haven't processed or whatever.
Is it something like that? Exactly.
And I can imagine too that doctors...
I mean, we have this weird dichotomy within our society that goes all the way back to the Greeks.
It's sort of the mind-body dichotomy.
If it's all in the mind, it can't be in the body.
The two are completely separate.
Or if it's in the body, it has no origins within the mind without looking at them as a sort of ecosystem.
And I think that I've been speaking with a bunch of people who've been doing this work recently.
The degree to which the brain is formed through early experiences so that it becomes a different brain than it would have otherwise, that the mind and the brain and the body are very much an ecosystem that very often self-reinforces these kinds of traumas.
I think doctors would have a hard time saying to patients, it's all in your head, but it's not all in your head, which is kind of an ambivalent or complex thing to say, if that makes any sense.
You can't really make the split.
Here are a couple of common examples that everyone is familiar with but never really think about the implications of them.
Getting cold hands under nervous tension.
That's due to the selective spasm of arteries carrying blood into the skin of one's hands.
Same thing with feet. Getting cold feet, the expression.
Turning pale with fright.
Same idea.
Selective spasm of the facial artery or blushing which is selective dilation of the facial artery.
So something is happening emotionally in your brain that is causing this rather gross physical manifestation The physiology of which is well understood, making it clear of the inseparable relationship of what's going on in your mind and what's going on in your body.
Right, right. And of course, if there were some toxic substance out there in the world that, you know, with a significant portion of people resulted in a 20-year reduction in lifespan, a 45% or 48% increased chance of contracting cancer and so on, I mean, the media would go completely insane about that.
And there would be people dragged in front of Congress and so on.
But when the toxic element, so to speak, within a child's life is caregivers, People seem to kind of draw up short before that reality and get very uncomfortable.
Yes. Well, a related example would be child obesity.
I don't see children, but I'm impressed that in seeing adults, with obese adults, the single most important question is how old were you when you first began putting on weight?
And most people not understanding the profundity of that have no particular problem answering it honestly.
The follow-up question is, why do you think it was then?
Why not three years earlier, five years later?
Why then? And some people will know and others will not want to know, but that's really the most important starting point.
And the coincidence of that age with parental loss, typically through divorce, is really striking.
And I have never seen anything about that in the literature.
I would guess that it's because so many of us have been divorced that it's really an uncomfortable subject that we'd rather distance ourselves from.
Right. And, I mean, that's a good segue.
If you have a little bit more time, I would love it if you would talk a little bit about the obesity studies.
I mean, I'll put some details out before the show about the ACE studies, but if you could talk a little bit about, or a lot about, if you like, the obesity studies, which I found also extremely fascinating because it's not something that is intuitive.
And, of course, that's where I think the most original and creative thinking goes on, which is the stuff that is counterfactual or counterperceptual in a way.
But it's really striking the correlations that you found between ACEs and particular kinds of ACEs in particular and obesity.
As you say, there is no baby that's born fat.
The only thing that's determined genetically is where the fat is going to sit on your bones, so to speak.
Exactly.
Yeah.
Well, the obesity program, which is a big program here, the obesity program really was the origin of the ACE study.
In a very real way, the ACE study was set up to determine whether the things that we were finding in our obese patients were represented in the general population, and if so, what sort of long-term consequences did they have?
And when I say things that we were finding in our obese patients, I'm talking about unexpected early childhood adverse experiences.
Here is the memorable case.
1985, a young woman comes in 29 years old.
Can you help me with my problem?
Our first mistake was in accepting her definition of what the problem was.
She weighed 408 pounds and so we bit into that and we said yes.
And in 51 weeks took her from 408 to 132 pounds.
Sorry to interrupt, but this is on the 400-odd calorie with correct electrolytes and minerals and supplements and so on, right?
This is the nearest starvation without medical consequences, right?
Exactly. And so we, of course, assume, my God, you know, this is really terrific that we can do this, etc.
So she stays at that weight for several weeks.
And then, in one three-week period, regained 37 pounds, which I previously thought to be physiologically impossible.
