A new map emerges
The map of the journey so far and its numerous points of reflection shows a diverse terrain with various specialist fields and multiple disciplines. The terrain includes classical epidemiology, clinical fields such as psychology and neurology, basic medical sciences such as immunology, endocrinology, cellular biology, genetics – including the emerging area of epigenetics – and neuroradiology, consciousness research and much more. The specialist fields have added pieces of the puzzle to an increasingly detailed and sharper image that reflected the effect of biography on the human body's biology
(12). However, despite collaboration across the fields steadily increasing due to the growing insight into the historically conditioned arbitrary nature of the disciplinary divisions, these pieces of the puzzle did not just readily come together. The divisions started to disintegrate, and it was gradually recognised that mental and physical trauma could trigger the same bodily phenomena: chronic pain, impaired immunological response to microbes and abnormal cells, increased inflammatory activity, disturbances in glucose, lipid and mineral levels, disturbances in various autonomic processes with increased resting heart rate, blood pressure and muscle tension, and poor sleep and digestion. This represented a challenge to biomedicine's traditional understanding of causality (13).
Book: Nadine Burke Harris. The Deepest Well. Healing the Long-term Effects of Childhood Adversity. Boston: Houghton Mifflin Harcourt, 2018.
Putting the pieces together and seeing them gradually shape a radically new map that is actually more closely aligned with the clinical reality of the medical profession, especially in general practice, can become a passion. I can attest to this. I know the joy and relief when another pixel fits perfectly into a 'white spot' on the map where new findings were bound to emerge sooner or later, and where this supports an understanding of long-term adversity as a source of illness.
'Exactly' is the word that springs to mind at a moment like this. The research group of Martin Teicher, an associate professor of psychiatry at Harvard University, Boston, invoked one such 'exactly' situation when it presented a review of all studies that had been conducted on the relationship between childhood adversity and changes in brain structures, functions and network architecture
(14). Overall, these studies document how painful and difficult experiences are literally inscribed in the body's physiology in a way that is closely linked to when and how the adversity occurred. Teicher's research group believes the findings require radical reflection: can psychiatric epidemiology have interpreted the proven structural and functional abnormalities – the effect of integrity violations – as if they were the cause of mental illness?
The journey to knowledge-producing places also takes us to New Zealand and the researchers behind the Dunedin Study, a prospective follow-up study of a representative sample of newborn babies from the 1972/73 cohort
(15). Follow-up studies were conducted on the cohort at ages 3, 5, 7, 9, 11, 15, 18, 21, 26, 32 and 38, with 95 % of the sample still in the follow-up group after 40 years. At the start of the study and in the three-year follow-up, the researchers defined the term 'childhood risk', characterised by childhood socioeconomic deprivation, exposure to maltreatment, low IQ and poor self-control. The findings for the three-year-olds were shown to predict with low to moderate accuracy which of these children would end up in various high-risk groups as adults. When combined, the four criteria for childhood risk accurately predicted which cohort members would be in a 'multiple high-cost group' as adults. A quarter of the cohort accounted for 66 % of the cohort's total welfare benefits as adults. This quarter smoked 54 % of the cohort's cigarettes, accounted for 40 % of the excess weight kilograms, 57 % of hospital admissions, used 78 % of all prescriptions and were convicted of 81 % of all criminal offences. Thirty per cent of the cohort accounted for almost 100 % of the welfare benefits received by the cohort.