What do we mean when we say adversity, toxic stress or resilience? To have a conversation that crosses disciplines—medicine, mental health, social service, juvenile justice, education—and includes everyone from health policy experts to grass-roots organizers, we need to be clear about our terms.
Adverse Childhood Experiences (ACEs)
This term refers to traumatic or disruptive things that happen in childhood. The original study published in 1998, of more than 17,000 members of Kaiser Permanente, looked at ten different categories of ACEs. These included physical and emotional neglect; physical, verbal and sexual abuse; parental abandonment through separation or divorce; a parent with a mental illness or substance abuse problem; and a family member in jail. Later ACE studies have included experiences such as racism and living in a violent neighborhood.
Hardship, distress or suffering. In the context of ACEs, adversity refers to circumstances in a child’s life including neglect, abuse and family dysfunction. It can also refer to hardships faced by individuals and communities due to natural disaster, violence, discrimination or poverty.
Allostasis, Allostatic Load
Allostasis refers to the way the brain and body respond to challenges or stresses: by reacting, adapting and then recovering. But if the stress is extreme, negative and unrelenting, the brain and body pay a price. That accumulated wear-and-tear, called allostatic load, can cause chemical imbalances, accelerate certain diseases, and even alter brain structures. Genetics, early brain development, the social and physical environment, diet and other behaviors can all influence a person’s allostatic load.
While the term “collective impact” is not limited to the work of building resilient communities, this approach, in which different sectors–for example, juvenile justice, education and social services–share an agenda and goals, has been key to creating successful social change. Collective impact initiatives, unlike simple collaborations, have a “backbone organization,” shared measurement systems, continuous communication and mutually reinforcing activities.
When children are exposed to multiple traumatic events, such as ongoing physical or sexual abuse, witnessing family or community violence, or separation from family members, they may suffer complex trauma, with deep and long-lasting effects on their ability to think, learn and relate to others. Research has shown that the more ACEs a person has, the higher his or her risk for problems including addiction, chronic physical conditions, depression and anxiety, self-harming behaviors, and other psychiatric disorders.
Even our genes respond to what happens to us, through chemical reactions that turn certain parts of the genome on or off in response to stress, diet, behavior, toxins and other factors. Epigenetics is the study of how the social and physical environment change the expression of our genes.
Where ACEs are concerned, neuroplasticity is the good news. It refers to the brain’s ability to grow, adapt, reorganize and form new connections throughout life. Exercise, sleep, music, spending time in nature, meditation, support from family and friends, and a reduction in stress can all help the brain recover from the effects of adverse experiences. Neuroplasticity means that ACEs are not destiny; the brain can be hurt, but it can also heal.
Post Traumatic Stress Disorder (PTSD)
It’s human nature to react to fear or danger; this is often called the “fight, flight or freeze” response. But many people, after experiencing traumatic stress, feel frightened even when they’re no longer at risk. PTSD can develop after experiencing a traumatic event such as war, sexual assault, a plane crash or an earthquake; it can also develop in response to the chronic stress of witnessing violence or being physically or sexually abused.
Think of these as the opposite of ACEs—the factors or circumstances in a child’s life that buffer her/him from harm and promote stability and resilience. Research has shown that supportive family and social relationships, exercise, adequate sleep, proper nutrition, spending time in nature, listening to music, and meditation are key protective factors for individuals. Protective community factors may include adequate housing, access to health care, support in times of need and caring adults outside the family who serve as mentors and role models.
This is the capacity to cope with stress, overcome adversity and thrive despite (and perhaps even because of) challenges in life. People who are resilient see setbacks and disappointments as opportunities to grow. While some people may seem to be naturally more resilient, research shows that children, adults and even communities can learn skills and ways of thinking that boost resilience and help them grow.
Secondary Trauma/Vicarious Trauma
This refers to the suffering and stress that comes from witnessing, helping or trying to help a traumatized person. Nurses, teachers, hospice workers, foster parents, child welfare workers, physicians, police officers and judges may experience secondary trauma; so can emergency workers who assist following a natural disaster. Symptoms of secondary trauma can include sadness, anger, poor concentration, emotional exhaustion and shame.
Social and Emotional Learning
This is the understanding that people learn best in the context of supportive relationships, and that teaching children certain skills—self-awareness, self-regulation, social awareness, responsible decision-making— in a caring and trauma-sensitive environment can not only help them thrive in school but can help prevent bullying, drug and alcohol use and other risky behavior.
Social Determinants of Health
In some ways, a person’s health is due to the “luck of the draw.” All the circumstances in which people are born, grow up, live and work affect how they develop physically, mentally and emotionally. These circumstances—an individual’s neighborhood, family, education, race, gender, class background, diet, workplace and access to health care, for instance—are in turn shaped by a bigger set of forces: economics, social policies and politics. But the social determinants of health are not fixed: individuals and communities can work to change those circumstances so all people have equal opportunities to grow and thrive.
Not all stress is bad for the brain and body. The stresses that are part of everyday life—taking a test, learning to drive, preparing for a job interview—can strengthen our problem-solving abilities and boost our resilience. But continual or extreme stress, especially in the early years, can damage a child’s ability to think, learn, grow and relate to others. It can have a lifelong effect on both physical and mental health. Research shows that nurturing, supportive relationships with adults can help reduce the damage caused by early toxic stress.
Trauma generally refers to an individual’s emotional response—including shock, denial, anger and physical symptoms—to a dramatic threat or event: being the victim of sexual or physical abuse, gun violence, war or natural disaster. But trauma can occur even without these cataclysmic events: ongoing neglect or family dysfunction can also be traumatic, triggering changes in the brain and body that lead to physical, behavioral and mental health problems in later life.
Health care systems, schools, child protection agencies and other such organizations can develop approaches that recognize the role of trauma in their clients’ and staff members’ lives. They can work to build trust, provide supportive relationships and work with clients as partners in healing. A trauma-informed or trauma-sensitive agency asks: “What happened to you?” rather than “What’s wrong with you?”