I was recently working with a young mother who struggled with depression and anxiety in the difficult year following the birth of her child. In addition to managing the herculean task of adjusting to motherhood, she had trouble coping with her baby’s complex medical needs. While I explained to her the importance of tending to her mental health and the connection between parental well-being and healthy child development, she burst out crying. “I feel so guilty,” she sobbed. “I’ve waited too late.”
I shared with her wisdom from pediatrician and trauma expert Nadine Burke Harris: Early adversity does not dictate your baby’s destiny. I told her she was a good mother and that cultivating positive experiences would offer her baby long-term protection. I also explained that I wouldn’t be so passionate about this work if it were devoid of hope. She laughed through her tears when I added, “because all doom and gloom would totally be the worst job ever.”
As a psychiatrist, I spend much of my time helping my adult patients overcome the consequences of adverse childhood and community experiences (ACEs). These traumatic experiences include environmental stressors like poverty, oppression, violence, and natural disasters as well as home-based stressors like being neglected, witnessing domestic violence, experiencing physical or emotional abuse, or having a parent with significant mental illness.
But just as negative experiences have a detrimental impact on a child’s long-term health, positive experiences — ones that cultivate a sense of stability, safety, and connectedness have a protective effect and can neutralize some of the damage caused by toxic stress. We talk a lot about ACEs in health care, especially when it comes to the health disparities experienced by the Black community. I wish we could talk more about PCEs, too. By focusing only on the negative, I fear we are giving parents — and adults who are grappling with their own childhood trauma — the false impression that prevention is the only way to mitigate the health consequences of adverse childhood experiences.
Since the 1990s, the research has been clear: Being exposed to chronic stress, both in utero and early childhood, puts kids at risk for a number of medical conditions, from cardiometabolic disease or depression and substance abuse, later in life.
But the impact of positive childhood experiences has only recently started to become clear. Learning about positive childhood experiences has not only changed the way I parent my children, but also how I practice medicine. As a reproductive psychiatrist, many of my patients come to see me after things have gone terribly awry in their pregnancy and parenthood journeys. Orienting our work toward cultivating positive experiences helps root us in hope.
I found my calling to reproductive psychiatry in the research describing the transgenerational impact of postpartum mental illness. Simply put, children struggle when their primary caregivers struggle. When these children grow up and become parents, they face a higher risk for postpartum depression themselves. The cycle perpetuates itself. Compared with white women, Black mothers are more likely to experience perinatal mood and anxiety disorders and receive worse mental health care, if any at all. In her book, “The Deepest Well,” Burke Harris, the first California surgeon general, writes movingly about growing up with a mother with an untreated psychiatric illness and how this adversity impacted her and her brother in adulthood: for her, a devastating pregnancy loss; for him, a catastrophic stroke at age 43. Caring for mothers, I thought, was the key to intergenerational health and well-being, especially in women of color like me.
While understanding the harmful effects of ACEs is critical, I worry that the message reaching people, including both doctors and patients, is that trauma is insurmountable. But as I have learned, that is absolutely not the case.
I first learned about positive childhood experiences during my women’s mental health and reproductive psychiatry fellowship while learning about the mental health burdens of benign uterine tumors, known as fibroids. A large research study found that people with uteruses who experienced ACEs, specifically abuse, were up to 36% more likely than their peers to develop uterine fibroids as adults. The worse the abuse, the longer abuse was endured, or the more types of abuse faced, the higher the risk. But for those “exposed to multiple forms of severe abuse as a child/teen,” the genuine interest of a supportive adult in childhood helped mitigate the risk of developing fibroids in adulthood, bringing them from a 1.7 times greater risk to a 1.24 times greater risk.
A 2019 study crystallized this idea, finding that the more positive experiences a person has to counterbalance trauma and adversity, the better the outcomes. It identified seven types of PCEs: the ability to talk with family about feelings, feeling that your family is supportive in difficult times, joyfully participating in community traditions, having a sense of belonging in high school and feeling supported by your friends, having at least two non-parent adults who genuinely cared about you, and feeling safe and protected by an adult at home.
While trauma is not insurmountable, it is immutable. Like my patient reeling over the hand she had been dealt, I too have felt burdened by stresses beyond my control. As a Black physician-mother I often think about the adversities my children were exposed to in utero: the horrors of the early pandemic and the footage of George Floyd’s murder on loop, traumatically etched into my brain.
Clinicians can develop compassion fatigue or a sense of purposelessness and withdrawal when chronically caring for victims of trauma. As a medical student facing seemingly endless doom and gloom, I often wondered whether what we did in the hospital actually mattered. I felt it most acutely when we discharged patients back into devastating and structurally violent situations that made them sick in the first place.
This is why it’s important for physicians, especially those who work with children and parents, to understand the power of positive childhood experiences and begin discussing them with patients. And this isn’t just about helping parents who are worried about trauma their own children have faced. As the Massachusetts Bureau of Family Health and Nutrition and Department of Public Health explains, we all have the power to foster positive childhood experiences in our communities.
I believe PCEs increase resilience not only in patients, but also in doctors. These days, regardless of the adversities in the background, I cherish opportunities to bring connection and belonging to the forefront. I offer words of affirmation when I see loving and attuned interactions between my patients and their children, because these interactions matter, and I tell them exactly why. When life’s traumas are inevitable, PCEs allow us to practice medicine and parent from a place of strength.
As a mother I’ve proactively sought to attenuate the traumatic challenges that my children will face like the first time they realize what the color of their skin means in America. It’s why I joined Jack and Jill of America, an organization of Black mothers dedicated to uplifting Black children and fostering positive experiences of enrichment and belonging. The mothers in this organization not only support each other, but also take a vested interest in each other’s children. I love that I get to nurture other children Black children alongside my daughters.
And at home, my 3- and 4-year-old daughters absolutely love our Sunday waffles. Each week, they “help” my husband by mixing all the ingredients and pouring the fresh batter over the heated waffle iron plates. This small tradition anchors our weekend, letting us all have a hand in creating a shared meal. I hope that someday, these Sundays will be a core memory for my children, one that fosters a sense of love and belonging. When we started this tradition, I didn’t realize that I was developing a positive childhood experience for my children.
Waffles alone may not be able to erase any trauma that they may face. Nevertheless, they are a small but important piece of a growing body of research, one that I hope my profession continues to pursue.