“Mum, I took the ACE quiz…”
Even a cursory look at certain sections of Twitter shows how hotly debated and seemingly ubiquitous the term ‘Adverse Childhood Experiences’, or ‘ACEs’, currently is. (Search #ACEs or #ACE.) If you’ve come to this blog it’s likely you have a fair idea of what ACEs is/are, so I won’t attempt to explain here what’s been recently and cogently described as a ‘chaotic concept’ and instead urge those who wish to know more to seek out a healthy balance of pro-ACE and ACE-sceptical resources. (I’ve decided not to post links here because that would involve at least indirectly linking to online ACE tests and, for reasons that’ll become clear, I don’t want to do that.)
This is the first in a series of blogs which are an attempt to commit to paper some of my current thoughts, questions and concerns about ACEs. It’s not intended to be an academic endeavour by any means, so the usual caveat applies, and I stand ready and willing to be corrected and/or to have my knowledge and understanding enhanced. These are just the thoughts of someone for whom ACEs raises some interesting and difficult questions due to the ways in which my own life experiences and those of many of the people I support in my professional life are framed within certain parts of what I call ‘ACE discourse’.
(I’m acutely aware at this point of the difficulties in discussing ACEs due to it being, as mentioned, a ‘chaotic concept’. Here I’m using the terms ‘ACE’ and ‘ACEs’ interchangeably in the knowledge that there are many and varied interpretations of what ACE/ACEs refers to. Indeed, a key problem in the debate is the lack of consensus about what the term actually means. But we have to start somewhere and this stuff definitely needs to be talked about because there’s a lot at stake, which I’ll explore in future blogs. For now, though, I focus on my personal perspectives.)
‘Got your ACE score?’
… is a question emblazoned, along with variants like ‘Take the ACE quiz!’, across pro-ACE websites, twitter feeds and forums in the manner of a viral ad campaign designed to create a ‘buzz’ about some product or other. Which is fine if you’re selling crisps or Pokémon, but rather less so if you’re promoting something that invites people to look back at their childhood through the lens of adversity. The cheerful abandon with which ACE discourse is proliferated across the world wide web is at odds with the seriousness with which it is taken as a policy idea. ACE/ACEs is to a very significant degree already underpinning national and regional public health policy decisions in Scotland.
(Incidentally, an argument could be made that ACEs is a ‘viral concept’, supported by a brand-friendly acronym that handily serves as a kind of short-hand or cypher for whatever people and organisations want to overlay on it. Increasingly 'ACEs' is being used interchangeably with 'trauma informed practice/policy’, which is a co-option of an already existing area of research and practice. This co-option is perilous because ACEs tends to simplify trauma by trying to yoke — unsatisfactorily — various dynamic, interwoven factors most often marked by complexity and specific contextual nuance into an attempt at a kind of single unified theory of childhood adversity, applicable to everyone. Which, to anyone with an understanding of diversity issues, is, of course, pure folly. Worse, because, in advancing this one-size-fits-all approach, ACEs distracts from the fact that childhood adversity and ongoing adult trauma are, fundamentally, complex social issues.)
So I took the ACE quiz
Accosted by these cheery entreaties to 'get your ACE score’, you’d be forgiven for succumbing to temptation to take the ACE test, if only to see what all the fuss is about. But before you do, let me tell you my experience of doing so…
I took the quiz and found I had an ‘ACE score’ that put me in the at-risk category for all the dreadful things that (according to ACEs proponents) are more likely to happen to you if you have ACEs, including — wait for it — EARLY DEATH. That’s right. According to many ACE proponents, an ACE score of 4 or more means you’re more likely to die younger. Up to 20 years younger, if you have an ACE score of 6 or more.
I would like to be absolutely clear here: I am not denying that adverse experiences can lead to profound and long lasting psychological and physiological effects across the life course. As someone who has experienced stress-related mental and physical illness, sometimes severe, I know too well how powerfully and insidiously our emotional world can affect us. In my professional life, paying attention to trauma enables me work, I think, more humanely and compassionately with people with the (stigmatising) diagnosis of emotionally unstable personality disorder (sometimes still known as borderline personality disorder ). I am with those who believe complex post traumatic stress disorder is very often a more suitable diagnosis, if we must have a diagnostic label at all. My concern is that the proliferation of online ACE checklists, quizzes etc, and the enthusiasm with which they’re promoted, constitute a kind of pop-determinism that is potentially damaging to the wellbeing of individuals seeking to know their ‘ACE score’.
