See no evil: How child trauma research helps us understand the Penn State tragedy

Published on
November 21, 2011

A few days before Jerry Sandusky was arrested on child sex abuse charges, and Penn State president Graham Spanier and long-time Penn State coach Joe Paterno were fired, NBA great Jerry West gave a very poignant interview on NPR about his new book: "West By West: My Charmed, Tormented Life."

When West was a boy, his father beat him and his siblings. "You know, I know what corporal punishment is," West told NPR host Scott Simon. "This was a lot more than that. And I think that I got to the point in my life where I'd had enough. And I told him one day after an incident with my sister where he had hit her and I just - I said to him, I said if you ever do that again, I am going to kill you. And I slept with a loaded shotgun under my bed."

Despite Jerry West's very difficult childhood, he became a success by anyone's standards. However, as he says, "I can't forget the things that I saw in my life. I will never forget those days." He lives with depression. He says he doesn't know what love is and, remarkably, has little self-esteem. Some people might say that Jerry West had some inner resilience that got him through those bad times. But that inner resilience was nurtured through playing basketball, where he had people who encouraged and mentored him.

So, let's think about little Jerry West, the 10-year-old, for a moment. Or kids like him - kids who were targets for Sandusky's charity, The Second Mlle. Those kids were called "disadvantaged". That's a euphemism - our society's code for kids who are living with or have experienced trauma. That trauma can include a parent who has abandoned them, or a parent is an alcoholic or addicted to other drugs, a parent who beats them, verbally abuses them, or neglects them. Or a family member in jail or diagnosed with a mental illness. Or the kids have seen their mom beaten up. And yes, they might even be experiencing sexual abuse at home – that's much more common than being sexually abused by a coach or a priest. And let's say that these kids look up to a coach and dream of being a successful athlete, or of just relying on the organization and its adults to obtain some relief from what's happening at home.

Let's say that instead of having a supportive coach, West had a coach who sodomized him in the school's shower room. Would little Jerry West have become an NBA star, or would that have been one trauma too many? Would his career have ended early because he drank himself into a stupor to stop the nightmares? Or would he have been unable to control his anger, beat up people at the slightest provocation and ended up a career criminal?

Contrary to popular belief, resilience is not innate. If you stress a child long enough and don't provide any nurturing to recover from the stress, research shows that the effects are damaging and long-term.

Just last month, Dr. Robert Block, president of the American Academy of Pediatrics, in an address at the organization's annual meeting said:

" toxic stress has now been shown to be a cause of behaviors like alcoholism and drug abuse, and a cause of significant diseases, from obesity to metabolic syndromes and diabetes, to cardiovascular and pulmonary disease and even some forms of cancer."

Block cited the CDC's Adverse Childhood Experience (ACE) Study, which began following 17,000 members of Kaiser Permanente in San Diego in the mid-1990s. Kaiser Permanente is a health maintenance organization with hospitals and clinics in several states around the country.

The ACE Study exposed what CDC physician and epidemiologist Dr. Robert Anda calls a "chronic public health disaster". Anda is one of the co-founders of the ACE Study, with Kaiser physician Dr. Vincent Felitti.

In a nutshell, the study measured 10 childhood traumas – physical, emotional and sexual abuse; emotional and physical neglect; a parent who's an alcoholic or addicted to other drugs; a mother who's been battered; a family member in prison or diagnosed with mental illness; and a loss of a parent through divorce, abandonment or death. (Of course, there are other possible traumatic events a child can experience – such as severe illness or catastrophic accident – but those were not measured.)

The findings stunned the researchers, and go a long way to explaining what happened at Penn State:

1. There's a direct link between childhood trauma and adult onset of chronic disease, such as diabetes, heart disease, emphysema, and some types of cancer.

2. People who had three or four types of trauma during their childhood (experiencing physical abuse, an alcoholic parent, and witnessing a mother who's a victim of domestic violence, for example, counts as an ACE score of 3) saw their risk of chronic disease jump 300 to 400 percent. Higher ACE scores resulted in risk levels increasing 800 to 1200 percent.

3. If a person experienced one type of trauma, there was a 90-plus percent chance that there would be more. In other words, trauma such as child sex abuse rarely occurs alone – substance abuse, mental illness or one of the other traumas also exists.

4. Only 30 percent of people in the study had zero ACEs.

Here's the final stunner – the 17,000 people who participated in the study were 75 percent white, middle to upper-middle class, 76 percent had attended or graduated from college, and, since they were members of Kaiser through their employers, they had jobs and great health care.

Fourteen states have done their own ACE surveys and are finding similar results. Thanks to the ACE Study, people who thought that child trauma occurs mostly in inner cities in communities of color are beginning to understand that child trauma is common and occurs in all segments of society.

