
Can Family Secrets Make You Sick? - rfreytag
http://www.npr.org/blogs/health/2015/03/02/377569413/can-family-secrets-make-you-sick
======
delish
I work in a US urban charter school that's in danger of losing its charter
because it fails financially and academically.

75% of its students are growing up without regular contact with their fathers,
25% without their mothers, and more than 10% are designated homeless (this
means they've moved more than 4 times in a year; the state defines this
designation).

The teachers are close with the students; we hear stories that tell us who has
a _really_ hard childhood. I can emphatically tell you that the harder the
student's life is, the more misbehavior they exhibit and the more unhealthy
they appear. By "appear" I mean weight, smell, visible grime, cuts and burns,
these sorts of things.

Here is a list of signs of child abuse:

[http://www.safehorizon.org/page/10-signs-of-child-
abuse-58.h...](http://www.safehorizon.org/page/10-signs-of-child-
abuse-58.html)

Here are signs you might not see as abuse when you come across them: thumb-
sucking, fear of going home, body odor.

Each of those is easy to criticize or fix: "Get that thumb out of your mouth."
"What do you mean you don't want to go home and watch [TV show they've
mentioned]?" "[behind their backs] so-and-so stinks."

(put a ":)" after each of those criticisms to see how they could be jokes or a
caring statements, depending on tone. Still, they don't go far enough in
addressing the underlying problem)

Those criticisms identify the wrong signifier for their sign. The signifier is
not sheer childishness (in the case of thumbsucking), but a coping mechanism
for abuse.

~~~
cbd1984
> fear of going home

Anyone who doesn't see this as a sign of abuse is an idiot.

I could have sugar-coated that, but some things need to be said outright.

(It's not a surefire sign of abuse, but if it doesn't qualify as a strong
piece of evidence to you, your brain is not working correctly.)

~~~
delish
You don't have to be a superhuman listener to hear what's being said when a
student looks you in the eye with tears and says, "I don't wanna go home."

But you _do_ have to be a superhuman listener when you have a thousand things
on your mind, several students out of arm's reach yelling at each other, some
students leaving the building without permission and without bus passes, etc
etc--and then you see a marooned student who _looks_ like he/she doesn't want
to go home.

Ultimately, if you're working one-on-one with a student who says he/she
doesn't want to go home, _in theory_ all you have to be is caring and curious,
to help.

But when you're in a public or charter school and you're _always occupied_
you'll benefit from training (in e.g. crisis prevention), and sensitization to
those key phrases. Those two things plus experience lead to intuition.

------
serve_yay
> "An association doesn't necessarily mean that one thing causes the other
> thing," says Floud.

Does anyone else get tired of seeing this all the time? It feels like the
standard, pat response nowadays of a smart person to basically any association
whatever. Of course ice cream sales in the summer don't cause murders, but in
turn, I seriously doubt anyone is saying that sexual assault somehow
physiologically deforms breast tissue directly leading to carcinoma.

Look, I know very little about medicine, I don't even know that much about
statistics. But wouldn't the idea be more like these traumas could stress the
body in some way that makes some of its subsystems perform in a degraded
manner, which over time develops into illness? As I say, I'm out of my depth
here. But that sort of response is starting to strike me as irksomely glib.

~~~
downandout
_> Does anyone else get tired of seeing this all the time?_

You're probably seeing it more often because more people have access to more
data than ever before and are making lots of connections that aren't
necessarily connected. Floud probably stated it this way because of the
inevitable eye-rolling that occurs in reaction to the more common way of
saying it: Correlation does not imply causation.

In this case, however, Floud is probably wrong. There is plenty of statistical
evidence to prove links between traumatic childhoods and undesirable
characteristics in adulthood. It isn't much further of a leap to assert that
physical changes, as a result of unnatural levels of stress hormones etc.,
could occur.

~~~
sukilot
This post could be the Wikipedia entry for "question begging". It is claiming
that correlation implies causation because of the observed correlation.