In pursuit of why, ultimately, it turns out that she was sleep-eating.
She was eating in a somnambulistic state and eating very large amounts, perhaps larger than might have been That might have been ingestible in a fully conscious state, and that coincided with the day that some guy at work propositioned her.
That was kind of interesting, and so in pursuit of what seems like kind of an extreme response to being propositioned, then comes the lengthy incest history with her grandfather.
And so suddenly even her job makes sense, She's a nurse's aide on the night shift in a convalescent hospital.
That is to say, she's paid to stay awake and on her feet all night long while the old people are in bed.
Oh boy! That's almost like the amygdala gets up for a snack, right?
It's that deep down in the fight-or-flight mechanism.
Yeah, so she quickly is back over 400 pounds and disappears for 12 years.
She then comes back and joins a group that we had put together for people in the 400 to 600 pound range and after being a participant in that for about two months, comes in and announces that her family has collected $20,000 for her to have bariatric surgery.
She has the surgery and at a point where she has lost 96 pounds, which is not clearly obvious to me.
I mean, you know, I took a word that she had done this, but the volumetric reduction of 96 pounds is not that clearly visible when you're starting out over 400.
At a point where she's lost 96 pounds, she becomes interactively suicidal.
She's hospitalized five times within the ensuing year.
Gets three courses of electroshock to try to control the suicidality, etc.
And then on video, a lengthy video interview, she says very clearly in response to, you know, why did this happen?
Why the suicidality?
Her answer is, the weight was coming off faster than I could handle it.
My wall was crumbling.
My wall was crumbling.
Right, so the fat is a shield, in a sense, against unwanted sexuality, which awakens the trauma of the history, right?
Overweight is overlooked, right?
Exactly. Being fat was not the problem.
Being fat was the marker of the problem.
In fact, it was a very real solution.
And do you recall or do you know what happened to this brave?
Very interesting story.
The video interview that I have with her is about an hour long.
She's now in her early 40s and she's fairly thin, you know, 250 pounds or so.
And she's comfortable speaking.
And the reason she's comfortable is because she knows she's going to die soon.
And the reason she's going to die is because in the intervening years, she has developed a condition known as primary pulmonary fibrosis.
If one went back 10 years, primary pulmonary fibrosis would have been a rock-solid example of a strictly Organic, biomedical, structural disease.
It has no known cause.
It's not related to smoking or air contamination and so forth.
No one knows why.
In the past few years, however, it's become clear that at least some significant minority of primary pulmonary fibrosis is associated with major chronic emotional stress.
And guys like Bruce Perry and Bruce McEwen have written extensively about this, that with major unrelieved chronic stress, one develops high levels of circulating cortisone.
That's damaging in its own way, like taking cortisone, say for rheumatoid arthritis, creates its own problems given time.
But furthermore, When one is well into this process, in a number of instances, there occurs the release of pro-inflammatory chemicals known as pro-inflammatory cytokines,
cytocell kind, K-I-N-E action, chemicals effecting inflammatory changes in the lining of small blood vessels.
Closing those vessels off and causing the scarring and destruction of the tissue that would be supplied by those vessels.
So the irreversible scarring of primary pulmonary fibrosis, in at least a significant minority of cases, appears due to the release of these pro-inflammatory cytokines, decades into situations of chronic major stress.
Cortisol, I believe, has also been implicated by some researchers at McGill as being one of the reasons why those with significant histories of child abuse have a much higher rate of contracting cancer, because the cortisol interferes with the ability of the body to detect and destroy the cancer cells.
I'm speaking as a complete amateur way out on a limb, but that's what I understood from the study.
Correct. A straightforward example of that that many more people would be familiar with It would be the fact that if someone is on lifetime immunosuppression as a result, let us say, of an organ transplant, that the prevalence of malignancy in those people is higher as a result of the lifetime immunosuppression.
Another way of putting it is all of us every day are having a few bacteria run through our bloodstreams.
You know, brush your teeth.