While the ACE Study was being done, brain researchers were providing the physiological explanation of how child trauma leads to adult onset of chronic diseases. When children endure continuous trauma, the hormones that provide the fight-flight-freeze response don't turn off. The hormones become toxic – they actually damage a child's brain. You can see the destruction on brain scans.

Dr. Jack Shonkoff at the Harvard University's Center on the Developing Child has put together a great video that explains this.

The result: Kids can't learn, they have difficulty making friends and they won't trust adults. They can't keep up in school, they get in fights or withdraw, and they're suspended from school. They cope with their trauma by turning to alcohol and other drugs, they smoke, they become daredevils, they eat too much, they engage in inappropriate sexual behavior, and/or become overachievers, i.e., workaholics. All this helps numb the psychological pain of years of being beaten or enduring an uncle forcing sex on them whenever he visited or being awakened at 2 a.m. by a drunk parent to be yelled at for hours. Their "drug of choice" – smoking, drinking, food, work – helps them escape from the misery of feeling like failures or that, somehow, they were responsible for the trauma they experienced. Above all, their drug of choice tempers their feelings of isolation and abandonment because our institutions have done nothing to help them. (Note to those who think that education is the answer to convincing people that smoking, drinking or overeating is bad for them: Please consider this – why would we ever expect someone to give up overeating, drinking too much or smoking if that person regards those behaviors as solutions, not problems?)

Carried on for decades, the double whammy of the physiological effects of stress and the effects of the coping behaviors will result in those chronic diseases that are costing our country the most emotionally and economically, says Dr. Vincent Felitti. Stress affects autoimmune functioning and releases inflammatory substances. Smoking, obesity, workaholism, alcoholism, drug abuse, etc. result in lung cancer, heart disease, diabetes, emphysema, depression, suicide, HIV-AIDS, and sexually transmitted diseases. People who have child trauma are also more likely to become perpetrators or victims of domestic violence and child abuse.

See the connection? Jerry Sandusky isn't an evil man. He wasn't born a pedophile. Pedophiles are made, not born. They're shaped by the trauma that was done to them, and if they aren't stopped and helped, they pass it on. And if he did the abuse that Pennsylvania's Thirty-Third Statewide Grand Jury report accuses him of doing, then in all likelihood he has also passed on his sickness to another. It's that simple.

And it's that complex, because we're all complicit in enabling child trauma, individually and institutionally (including my profession, the news media). Until it becomes visible on the body of a child – bruises, broken bones, starvation, etc. – our institutions don't interfere in families where trauma occurs. In other words, our culture allows children to be beaten, raped, yelled at, ignored and/or starved. Our institutions further traumatize kids who act out their trauma by behaving badly in school by suspending them or ignoring those with obvious symptoms, or locking kids up. And when we can no longer ignore heinous abuse, our solutions are to shame and blame.

No wonder most child trauma remains hidden. That's why the ACE Study found that 70 percent of people in those white middle-class families experienced at least one type of serious child trauma (other ACE studies are seeing the same results).

It's easier for us to focus our fears on strangers instead of fathers, uncles, grandfathers, coaches, priests, mothers, aunts, etc. Or not to talk about it at all, as happened at Penn State. As Cherie Porter, my friend and a woman who's fostered many abused and neglected babies, and who has broken the cycle of abuse in her own life, said, we just don't have the language to talk about this. We wait until a situation escalates, in the Penn State case, allegedly to sodomy. And then we run screaming from the room, metaphorically speaking, and revert to the word, "evil", which doesn't help us solve anything.

There is hope, however. Small groups of people around the country are trying to figure out how to talk about this. They're learning how to integrate the research about child trauma prevention into our society at every level, and how to make sure all of our institutions do not further traumatize children who are experiencing trauma.

As I was writing this a few days ago, a small group of legislators and health experts was meeting in Minnesota, which is one of a few states – including Iowa, Nebraska, Illinois, Maine and Florida – whose goal is to become ACE-informed. Washington State is the leader in this effort, and has created a state-wide network called the Family Policy Council not only to prevent child trauma but to create trauma-sensitive institutions – schools, juvenile justice systems, medical clinics -- so that kids who are having hard time aren't further traumatized, and to build resilience in them through nurturing and support.

Although the ACE Study shows a direct link between child trauma and adult onset of chronic disease, it's not just health that's affected by child trauma, says Dr. Rob Anda in this presentation he did in May at a meeting of the Alberta Family Wellness Initiative in Canada. "I see this as a developmental process that affects all of society," he says.

We clearly saw that play out when the consequences of child trauma brought down a university president and a football legend.

(Updated and reposted from