------
Alex3917
A lot of the data in the ACE study is actually pretty dodgy -- what people are
comfortable admitting to changes over time, and also people forget things as
they get older. So comparing responses from a 70-year-old to responses from a
30-year-old about things that happened in their childhood is kind of apples
and oranges. I still think it's an important study and worth talking about,
but I'm not sure I really believe that, say, people are 5x more likely to
commit suicide or 4.5x more likely to get an STD than they were 20 years
earlier.

------
gwern
> Cancer, addiction, diabetes and stroke (just to name a few) occurred more
> often among people with high ACE scores.

Pretty major known confounding here. Family-based, adoption, twin, GCTA or
GWAS studies usually find low effects from shared environment but high
heritability or specific hits, especially for addiction & diabetes (stroke and
cancer are less well known but still plenty of GWAS hits for those too). And
this is true of various aspects of bad parenting like physical abuse as well.

------
vinceguidry
> She thinks doctors and patients should take care not to overinterpret an ACE
> score — it's not a crystal ball that predicts health or illness.

It's also a hell of a lot more depressing if true. We can fix biological
issues a hell of a lot more easily than we can convince people to not be so
shitty to each other.

------
mjklin
Smartphone with no plan for when you have Wi-Fi, prepaid phone for when you
don't.

That's how we do it. Best of both worlds.

------
jahooma
Notice how the lone medical expert represented was skeptical of the findings.

That's because among serious psychologists and those who study genetics, the
view advocated here is pretty much _exactly wrong_ : your childhood
experiences have almost no effect on the adult you become.

The public and the media tend to believe otherwise, and regularly put out
stories like this one, perpetuating the myth. But it's just not true.

We've known for years that the genes you inherit from your parents are far
more important than whatever parenting they do. Adopted siblings raised in the
same household grow up to be no more similar than strangers plucked off the
street. And identical twins raised apart grow up to be ridiculously similar --
almost creepily so -- despite having no shared environment. When you run the
correlations, genes turn up as a large factor in every single measurable
outcome (education level, income, IQ, height, weight, personality, choice of
college major, and so on), whereas shared environment -- where you grew up,
how your parents raised you, your socioeconomic status -- begins as a moderate
impact while you are a child and then slowly disappears in your teens, until
at age 25, your IQ and personality have basically nothing to do with whether
your parents read to you at night or spanked you or talked to you or ignored
you completely, or what siblings you grew up with, or what house you grew up
in, or what town you grew up in.

(Coincidentally, ACE is a relevant acronym here, but it stands for something
different than from what it does in the article. Additive genetics, Common
environment, and unique Environment are the components of the outcome of twin
studies. Common environment is the factor of your parents and household, and
unique environment is every other environmental factor.
[http://en.wikipedia.org/wiki/Twin_study#Methods](http://en.wikipedia.org/wiki/Twin_study#Methods))

Now, there is a small caveat to the above. If you were severely abused as
child that can impact you later, but it truly has to be severe abuse. To lower
a child's IQ, you'd have to really starve them or deprive them of key
nutrients -- but this pretty much never happens in the US. A diet of only
McDonald's is more than sufficient to prevent this kind of stunting. Likewise,
the sexual or physical abuse would have to be pretty extreme to impact you
later -- much more than this story let on.

\-----------------

So, the real story behind this NPR piece is that people with bad parents often
grow up to have problems not because of bad parenting, but because their bad
parents happened to pass them bad genes. In other words, the common cause was
that both the child and the parents had bad genes. You should never trust a
study about parenting or the effects of the environment if it doesn't take
genes into account.

And this is where people get uncomfortable, because no one wants to believe
that something you're born with, something you cannot change, is so important
to who you are. The "truth" about the effects of genes and your environment
does not fit in well with mainstream ideals of equality of opportunity and
free will. Thus, the impact of genes are routinely downplayed everywhere you
look, and environmental effects are raised up, like in this piece. There is
broad, systemic bias at work, making the world out to be the way we want it,
rather than the way it really is.

But we do ourselves a profound disservice in this (often unintentional) act of
twisting the truth to fit our ideals. It causes grief when we blame fat people
for being lazy or lacking self control, when in reality their obesity is
largely a product of their genes and the modern phenomenon of cheap and tasty
food. We praise smart kids with lucky genes who get A's, while putting down
their less bright peers, even if they worked harder, because they only managed
to get C's. We love beautiful people, but shun their less appealing peers.