A minor cut, a hard bowel movement, whatever.
Our immune systems process those things out and we never know the difference.
The same thing in terms of malignancy.
We're all forming malignant cells at a very low rate and they're routinely processed out.
So getting cancer means one of two things.
Either the rate of production of malignant cells increases markedly exposure to carcinogens to heavy smoking and so forth or something is damaging the body's immune system's ability to process those abnormal cells out and that's what you're dealing with when you're talking about long-term hypercortisolemia or other forms of immune suppression such as Such as are used in situations of organ transplants.
Right, right. I also found it interesting, and it's a very sensitive subject, as of course is everything that we're talking about here, but the sensitive subject that I thought stuck out in the obesity program was the, I think as you phrased it, the unrecognized and unspoken benefits of obesity.
Now, we talked a little bit about that, but if you could expand on that, I'd appreciate it.
Well, that's really interesting.
Every week, every Thursday evening, and if you're ever in San Diego, let me know ahead of time because you could sit in and hear this firsthand.
Every Thursday evening we have here a meeting for people who are thinking that week of joining the obesity program.
And I'll explain to them that rather than describing the program to them, we're going to give them a free sample.
We're going to do some stuff typical of the program with them, and they can use that to decide whether they want to or don't want to join the program.
And I explain that the same dozen or so people meet for two hours every week with the same counselor, basically working on answering certain questions as a group That we have found productive in the course of treating successfully and unsuccessfully about 30,000 people now.
And so here's the first question.
Tell me why, not how, how is obvious.
Tell me why you think people get fat.
The answers are spectacular.
Stress, depression, people leave you alone, men won't bother you.
What the hell?
Don't you read the magazines from the supermarket that your metabolism is ruined?
People don't say genetics.
People don't say because processed food or corn sugar or whatever.
They do, but maybe every three weeks.
I'll point out to them, look at your list.
Notably, look what's missing from your list.
If you've been here last week, You'd have seen a very similar list or last month, etc.
Okay. Second question.
We all know, I mean God knows we know here, that sometimes people who lose a lot of weight regain it all, if not more.
You know, lose 100, regain 120.
So when that happens, why does that happen?
And always people will quickly respond because if you don't deal with the underlying issues, it'll come back.
That's rather a profound insight.
I'm sorry to interrupt you, and I do want you to continue, but it just repeatedly has struck me, in reading this and in other material that I've read, how incredibly close we are to the truth in life at all times.
It just takes one intelligent, sympathetic question for it all to come out.
It's not like digging for gold in the Arctic.
It's right there when you just ask one question.
Yes, certainly so.
And it's really hidden In many of our everyday phrases, and I'll come to that in a moment.
So always that answer comes up, you know, if you don't deal with the underlying issues, it'll come back.
Maybe 60% of the time someone will propose it comes back because major weight loss is threatening.
Usually to the person losing the weight, but sometimes to people close to them.
The third question, tell me the advantages of being fat.
An ugly question.
Not being heavy, not being overweight, or being fat.
Always, the answers will break into three categories.
It is sexually protective.
That's fairly easy to understand.
It's physically protective.
think of the expression throwing your weight around.
You mean there's a kind of intimidation factor?
Yeah, sure.
I remember years ago we had two men in the program that lost between 100 and 150 pounds They were guards of the state penitentiary.
They made no bones about it.
They did not feel comfortable going into work regular size.
They felt a lot safer going in looking as big as a refrigerator.
And the third category is that it's socially protective.
People will expect less of you.
And in what way does that show up?
I was a little confused by that.
Okay.
Let's say you're a middle-aged unmarried woman and you have married friends.
To whom will you be more acceptable to those married friends?
Slender or obese?
Right. And they would also pressure you, in a sense, less to get married or do things that you may be averse to if they won't introduce you to others and so on.
Sure. All of that.
In terms of, well, you know, social expectations.
Well, you know, I really can't go.
I can't go.
It's just too hard for me to walk up the stairs to get there.
People expect less of you at work.
