“I was only five-years-old when my neighbor started harassing me. Even as a child, I could sense that something bad was happening to me, but I could not stop him out of fear. He continued to do it for a year before his family moved out of the apartment.” The victim told the reporter that she did not have any idea about sexual abuse. We all know that talking on topics like sexual abuse is considered as taboo in Pakistan. Therefore, neither her school teachers nor her parents ever aware her regarding this matter.
It took her 24 years to get control of her fears and finally, open up about her traumas. She has been recently seeing a therapist because that trauma seriously affects her life in more than one way. We need to provide victims with such confidence that they courageously speak out loud and clear. We need to assure them that they will be heard because a childhood trauma indeed affects across a lifetime.
How childhood trauma affects a lifetime?
In the mid-1990s, the CDC and the Kaiser Permanente discovered the exposure that significantly increases the risks of deaths in the United States. In a high amount, it affects brain development, the immune system, and hormonal systems. It also affects the readability and transcription of DNA. It triples risks of heart disease and lung cancer, as well as reduces the life expectancy to 20-years, of those people who have taken too high doses of this exposure.
And this exposure is childhood trauma.
It includes the threats that that is incredibly severe and prevalent that they exactly get under our skin and alter our physiology, for example, abuse, neglect, growing up with a parent, or a family member, who is struggling with mental health disorders or drug dependence.
A young and ardent doctor named Nadine Burke Harris is the one who called everyone’s attention towards the effects of childhood trauma on the emotional and behavioral development of a person. After completing her residency, she started working for the California Pacific Medical Center. With affiliation, with this hospital, she opened up a clinic in, the poorest and underserved neighborhood in San Francisco, Bayview-Hunters Point, where she showed worry that regular medical treatments weren’t helping in most cases of auto-immune diseases, out-of-control asthma, and failure to thrive.
Adverse Childhood Experiences
The Adverse Childhood Experiences study is something that everyone needs to know. Dr. Vince Felliti did it at Kaiser and Dr. Bob Anda at CDC, in which they asked 17500 adults about their past of exposure to what they called “Adverse Childhood Experiences”. Those experiences include physical, emotional, or sexual abuse, physical or emotional neglect. As well as parental mental illness, drug or substance dependence, incarceration, parental separation or divorce, or domestic violence.
For every yes, you would get the point on your ACE score. A person with an ACE score of four or more, their risk of chronic obstructive pulmonary disease. The chances of Hepatitis is 2.5 times more than that of having a zero ACE score. The risks of getting caught by depression are 4.5 times more. For suicidality, the chances are 12 times more than an average person. A person with an ACE score of seven or more, the risks of having lung cancer are three times as compared to someone with a zero ACE score. For that person, the chances of ischemic heart disease are 3.5 times more.
The child may not remember but, the body remembers
How exposure to early adversity affects the developing brains and bodies of children? There are real neurologic reasons for why people exposed to high amounts of trouble are more likely to engage in high-risk behavior. This exposure affects areas like the nucleus accumbens. It is the pleasure and reward center of the brain that is involved in substance dependence. It hinders the prefrontal cortex, which is essential for impulse control and executive function, a critical area for learning. On MRI scans, we can see the visible difference in the amygdala, which is the brain’s fear response center.
Whereas, the other studies explain that even if a person is not involved in any high-risk behavior, has still high chances of developing heart disease or cancer. It is because of the hypothalamic-pituitary-adrenal axis, the brain’s and body’s stress response system, that controls our fight or flight system. For instance, the person is walking in a forest and encounter a bear. Immediately, his hypothalamus sends signals to his pituitary, which sends signals to his adrenal gland and ask to release stress hormone. In return, your heart starts to pound, your pupils dilate, your airways open up, and the person is then ready to either fight with the bear or flight away from the bear. Problems started to increase when the bear comes home every night, and the system activates over and over again. So, it changes from being adaptive or life-saving to health-damaging.
Children are susceptible to this constant stress activation because their brains and bodies are developing. High amounts of adversity not only affect their brain structure and function but, also affect the developing immune system, hormonal system and also made changes in the readability and transcription of DNA.
Unaddressed public health threat
A very important public health threat that we need to address is Adverse Childhood Experiences. This threat is the biggest that the world is facing today. Earlier, it seems as if this issue has been marginalized because it does not apply to most of us. The thought said that this issue belongs to someone in the neighborhood.
