Scared Sick

by Robin Karr-Morse
Basic Books, 2012
Review by Sue Bond on Aug 7th 2012

I cannot recommend Scared Sick highly enough because of its approachable style, clear explanation of complex medical science for the general reader, passionate advocacy for babies and small children, and its importance in encouraging everyone to pay attention to what we are doing to the youngest members of our societies. I was shocked to learn that it was only from the late 1980s that newborns, whether premature or full term, were given anesthesia when operated on for conditions such as heart defects. It was thought the infantile central nervous system was not developed enough for neonates to feel pain, and so they were simply paralyzed for surgery with no pain relief. It seems to take us a long time before we notice the suffering of others, and the effects it has on them. No wonder we are still in the early days of noticing psychological stress and instigating preventative programs and therapies for it.

This book aims to present scientific evidence for the connection between fear and ill health, both physical and mental. It does that, emphatically. Although the book is written from the American point of view, the authors acknowledge that the issues raised are of global importance.

Robin Karr-Morse is a family therapist, and Meredith Wiley is the state director of Fight Crime: Invest in Kids New York. Their previous book, Ghosts from the Nursery: Tracing the Roots of Violence, garnered much response from readers, and led them to continue their research in order to ask a common question: what happened to the majority of the children who suffered abuse and neglect, but who didn't go on to commit violence?

The results from many different experimental and epidemiological studies are presented, but the authors do acknowledge that some research is ongoing and, as yet, not conclusive. However, much of it presents connections that are startling, with large implications for human health, both child and adult. The roots of ADHD, autism, depression, schizophrenia, chronic fatigue, fibromyalgia, heart disease and cancer could lie in what happens to us prenatally, as newborns, and through to at least our second birthday. It is a stark and powerful demonstration of how everything is connected, the mind and the body, nature and nurture, genes and their environment.

The first chapter highlights the results of the Adverse Childhood Experiences (ACE) Study conducted by Drs. Vincent Felitti and Robert Anda. The single most stunning finding is the sheer prevalence of adverse childhood exposures themselves (go to the website, http://www.cdc.gov/ace/index.htm, for further information). The questionnaire asked about recurrent childhood maltreatment as well as dysfunctional households with alcoholism or other drug abuse, imprisonment of a family member, chronic mental illness, violence towards the mother, and parental loss (through, for example, divorce or death). The researchers found that the higher the ACE score, the more likely it was that the person engaged in risky behavior like smoking, drinking, underage sex, and so forth. But they also showed increased likelihood of heart disease, cancer, depression and suicide. Those with an ACE score of six or more died nearly twenty years earlier than normal. There was also a high correlation between addiction and high ACE score. It shows convincingly that cumulative emotional trauma produces and increase in physical and mental disease. The rest of the book builds on these findings.

The authors neatly explain the complexities of the biology of stress and trauma--the hypothalamic–pituitary–adrenal axis--and differentiate between chronic toxic stress and trauma in terms of what it produces in the child. They spend another chapter outlining the effects of stress and trauma on the autonomic nervous system, and discuss Dr. Robert Scaer's hypothesis about hidden trauma:

Past trauma is masked by the metamorphosis of the event into physical symptoms and behaviors that are typically attributed to hypochondria or mental illness or character weakness on the part of the patient. Trauma is even more deeply hidden when it is rooted in earliest childhood. Whereas stress is readily observable and seen as external to the patient, trauma and its symptoms are often seen as being of the victim's own making. (39)

So, the diseases of stress reflect abnormal productions of cortisol, either too much (such as diabetes and osteoporosis) or an exhaustion (allergies, lupus, fatigue), along with inflammation and problems with hippocampal function. The diseases of trauma 'reflect the seesaw cycling of both divisions of the autonomic nervous system' (45), such as fibromyalgia, chronic fatigue, inflammatory bowel disease. This could obviously prove an important factor in the treatment of diseases like ME/CFS, for so long regarded as 'hysterical' conditions or malingering. They continue in this chapter to discuss the effects on memory, noting that fear plays a role in all forms of memory loss; Alzheimer's disease could very well have its origins, at least partly, in chronic anxiety and trauma as well.

Chapters 4 and 5 address the stages in a human being's development from prenatal and perinatal through infancy and toddlerhood, reminding us of the importance of what happens to us and our mothers when we are still in the womb, as well as the vital process of attachment between baby and primary caregiver. Attachment disruption can produce, depending on its severity and chronicity, devastating and long-lasting effects on a baby, and the authors cannot emphasize this more. One of the most important things about their book is their clear and unwavering commitment to child welfare, even to the point of risking approbation for their views on the dangers of child care unless it is of high quality, consistent, and the child is not too young (and they give the reader studies that show these dangers).

Karr-Morse and Wiley realize that parents often must work to sustain their families, and, instead of insisting that mothers relinquish their careers, emphasize the need for paid parental leave to enable babies and children to have their mothers (and/or fathers) stay with them in the crucial early time. They go on to write that at two years it has been shown that children benefit from being with other children, and that, when conditions at home are adverse, good quality child care can be lifesaving.

This leads in to the next chapter on parental neglect and abuse of children, including the damaging effects of maternal depression on the attachment process, and the succinct statement by Dr Bruce Perry that children are malleable rather than resilient. Not all children are damaged from deliberate abuse; instead their parents may just not understand the effects that certain events have on them, believing they won't remember or didn't notice.

Chapter 7 deals with the absorbing story of the role of genetics and epigenetics in human health, and how this is influenced from the womb onwards, including for addiction, mental illness, obesity, and heart disease. Chapter 8 discusses the specific attachment disorders, and the last two chapters deal with therapy and the importance of recognizing the effects of trauma on children worldwide.

I acknowledge that some of the material they present is still in its early stages of research, but much is what we should already know at this stage of our civilization about the relationship between parents and children. It is a powerful reminder to take the mental as well as the physical health of babies and children seriously, both for their own sakes, as well as for their--and our--future health.

Sue Bond is a writer and reviewer in Brisbane, Australia, and has degrees in medicine, literature, and creative writing. Her blog can be found at http://thewordygecko.wordpress.com.

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