It may be unfair, but you show up weighing 400 pounds, people will unconsciously attribute, you must be kind of dumb or slow or ineffective or unreliable, etc.
So in all sorts of ways, people's social expectations are reduced.
You may be somebody who's not looking to have expectations reduced, But there are a lot of such people in the world.
Sorry to interrupt, but it also just struck me that if it seems to be the case with a significant number of obese, particularly women, if some sort of sexual molestation or exploitation is buried in the past, as it is, in a sense, under the flesh, the weight loss may, you know, like a tide coming out to reveal a body in the sand, the weight loss may trigger memories or problems, and so, in a sense, the family Doesn't want the weight loss to occur, again, at a very unconscious level, because of the crimes that may be revealed in the past.
All of that's true.
Yeah, so should you ever be in San Diego on a Thursday, let me know ahead of time, and you might be interested in sitting in and hearing this firsthand.
Oh, I certainly would be. Thank you.
It's quite extraordinary.
The truth is right there.
Everybody has the answers right there.
You just have to ask the question.
Most people, of course, will go through their whole lives surrounded by people who love and claim to and all this without asking those basic questions that can be so enormously liberating.
I think the absence of those questions is felt almost every day by people in this kind of distress.
Oh, sure. Sure. And think how, at some level, we have some awareness of these things.
Built into various phrases, you know, throwing your weight around.
The expression, a fucked up kid.
Everybody knows what that means.
You know, it's an uncouth expression, you know, nice people don't talk about that, etc.
So it's a way of comfortably distancing oneself from something that you do understand at some level.
Right. Or comfort food.
The other advantage is self-medication, anxiety.
Absolutely. Some of this has been well depicted in motion pictures.
There was some years ago the movie Home for the Holidays.
With a guy named John Candy who was a quite obese movie actor who subsequently died of the complications of obesity, Home for the Holidays was the depiction of a family get-together for Thanksgiving.
Although it was advertised as a comedy, this was a lethally serious movie showing the family coming together.
And there's a couple who have withdrawn into an alcoholic stupor.
Uncle Joe has withdrawn behind a cloud of cigar smoke.
Two other people are eating themselves into oblivion, etc.
So part of the reason why so much eating goes on at the holidays is not out of joy, but it's out of anguish at the disparity between what's hoped for and what is often delivered.
Now, you also mentioned the psychoactive properties of food, which is not something I know much about, but it's very interesting because if it is a form of self-medication, you would expect it to have, like drugs and nicotine, and I guess caffeine as well, psychoactive properties.
What are those properties that food possesses?
Well, you know, I think about it for a moment, buried in the expression, sit down, have something to eat, you'll feel better.
For many people, it's an effective, certainly easily available way of reducing anxiety, reducing anger, And assuaging depression.
And those same properties are held by nicotine.
Yeah, and there seems to be some theories that nicotine actually replaces some brain connectors that may have been inhibited during childhood trauma, that it is a very precise form of self-medication.
There are two broad categories of neural receptors in the central nervous system.
One is the category of nicotinic receptors and the other is the category of muscarinic receptors.
So it has a fairly broad range of neural activity.
Again, on a more simple level, you think back to the To the peace pipe of American Indians.
I mean, they weren't burning oak leaves or moss in there.
They were selectively burning nicotine leaves.
Right, and if it gives you a relief, in a sense, from the symptoms of childhood trauma, then the withdrawal is not just biochemical, or I guess it is, but it also uncovers, again, like the surf pulling back to reveal a body in the sand.
It uncovers some of the prior traumas as well.
Sure, sure. And so one commonly used substitute is food.
And so many people stop smoking only to put on weight.
Right, right. Now, I was also fascinated that every single diet pill safe one has a potent, prior to a recent one, anti-depressive activity.
Yeah, exactly. And, you know, recently there have been a whole new category that have come out of so-called fat absorption blockers.
You know, simple enough idea.
But the thing about antidepressant activity is an important one.
