Dr. Vince Felitti explains how medicine can be more like religion and help patients overcome adversity

To hear Dr. Vince Felitti tell it, his accidental discovery about the correlation between adverse childhood experiences and long-term wellness is just that: accidental.

It was the mid-90s, and Felitti was trying new weight loss treatments at an obesity clinic at Kaiser Permanente in San Diego. He could get patients to shed weight — sometimes hundreds of pounds — but some would gain it all back.

It was a frustrated chat with such a patient that evolved into Felitti’s landmark study, and a beacon today in understanding the connection between childhood experiences and health.

Felitti simply wanted to know why a patient couldn’t keep the weight off, and her answer seemed at first to have nothing to do with health.

An older man, who was also her superior at work, had expressed interest in her sexually after the patient lost weight. He’d been making comments about how good she looked. Gaining the weight back, it seemed, offered an out from his unwanted advances; it also offered an out from childhood memories of when she had been sexually abused.

Felitti started talking to his patients, not just about their eating habits. He uncovered a striking correlation between childhood sexual abuse and disordered eating as he collected data from tens of thousands of patients on adverse childhood experiences, which became known as ACEs. An adapted version of Felitti’s team’s ACE questionnaire is still in use.

A later analysis of 125,000 patients over a two-year period revealed another striking correlation: a 35 percent reduction in doctor’s office visits and an 11 percent reduction in ER visits after patients revealed their untold history of childhood trauma. “That is worth a staggering amount of money,” Felitti adds.

And yet, despite an overwhelming academic interest in his findings, Felitti says the medical establishment has been slow to grab on to the questionnaire.

“What’s amazing is the resistance to medicine in using it,” he says. Felitti ticks through the excuses: “There’s no time, insurance doesn’t cover it, you can’t ask patients questions like that, if I wanted to become a shrink, I would’ve become a goddam shrink.”

Felitti spoke to doctors, educators, criminal justice professionals and others during a conference in San Francisco last week. It’s an interdisciplinary crowd that has finally started taking his science seriously. One notable champion is Dr. Nadine Burke Harris, a pediatrician and founder of the Center for Youth Wellness in San Francisco, the host of the Children Can Thrive conference.

She’s now leading the charge on getting a clinical understanding of adverse childhood experiences—which range from verbal abuse to losing a parent, hunger to a relative getting incarcerated — integrated into the systems that serve kids.

That’s where it gets tricky. The data and the staggering correlations between health and adversity are one thing, but treating those root causes, like poverty and violence, is another.

But as the court system and public education start to learn about how to avoid re-traumatizing kids who’ve already suffered enough, there’s this remarkable insight from Felitti: Simply asking the questions and giving patients the chance to share a long-held secret through the ACE questionnaire improves their health.

What’s the medical explanation for such marked improvements? It sounds touchy-feely, and this is where Felitti delves into metaphor, and the discussion begins to shift from cold hard science to an analysis of human experience and truth.

“Simply asking, listening, and implicitly accepting is a very powerful tool,” Felitti says. The message: “You’re still an acceptable person even though you’ve told me this story you’ve been ashamed of all your life.”

Maybe this is something we’ve known all along, without needing the medical profession to document and prove it. Felitti sees a parallel experience in the Catholic church of all places.

“Confession is an interesting device that’s been in use for 1,800 years,” he says. “Maybe it meets some basic human need to have lasted that long. One person tells someone important to them—a priest, or a doctor — something shameful about themselves … I think that’s the big operating principle in the 35 percent reduction.”

Photo by Emilio Labrador via Flickr.