So I ask you: Where is the compassion for those with unlucky genes? Where is
the support for those who don't have the talent to live out the American
Dream? Why is it that no one knows or cares about genetic luck -- probably the
greatest source of inequality and unfairness in our world?

------
ghshephard
Alternative Hypothesis (and there are many): People of a lower-socioeconomic
demographic both have greater chances of a poor upbringing as well as poor
health as they get older.

Lot of confounding variables you need to correct for here.

~~~
mvarner
"The 17,000 or so patients in this study were mostly middle-aged white people,
upper- and middle-class, from San Diego."

It's true that there are a lot of variables when asking broad questions like
what causes poor health, but it seems like the majority of the participants
weren't of a lower-socioeconomic demographic, as indicated in the article.

~~~
im3w1l
It is "adjusted for age, gender, race, and educational attainment."

84% where white.

59% of Americans identify as middle class, upper-middle or upperclass. So
saying that the study used mostly upper- and middle-class doesn't really tell
us anything.

~~~
sukilot
Since the wealthier people call themselves middle class, 59% is approximately
the 95th to 36th percentiles.

------
sandworm
"Well, my God, this is the second incest case I've seen in [then] 23 years of
practice"

I don't believe this. Either the doc has deliberately kept his eyes shut or
hasn't spent much time talking to patients. Incest, a term wide than but
inclusive of most 'child abuse', is far more widespread than laypersons
realize. Docs see it regularly and geneticists debate the ethics of tests any
test which might reveal family secrets.

[http://blogs.nature.com/spoonful/2011/02/qa_the_insidious_an...](http://blogs.nature.com/spoonful/2011/02/qa_the_insidious_and_incestuou.html)

~~~
zzalpha
And yet this very post describes incest as "relatively rare". Now maybe folks
don't realize that still means it's more common than they might expect. But
the article doesn't seem to support the claim that " docs see it regularly",
unless I missed something (which is entirely possible).

~~~
scintill76
I noticed this too. To give the benefit of the doubt, it's hard to know what
that sentence means, because of some ambiguity over whether it's about a) only
incest that results in a child, b) "routine genetic tests" detecting incest,
c) "rare" as in, say, "only" 3% of babies are the result of incest, which
would still probably surprise a lot of people. (I'm not even sure what
percentage I would personally expect or be surprised by.)

~~~
sandworm
Rare is a difficult term to nail down. I was taken aback by the statement that
he had only seen two cases over 23 years.

To think of how not-rare it is, think of all the heterosexual child abuse that
goes on within families. Child abuse is not considered rare. But how many of
those abuses might result in pregnancies? Any doctor who deals regularly with
young people, specifically young girls who might be pregnant, sees this
regularly if they care to look. The pregnant teenager whose boyfriend "isn't
around anymore" is a non-rare situation. Some subset of those are pregnant by
their fathers/brothers. The problem is that asking, or performing tests that
might identify the true father, may do more harm than good. So doctors don't
push the matter. That doesn't mean they do not suspect what's going on.

What do you say to a girl pregnant by her brother? Termination is not a great
option, the kid may well be healthy. Reporting the abuse, breaking up the
household, isn't going to help either. From the doctor's perspective there
isn't much they can do.

~~~
DanBC
> What do you say to a girl pregnant by her brother? Termination is not a
> great option, the kid may well be healthy. Reporting the abuse, breaking up
> the household, isn't going to help either. From the doctor's perspective
> there isn't much they can do.

This attitude, while understandable, is very damaging.

You report the abuse. You do so because your professional registration
probably tells you to; there might even be mandatory laws requiring you to;
and because you know that you do not have access to reports from other
agencies (police, school, sexual health clinics, etc) and so you cannot
understand the whole picture.

You're right that interventions for abused children are appalling and that
looked after children have some pretty lousy outcomes (shorter life, lower
quality of life, increased mental illness, increased risk of death by suicide,
increased criminal behaviour, etc etc etc)

~~~
sukilot
You advocate handing the matter over to government, even though you know
government fails to handle it better than not? That's cruel.