You know, starting back in 1932 with dextroamphetamine and proceeding up through all sorts of Variations on that, the only exception having been fenfluramine,
which was half of the combination of fenfen, which was fentramine, potent antidepressant activity, and fenfluramine, potent anti-anxiety activity.
Right, right. And the two major predictors that you identify of regaining weight after being lost, the history of childhood sexual abuse and currently being married to an alcoholic, was also, again, you know, almost every other sentence or paragraph sends a chill down,
I think, a sensitive person's spine, that those two things, being significant predictors, of course, they have nothing to do with nutrition or exercise, I mean, as the cause of these issues, but are very much environmental and we would assume a reproduction of prior traumas.
Well, you see, you bring up an interesting point because oftentimes the discomfort of dealing with the serious underpinnings of obesity is concealed by quick referral to a dietitian as though lack of knowledge is why you're fat.
You know, we need to teach you how to eat right.
Well, so if you take my patient who is raped at 23 and gains 105 pounds in the next year, That kind of thinking would imply that she must have obviously had the knowledge to eat right for 23 years because she was slender, and then getting rape that causes that knowledge to fall out of her brain.
Right. Or she says, I like food, is why I eat.
But of course, did her food relationship change so substantially at the time of the wreck?
Well, of course not, right? Yeah.
Right. Right.
Now... Curing type 2 diabetes, this blows my mind a little bit.
That's certainly interesting.
Very few physicians are aware of that.
Most would not waste time stopping to think about it, even if they believed it possible because they'd say, well, yeah, sure.
I mean, how the hell are you going to get 100 pounds off somebody?
But in fact, that was our finding.
I believe we had a sample of 320 consecutive type 2 diabetics that we studied and lo and behold, at the end of the program, average weight loss was 62 pounds.
At the end of the program, it was either 71% or 74% of them were no longer diagnosably diabetic.
I don't mean they were better controlled or anything.
I mean they were no longer diagnosably diabetic.
Right, and the idea that type 2 is even, like, controllable in a sense, but in a sense, it can be eliminated through the diet programs that you run, which rely heavily upon an examination of the psychological or historical causes behind food as self-medication for trauma.
I mean, that really is, it's a very long link, but it seems that the data completely supports it.
He does. And I really do appreciate your time.
I really wanted to end up with this statement.
Michael Balenta, you quoted him, but he said, patients see doctors because of anxiety, while doctors see patients because of disease.
Therein lies the problem between the two.
Now, obviously, we could spend hours just talking about that one statement, but you included in that for, I think it sums up a lot of the work that you do very well, if you could expand on why that quote is so important to you and had such great resonance for me.
Well, we're often working at odds.
We're not working on the same problem.
What's perceived as a problem to a physician may be perceived as a solution by the patient.
I have never yet met anyone who smoked two or three packs a day to get lung cancer or heart disease or bladder cancer.
People smoke for relief.
Because of the psychoactive benefits of nicotine, which has potent anti-anxiety, anti-depressant, appetite-suppressant, and anger-suppressant properties that have been well documented in the world's medical literature, certainly in the first two-thirds of the 20th century.
Interest in pursuing that line for the past third of a decade or so, third of a century or so, has fallen off.
Coincident with the huge public health onslaught against smoking.
But that's interesting, you see, because here in Southern California, I mean, it is very difficult to smoke comfortably.
You can't smoke in office buildings and hotels and bars and restaurants and so forth.
You can't even smoke on a public beach, for God's sake.
Now, the interesting thing is that in the past 13 years, in spite of this ever-increasing public health onslaught against smoking, in the past 13 years, there has been no net decrease in cigarette smoking in the United States.
It's about 22%.
You know, a huge decrease in the 60s and 70s with the first Surgeon General's report and so forth.
You know, all of the nickel-and-dime smokers kind of dropped out.
The people who weren't smoking or who smoking was not a symptom of significant prior trauma were able to drop the habit relatively easily, but there's the hardcore people for whom it's a necessary self-medication in the absence of alternatives.
Exactly. And the benefit of nicotine will occur with inhalation in 15 or 20 seconds.