Science fiction literature abounds with examples of characters who gain knowledge of the time and circumstances of their mortal fates. Invariably, these characters are driven to the limits of mental and emotional endurance — if not outright mad — by this knowledge. My own reaction to discovering my ACE score was to question my own upbringing and the role adults played in it. This wasn’t in the least bit helpful. In fact, it precipitated a period of self-involved gloom that was quite unpleasant for me and, irony of ironies, led me to being distracted and downright grumpy around my own children. I began to question every decision and misstep made by my parents, who were, like most working class parents in Thatcher’s Britain, doing the best they could with what little they had. Far from perfect, but a long, long way from dreadful. But I would say that. They were my parents.
Before I took the ACE test, I was already aware of and was dealing with certain childhood experiences I’d had with other adults in and orbiting my family. Like a lot of families, we had our peculiarities, our strange and hidden corridors and rooms, barely touched, acknowledged in hallway whispers and knowing looks and swift changes of subject, but in years to come I was able, with some of those involved at the time, to open some of those doors and found a surprising willingness to discuss the things we found there. Remember, this was before I took the ACE test. In fact, doing the ACEs checklist years later was an unnecessary retreading of some of that ground, re-opening resolved and part-resolved questions, and causing me a great deal of worry about what the future held for me and my young family. Am I going to die young because of the fallibility of the adults that were around me as a child? What will that do to my own children? Should I speak to them about it? Would they understand? What would be the effect on them of knowledge about my ACEs?
So, for me, finding out my ACE score was really quite painful indeed (you might call it an ‘adverse adult experience’). Neither was it great for my kids, whose dad suddenly became preoccupied and sullen for a while before he remembered that other people were contending with things every day that put his solipsism sharply into perspective.
Also, what was I to do with this knowledge? Like a character in an old sci fi paperback, I stumbled from scene to scene in my life, there but not really there, preoccupied by the thought that terrible things lay in my past and also, as a consequence, in my future: predetermined pathological doom, no less.
And that’s the problem with getting your ACE score: there’s nowhere to go with it. It just sits there, like an unidentified lump you think you should maybe see the doctor about but are too scared to ask.
Another thing that happens is that you start telling people your ACE score, especially people in the ACE ‘movement’. At least I did, in the mistaken belief that a) it legitimised in their eyes my participation in the debate (’Hey, I got adversity!’) and b) they actually cared. My experience — with perhaps one or two notable exceptions — of debating with ACE advocates online has been that critics are viewed and treated with deep suspicion and a disclosure of ACEs by an ACE sceptic elicits zero acknowledgement. We don’t fit the narrative. To be fair, what are they going to do with that information anyway? Which is a key point. No-one has any idea what to do with ACE scores, not at individual level anyway. ACE scores are population-level data so, in my view, it’s irresponsible to the extreme to encourage people to take the ACE test in order to find out their score, cos then what?
We are told, variously, the antidotes to ACEs are stable, nurturing relationships, kindness, empathy, compassion and love. While these things are undoubtedly highly desirable and, in some cases, crucial to humane, responsive and responsible policy and practice, they are not on their own going to reap the radical changes in society ACEs advocates frequently claim. In fact, ACE discourse, underpinned as it is by a focus on correcting defects within individuals and families without wider appreciation of poverty and structural inequalities, is far from radical. It is inherently conservative. Childhood adversity and trauma are, as I’ve said, complex social issues and, as such, require complex social responses, rooted in consideration of the wider contexts in which the trauma is experienced. ACEs are not only a co-option of the already existing area of trauma research and practice (an area not without its problems and which therefore needs to be approached with a suitable amount of critical reflection) but a dangerous step toward an oversimplified and depolitcised way of looking at and working with trauma, with the myriad dangers that brings. My worry is that by the time we realise ACEs can never deliver on its promises, the claims that it represents a 'revolution' in society or, indeed, that it constitutes, as has been claimed, somewhat ambitiously to say the least, the 'next evolutionary step' for humanity, a lot of time and public money will have been spent on it — resources that could, frankly, be better spent elsewhere. Investment, material and otherwise, in communities and the people that live in them is key to reducing poverty and tackling social and health inequalities. ACEs promotes the idea that people who have experienced adversity in childhood are, basically, damaged and need fixing. With the rise of the ACE-aware nation movement in Scotland, which has seen ACEs increasingly influence policy resulting in, among other things, proposals for professionals and staff to routinely enquire about individuals’ ACEs, there are concerns that ACEs heralds a shift toward greater state interference in people’s lives.
So I’m not going to talk about my ACE score anymore and I urge anyone thinking of finding out theirs to approach the process— indeed the whole issue of ACEs — with a suitable degree of caution and a healthy dose of scepticism.
Next up: 'ACEs and -isms'