If we see the data of daily suicide cases or the number of rape cases, that puts the light on something else. With that statistics, the reality began to pop up, which declares that the issue has not been marginalized because it belongs to people in the neighborhood but, in actual it has been marginalized because it belongs to most of us and it is the issue of our whole society. We do not want to look at it; we would rather be sick. But, science is evident that early adversity affects health across the lifetime to a great extent, that one cannot imagine.
Bourgeoning suicide cases in Pakistan
In our society, parents are not well aware of the mental health issues of their children. Therefore, the parents are not mindful of what their children are going through, a rough patch, or a smooth one. Because for parents in Pakistan, a child is ill only when he has gotten a cough or cold. Other types of diseases like ACEs are the ones of which they are entirely unaware. When their child commits suicide, then, they get to know that he/she was going through something difficult in life. The children who are facing any kind of abuse or neglect are at more risk to undergo suicide attempts. Therefore, all they need is proper guidance and attention.
The number of suicide cases is increasing to an exponential rate in the world. Whereas, the Asian states are contributing to 60% to these increasing numbers. Pakistan, a state with a weak health care system, and meager mental health facilities. The rise in suicide cases is shocking and alarming. Even, if the parents take their child to a therapist, they usually do not get the type of treatment they want to provide their child.
Rape cases in Pakistan and childhood trauma prevails
The abuse cases in Pakistan haunt society for so many reasons. There are risks that the perpetrator might be a family member, and the family blindly trusts that person. Whereas, the lack of communication between parents and children often adds fuel to the fire. It is sadly a regular occurrence in Pakistan which tries to hide under the guise of religion. Still, it is horrifying that pedophilia or child abuse is neither in control nor in check in our society.
The infamous Zainab’s case in Kasur and Marwah’s case in Karachi are just two notorious incidents that present a very crucial picture of the disease that is destroying our society. These types of issues are increasing the threat level of our children; they feel threatened to leave and even to live in their own house. They do not feel safe anywhere they go. Torturing and harassing of boys in their madrassas is another case. What type of mark those teachers leave on their bodies is a question but, what kind of impact they leave on their minds is another question that still needs to address by the government and judiciary.
There are thousands of abuse cases that are not even taken to court or reported because of the Ghar ki izzat. According to the recent report, eight children are sexually abused every day in Pakistan. Another story says that sexual abuse cases are increased by 14 percent in the first half of 2020 in Pakistan. These cases genuinely need support and assistance from family members and the government of our country. The future of our nation depends on these children if they are not feeling secure in their own country then, where will they feel secure?
Measures for prevention
Childhood trauma affects across a lifetime and children should know about the basics of good touch and bad touch if we want to reduce or prevent the risks of the abuse. Parents should also need to look after the activities in which their children are taking part and teach them self-defense strategies in case they experience a bad touch. It is important for parents to have friendly relations x with the children because when children trust their parents and siblings they will share their problems with them. The development of trustworthy relations with family members can surely decrease the risk of a person to reach a state of depression. Parents should encourage them to share their daily activities, as well as talk about people they have interacted with.
Ahmad: A short film based on the concept of a child following the guidance of his father
There a short film on child abuse, by Annas Khan, named “Ahmad”. This film is based on the concept that children should follow the instructions and guidance of their parents. They should not trust any outsider and in case of an emergency, they should reach out to trustworthy people like the police.
Moving from ACEs to Resilience
Resilience is another short movie, released in 2016, based on childhood trauma and its effects on people’s lives. It shows people are affected by their adverse childhood experiences throughout their life and how with the help of good support and through best clinical practice or treatment they get through this difficult time. People in this video tell everyone how they traveled the distance from ACEs to achieving resilience. They accepted the fact that childhood trauma affects across a lifetime and their doctors provide them with the assistance of every type they want.
Childhood trauma affects across a lifetime but, most people do not have the idea about the important techniques which are necessary to heal the impacts of ACEs, and stress. It includes the routine screening of every kid at their regular physical. There should be a team that works to reduce the dose of adversity and treat the symptoms using the techniques of home visits, care coordination, mental health care, nutrition, and medication when necessary. Training of doctors regarding routine treatment and screening is very important. But, our country lacks in that case, therefore, doctors should be well-trained, because if they will not be given the training today then, when?
What we need all to understand is, that the problem of ACEs is treatable and beatable. This is for real, and this is all of us.