The risk of it, which is quite real, will occur in 15 or 20 years.
And most of us Faced with major current problems, we'll end up selling out the future to get current relief.
Right, and of course, if you've grown up in a troubled household, the deferral of gratification is not something that you will have been taught much about, sadly.
Well put. Not everyone is interested in serving out a full life sentence.
Right, that's a very powerful way.
I mean, I remember a year or two ago with the third question in the obesity meeting.
What are the advantages of being fat?
Some guy in the back row who hasn't said anything blurts out, don't last this long.
What doesn't last this long?
Your life. Well taken point.
We don't pay attention to that.
Depression is a huge issue underlying obesity.
I've never met anyone who got fat out of joy.
Right, and of course, in that mindset that life is a disease that you cure by overeating, it's a chilling perspective.
Yes. I've only been working in this dataset for a short period of time, though I've been working with trying to help people to understand the links between prior trauma and current dysfunction for years and years.
So, clearly this information needs to get, I think, to a wider audience, but as you point out, I mean, Freud was the first to discover that certain kinds of illnesses previously diagnosed as hysterical or whatever actually had their roots in childhood trauma, and I mean, that's over a hundred years ago, and there still seems to be such a large barrier to getting this information out.
Do you have any suggestions or thoughts?
I mean, I'm sure you do, but what are they in terms of getting this information out to a wider group?
I'm hoping to find some capable author who would be willing to write a book for general audiences on the ACE Study.
The title that I would propose would be Turning Gold into Lead and the subtitle would be the Adverse Childhood Experiences Study.
In terms of trying to do something That would be usefully preventive, and we've thought a lot about this.
My belief is that the most usefully preventive thing that I can conceive of would be to figure out how to improve parenting skills across the country, understanding full well that there are going to be people who are going to murder or otherwise destroy their children, and we really don't know how to pre-identify those.
But there are a huge number of people Who have had no first-hand personal experience with supportive parenting in their own childhoods, many of whom want to do better, might do better if they only knew what the health supportive parenting looked like.
So how could one provide that information affordably, acceptably, etc., and not run into problems like, you know, Goddamn government's not going to tell me how to raise my kid.
And the one thought that occurs to me recurrently is the enormous potential that soap operas would have.
I wasn't expecting that, so please tell me more.
Huge audiences.
The bill is paid for.
What we're talking about is thematically lurid material in the hands of capable writers.
What if you were to weave into the storyline of a soap opera, an illustration of what destructive parenting looked like and how it played out over time, contrasting that with an illustration of what supportive parenting looked like and how that played out over time.
Basically, you're not giving lessons.
You're telling a story.
So you're flying below the radar of resistance.
Right, and of course, the majority of people who were watching it would be stay-at-home moms.
And of course, the hand that rocks the cradle, carves the future, rules the world, however you want to put it, right?
Yeah. So I'm looking for someone who would be interested in developing a pilot for that, to test it out.
When you think of the enormous Influence that programs have had for children, Sesame Street, Mr.
Rogers, Captain Kangaroo and so forth.
I'm talking about the same concept, but for adults.
Well, you know, I'm arm and arm with you there, brother, about the need for, we can only create a better world through improved parenting.
What we can do after the fact, you know, after the brain has developed and been carved into the particular channels that it has, is such a resource-intensive program that, you know, in this, you know, a pound of prevention is worth four tons of cure.
And so I completely agree with you that the improvement of parenting is the most pressing problem, In any appreciable way, for a hundred years.
And if you look at the progress that we've had in the dark arts of war and weaponry, compared to the lack of progress in the sunnier arts of parenting, we really are fighting a pretty intense race.
Yes, I mean, in that same period of time, electricity has appeared on the scene.
Yeah, we've gone to the moon and back and we can't do the same thing with reaching our children's hearts, so to speak, in a consistent way.
Let me give you a name of someone you might be interested in talking with someday.
a Canadian, a psychologist out in British Columbia, I believe at the University of British Columbia, a guy named Bruce Alexander.
