‘Your brain is not broken:’ ACEs screening draws pushback

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  1. James Dickinson

    You are right. To make it worth screening, there needs to be a follow-up process to select out those who truly have a problem, and some effective managment that can be done for them. For individual clinicians the most important value of ACEs is sensitivity to adverse effects that this particular patient may have sustained, and to help them learn to cope in better ways than they learned from their own family. But often there is no specific clinical intervention: we cannot reverse the effects of a parent incarceration, or childhood beatings. But we can give people time, hear them out, see them more often, and be with them as they work through behavior change. They do not always have to be referred for the very limited specialist mental health support, where too often drug treatment is started for these “problems of life”.
    This is often the work of primary care, especially working with deprived populations. A reflective blog that helps us to think through how to help is “abetternhs” buy Jonathon Tomlinson, a GP in the East End of London. I recommend it to all primary care clinicians, and those who wish to better understand the work of primary care, blending “medical” and “social” care for people.

    • Jonathon Tomlinson

      Thanks James – the link to my blog is https://abetternhs.net/
      I’ve recently been asking patients about what they think about ACE screening and what they say is important. Firstly – not every ACE is traumatic and not everything that is traumatic is included in the ACE questionnaire. Secondly – as Gabor Mate says, “It’s not what happened to you, it’s what happens inside you”, or as Bessel Van de kolk says, “The body keeps the score”. One of my patients described childhood trauma as being like a hurricane: The hurricane it’s self is brutal, but once it’s over it’s the devastation that’s left behind that’s traumatic and the work to clear that up that is trauma-informed care. I prefer ‘targeted enquiry’ but if people are suffering The Trauma World then it may be enough to acknowledge that without itemising the traumatic events. https://abetternhs.net/2020/01/20/the-trauma-world-and-the-healing-world/

  2. Harry Zeit MD

    The title of this article is oh so misleading, and will lead people to the wrong conclusions.

    The arguments about not screening for ACEs are similar to ones for not screening for depression. We simply lack the resources to treat everyone in need.

    Maybe a better title would concern the importance of bringing trauma-informed care to our medical system which currently does not practice or train in a trauma-informed manner.

    A healthy debate can only take place when those encouraging debate speak from integrity – which is the case, more or less, with the article but not with the title. The title only encourages foreclosure of curiosity and an unhealthy and misguided focus on brain – broken or otherwise.

  3. Carol Ng

    love this article, and the positive slant that we as physicians need to focus on………. resilience and strength.
    and our ability to “adapt and survive.”

  4. Denise Connors

    “It’s really about seeing that person as they are, validating them, and walking beside them on their journey. It’s relationship-based care that is most important for patients to improve,” says Sze.
    Dr. Anda says integrating ACEs inquiry into history taking is part of quality care. History taking does not equal clinical screening yet is essential for comprehensive patient-centred care. Asking, listening attentively, validating a patient’s experience and helping them understand the impacts of adversity on their health IS a powerful intervention.

  5. Mike Fraumeni

    Excellent read Joanna, very informative and well written. Reminds me of what renowned neurologist Dr. Sandra Black says, this from a recent posting:

    “Behind the Research: The Dr. Sandra Black Centre for Brain Resilience & Recovery”
    — “Many factors can influence the brain’s resiliency– genes, environment, education, fitness, and personality factors may play a role in how people recover from stroke or other brain injury or resist the gradual deterioration that occurs in Alzheimer’s disease and other dementias.” …


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