17
We Eat Our Young
America is going to hell if we don’t use her vast resources to end poverty and make it possible for all of God’s children to have the basic necessities of life.
—MARTIN LUTHER KING JR.
Gary Knapp is no longer shooting at Dee, for he is long dead, along with all of his children except the youngest, Keylan. The challenge now is Gary’s grandchildren, for they are having their own run-ins with drugs, alcohol and the law. Keylan muses about a family curse, but it’s more that each generation inherits disadvantage.
We like to think young children are malleable and resilient, but they can also be as fragile as spring blossoms in a hurricane. As a society, we denounce “delinquents,” “hoodlums” and “hooligans,” but the truth is that we routinely fail troubled kids before they fail us. More children die each year in the United States from abuse and neglect than from cancer. For every child who dies, thousands are injured, raped or brutally abused. We shrug as millions of children undergo trauma in ways that harm them and unravel our social fabric—and then we blame the kids when things go wrong. Some species eat their young; it turns out that we are one of them.
Keylan’s son avoided drugs because of his own family’s experience and went to college for a time with money that Keylan had sent him. All seemed promising. A big, strong man, the son found good work as an electrician. Unfortunately, he had a predilection for impulsiveness and violence, like so many in his circle. “The girlfriend he was with, she kept screwing around with some Mexican drug dealer,” Keylan explained. This inflamed his son. “He got drunk, took his forty-five, went down there and shot the damned cars up in the driveway and told them, ‘Get the fuck out of town and leave my girlfriend alone.’ ” The police arrived and arrested the young man, who is still in prison.
Evidence from neuroscience, psychology and economics underscores that a crucial window for helping American children is the first five years, partly because they often suffer lifelong brain damage when raised in chaos and deprivation during those years. In these circumstances, they are exposed to “toxic stress” and their brains are flooded with cortisol, a stress hormone that changes brain anatomy. Peer-reviewed studies have found that five-year-olds who have experienced serious adversity have thinner frontal cortexes on average, and as a result less impulse control, less emotional regulation and less working memory.
Given the scale of substance abuse in America, it’s also inevitable that large numbers of children are exposed prenatally. Almost one-fifth of children born in West Virginia have been exposed in the womb to drugs or alcohol, and research, while not conclusive, suggests that later in life they will be much more susceptible to substance abuse. We now have a term for these childhood traumas and toxic stresses: adverse childhood experiences, or ACEs. An ACE can be physical abuse, a parental divorce or living with an alcoholic. Many adults have one, and one in eight has four or more. Even though the ACEs occur in childhood, they correlate to problems in adulthood: with four ACEs, a person has a 460 percent increased risk of adult depression and a 1,220 percent increased chance of adult suicide.
One of the most infuriating elements of American myopia about investing in at-risk kids is that politicians often insist that they don’t have the funds to pay for social services—but they somehow find the resources to pay for prisons later on. Republican lawmakers don’t want to pay for $500 IUDs for low-income women, so they pay $17,000 for Medicaid births. They don’t want to pay to reduce lead poisoning, even though that means paying for special-education classes for years to come; one study by the Pew Research Center found that every dollar invested in large-scale efforts to reduce lead poisoning saves $17 in public money later on.
Indeed, some of our most successful national policies have been those that targeted at-risk children. We’ve reduced teen pregnancies by 67 percent since the modern peak in 1991. We’ve raised high-school graduation rates by 5 percentage points since 2011. But too often, we underinvest in proven strategies. The cost of this myopia is that dysfunction is transmitted to another generation, at enormous human cost and public expense—and then we blame the victims.
One of the most important advocates for troubled children in America is George B. Kaiser, a Tulsa billionaire whose family escaped Nazi Germany and made money first in the oil business and then in banking. Kaiser, a lean and graying septuagenarian, told us that he was moved by the evidence that early interventions could break the cycle of poverty and concluded that creating opportunities for children was essential to provide basic fairness in life.
