More from Billy on trauma & its lingering impacts: The Journey from Childhood Trauma to Addiction.
“Are you gay?”
I suppose he had to ask the question. It was 1987, I was deathly ill, losing a lot of weight, and no one could seem to figure out why. With HIV dominating most of the day’s headlines, it wasn’t a ridiculous thing to ask—though, at the time, it made me cry.
I went crawling from my pediatrician who shrugged his shoulders, to my mother’s general practitioner who prescribed barbiturates (ah, the 80s), and now, I was at a gastrointestinal specialist whose first thought was to ask me this invasive question in front of my father.
But, no, I was not gay—and if I remember correctly, I don’t think I even had heterosexual intercourse at that point. Finally, though, when the pain was worse than anything I had ever experienced, and I really thought I was just going to die of some unknown illness, another specialist suggested I go see a doctor at the State University of New York at Stony Brook’s teaching hospital. It was there where it was finally determined that I had Crohn’s Disease. I was admitted and in two weeks’ time, they had my weight up and my illness quelled for a bit.
Of course, I am not a medical professional, but dinnertime, when I was a kid, was never a pleasant affair, and all of the anxiety and stomachaches I experienced night after night in that setting probably had a lot to do with my eventual diagnosis.
Doctors, throughout my 20s and 30s, never wanted to commit to validating this theory, but with chronic illness, the patient often winds up becoming their own doctor over time, monitoring what sorts of things cause the disease to flare up and what situations and foods to avoid. Anything that would have given me abdominal discomfort as a child will aggravate my condition today, so the connection is undeniable.
Over the last decade, doctors of the western world have—for the most part—become more willing to accept ideas that go beyond simply diagnosing and prescribing medication. San Francisco pediatrician Nadine Burke-Harris once explained to Ira Glass on “This American Life,” “If you’re in a forest and see a bear, a very efficient fight or flight system instantly floods your body with adrenaline and cortisol and shuts off the thinking portion of your brain that would stop to consider other options. This is very helpful if you’re in a forest and you need to run from a bear. The problem is when that bear comes home from the bar every night.”
That thinking portion of the brain that Burke-Harris is referring to is the prefrontal cortex—the area responsible for complex planning, decision making, and personality. When a child gets caught up in a loop of toxic stress response, that fight-or-flight response tends to override and sometimes even decrease blood flow to the prefrontal cortex. Over time, because behavior patterns can rewire the brain (neuroplasticity), executive functions become compromised.
One of the core executive functions is emotional self-regulation. In my personal situation, I always suspected that it was quite possible that this accounted for my ceaseless ruminations, since childhood, that—over time—created gastrointestinal issues. The same issues that eventually progressed into Crohn’s Disease. This was, of course, a personal theory—an intuitive feeling. That is, until recently, when the medical community began publishing studies that illustrated quantifiable proof bearing this out.
One such study, Association of Stress-Related Disorders with Subsequent Autoimmune Disease, appeared in the Journal of the American Medical Association in 2018. It’s a scholarly article and would give most laypeople a headache, but it names 41 different autoimmune diseases that can be linked to early trauma. More studies need to be done, but it’d be shortsighted to ignore the summarized results of this one.
In the meantime, we need to demand more from the medical community—most especially in the neighborhoods where the only thing that seems to be abundant is poverty and lack. It is here—where resources are most scarce—where much of the childhood trauma goes unaddressed. The butcher-shop mentality of diagnosing, prescribing medication, and sending children right back to the “bear who comes home from the bar every night,” is not working. This is why critics of American healthcare often complain that it is not “healthcare” at all—it’s sick care.
In other words, little is done to prevent major issues from happening.
And in the case of chronic illness, prevention is the only hope. For Crohn’s Disease and many other autoimmune maladies, there is still no cure.