Adverse Global Experiences (AGEs) and the Amygdala: Implications for Doctoring and Health

In what paradigm do we operate as physicians? How does this affect our care of patients?

In December 1999, Donella Meadows published an article in Sustainability Institute titled “Leverage Points: Places to Intervene in a System.”¹ She starts at the bottom with number 12 (constants, parameters, numbers) and goes through number five (the structure of information flows) up to number two (the mindset or paradigm out of which the system—its goals, structure, rules, delays, parameters—arises). Number one is the power to transcend paradigms.

Just a year earlier, Drs. Robert Anda and Vincent Felliti published “Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults” in the American Journal of Preventive Medicine.² The Adverse Childhood Experiences (ACEs) study offers a paradigm shift. Anda and Felliti repeatedly encountered what physicians still see in practice today. From obesity to tobacco abuse, chronic disease in adulthood so often has a backstory of adversity in childhood. The old paradigm was “What’s wrong with you?” ACEs invite us to ask, “What happened to you, what are your strengths and needs?”

Adversity and resilience research has blossomed in the two decades since. We understand many of the neural pathways by which toxic stress in childhood translates into lifelong disease.^{3, 4} Our mammalian brains evolved to cope with short periods of danger against a backdrop of relative stability and safety. When a threat is ongoing, high levels of stress hormones literally kill brain cells. This begs the question: do we need a new paradigm? Dr. Anda would be the first to acknowledge that beyond the 10 originally described ACEs, children face poverty, racism, sexism, bullying, etc. Are there toxic stresses beyond childhood, dangers affecting every aspect…

Keep reading: Adverse Global Experiences (AGEs) and the Amygdala: Implications for Doctoring and Health

ACEs in the Era of Inequality and AGES

To reduce adverse childhood experiences and build healthy communities, we must address inequality in the context of adverse global experiences

Abstract

Adverse childhood experiences, or ACEs, affect a diversity of health outcomes from substance use to cardiovascular disease. We now understand some of the biologic pathways that translate this trauma into poor health, and exciting work to link this research with community improvement efforts forms the NEAR sciences: Neuroscience, Epigenetics, ACEs, and Resilience. A separate and substantial body of research has found wealth inequality to strongly and adversely affect a comparably wide range of health outcomes, including child well-being; it could be argued that inequality is upstream of ACEs. Finally, overwhelming evidence spanning the breadth of scientific inquiry shows how human activity threatens planetary health in what might be called “adverse global experiences,” or AGEs. We have a unique opportunity to make explicit the links between individual and global health. To improve the health of all we must address ACEs and AGEs and everything in between. Such a monumental task will only be achieved when we succeed in an even larger one—a sea change in our collective vision. Herein lies hope. That sea change may be so intrinsically appealing that its adoption may surprise us with its speed.

Introduction

“The health of the individual cannot be separated from the health of the family, the community and the world.”            —the real Dr. Hunter Patch Adams

10 years into my medical career I took a 2-day training on the NEAR sciences: Neuroscience, Epigenetics, Adverse Childhood Experiences (ACEs), and Resilience. I’ve since shared this with audiences from physicians to teachers to parents struggling with their own ACEs. There is now tremendous hope around reducing ACEs and mitigating their effects through resilience research and interventions. Yet the data shows that childhood adversity is increasing.¹ Correspondingly, US mortality, already worse than in 35 other nations, has increased for 3 consecutive years, unprecedented in modern history.² Why is this happening?

The answer is complex. It carries us beyond the scope, as large a scope as it is…

Keep reading: ACEs in the Era of Inequality and AGES