And the point of talking with him would be about the so-called rat park experiments.
Rat park experiments.
I was always troubled, for instance, in thinking about addiction, about these studies where you have some rats in a cage and you give them a drink of water versus a drink of water with heroin in it and they prefer the water with heroin.
Implying that there was something intrinsically addictive about the heroin and so on.
So he has the dazzling concept that maybe a rat in a cage, even though it's a clean cage in a warm room with three square meals a day, is not in a peaceful setting.
And this is a highly stressed animal and that makes the difference.
So what he does is he sets up a so-called rat park, an outdoor scene caged, an outdoor scene fenced and so forth, you know, with dirt and rocks and bushes and trash and so forth, a nice homey place for a rat.
And interestingly, when the rats are given the choice there between water or water plus heroin, there's no selective choice of the water plus heroin.
So if you're ever thinking about addiction, He's an interesting guy to keep in mind.
Absolutely, yeah. I mean, this goes all the way back to Desi Morrison, the human zoo from the 1970s, where he talked about modern cities and perhaps even modern families as being as sort of natural to our nature as a zoo is to an animal, and that zoos create dysfunction, particularly sexual dysfunction, in animals, and that also may be the case with us in these stressful environments that so many of us grew up in and live in.
Yes, yes. Do me a favor.
Sure. If you have your radio program posted on the internet or if you can make a CD of how you're going to use this, I'd be interested in listening to it or getting a copy or what have you.
Oh, absolutely. I will send you a link to...
I usually publish with video and with audio.
I will send you a link to both. I really do appreciate it.
I think the work that you are doing and your colleagues are doing with this ACE material is...
Incredibly important. I mean, there is a lot of significant theorizing that's been starting over the last 10 or 20 years.
And I spoke recently with Stuart Shanker from York University, Alison Gopnik, to really try and publicize as much as possible the degree to which lives can be dominated by early trauma.
It's really, I think, impossible to understand conflict and criminality and aggression and abuse and suicidality without looking into these dark and invisible roots, you know, the chambers of the soul that we never see, which is the early childhood experiences.
And the more that we can unearth these bones, so to speak, I think, the far better.
I think, I can't believe that, I mean, parents don't want to do this fundamentally.
They don't go through the stress and the struggle of pregnancy and childbirth and child raising and getting up at night.
They don't do that fundamentally in order to torture their children.
That would be to have a view of human nature that would be diabolical.
But I think you're right.
It's in the absence of positive role models.
And most people know, like, if you ask them what good parenting is, they would say the right things.
But there's such a gulf between theory and practice and how people live that the more we can get people to understand what they're doing to their children, if they allow the children to be exposed to trauma, what they're doing to the world as a whole is, I really do believe that people will change, but I think it's just not clear yet.
Children are conceived to be or believed to be incredibly resilient, and it really doesn't seem to be the case.
However well-functioning they may appear as adults, the resilience is just not there at the neurological level.
Certainly so.
A woman named Emmy Werner is a big publisher on resiliency, and one of the things that I remember most from one of her books is the comment that amongst a group of people that they had considered to be highly resilient,
in other words, were doing well by conventional standards in spite of disastrous histories, They were shocked and surprised to find how much organic disease was present in that group.
Right, right, right.
I mean, and you can see this even as we talked about at the beginning of this conversation with the Kaiser study members who are, you know, able to afford really good health insurance, whose language skills are great, who can ask and answer questions easily, and they still have a very high prevalence of these kinds of problems, which have the objective health consequences.
It's really challenging to think just how much worse it is further down the economic ladder.
All right. Well, thank you.
Thank you again so much.
I really do appreciate your time.
I will send you a copy of this, and I will also ask if anybody's interested in helping you out with your various projects, they can send me an email at host at freedomainradio.com, and if it seems to be with a resume, I will forward anyone along to you who might be of interest, because anything that I can do to help what you guys are doing, I'm more than happy to do.
Thank you kindly. All right.
Take care. Best wishes for the holidays.
Yes, you too. Thank you very much.
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