“No newborn child bears responsibility for the circumstances of her birth, and yet those circumstances to a very large degree determine her,” he says. “And that seems fundamentally unfair.” Kaiser has used his wealth to finance experimental programs that have made Tulsa a surprising red-state laboratory for evidence-driven initiatives to break the cycle of poverty. His George Kaiser Family Foundation nurtured the Women in Recovery program in Tulsa that helped Rebecca Hale break out of drugs, and a big focus has been on helping children—because that’s where the greatest impact is. He adds that it’s “absolutely, fundamentally unfair” that wealthy American kids have enormous advantages over children born in more dire circumstances.
“Successful people tend to believe or want to believe that they got where they got by initiative and discipline and intelligence, which they developed on their own,” Kaiser says. “I tend to believe that we got where we got largely by dumb luck and by what Warren Buffett calls winning the ovarian lottery.”
FARLAN KNAPP, Nick’s classmate, tried to be the loving dad that he had never had. He did much of the cooking and cleaning in the house. “I’d call him on holidays where I’d ask him what he was doing,” said Dee. He would reply, “I’m trying to stuff this turkey, Mom. And it’s sliding down the sink!” He had long, honest conversations with his daughters, Amber and Andrea, and spent time joking with them or taking them fishing. He teased Andrea for being “wimpy” when she would fuss at being woken at four a.m. to go steelhead fishing. While Farlan had detested his father and plotted to kill him, the girls idolized their dad.
Still, the girls grew up surrounded by the temptations of alcohol and drugs; in one of Amber’s baby pictures, there’s a plate of cocaine in the background. And for all Farlan’s affection for his daughters, the home had the same bleak atmosphere as the one he had grown up in a generation earlier, for he and his wife battled furiously.
“Part of the reason that my sister and I knew that he was dying from AIDS or HIV or hep C was because she would tell him, ‘Go dig your grave and die, AIDS boy,’ ” Amber recalled. In fact, although he had AIDS and hepatitis C, he ended up dying of alcohol-related liver failure. Farlan sometimes retreated from such verbal abuse, Amber said, and other times struck back physically. During these fights, Amber emerged as a protective big sister: she would cover Andrea’s ears so she wouldn’t hear the fighting.
When Amber was in seventh grade, she became friends with a handsome eighth-grade boy named Nicholas Baughman, a son of a single mom. The most common version in the Knapp family of what happened next is that Amber and Nicholas fell into each other’s arms and, during a hookup, began talking about their families.
“My dad is named Farlan,” Amber began.
“No, my dad is named Farlan,” Nicholas interrupted.
Confused, they resolved to each bring a photo of their father to school the next day—and that’s how they found out that they were siblings. In fact, as both Nicholas and Amber tell it, they were good friends but not romantic partners. Nicholas says that he had never met his dad but knew that he was named Farlan Knapp—and knew that Amber’s last name was Knapp but didn’t think much of it until, one day, he heard that Amber’s father’s first name was Farlan. The next day, Nicholas pulled Amber aside at school and showed her the only photo he had of his dad, taken at age eighteen.
“Do you recognize the guy in this picture?” he asked.
“No,” Amber replied flatly.
“Look closely,” Nicholas urged. “Do you recognize this guy?”
“It looks like my uncle Keylan,” she replied doubtfully. Then she flipped the photo over and saw a scrawl: “Farlan.” Her jaw dropped.
“Did your dad ever tell you that you have an older brother?” Nicholas asked.
Amber became close friends for a time with her half-brother, and Farlan worked on building a relationship with his teenage son. Nicholas Baughman ended up joining the navy, then earning a college degree and getting a good job in the private sector. He represents a successful path that the Knapps had been capable of but that none of them managed.
As for Amber, she graduated from high school, rented her own apartment and then took in Andrea, who was fifteen, to give her a more stable life and encourage her to stay in high school. Years passed, and for a time the girls seemed to have made it. After high school, Andrea married and started her own real estate business. Gorgeous, smart, talented and entrepreneurial, Andrea seemed to be thriving. But Farlan’s death devastated both his daughters, and Andrea accelerated her binge drinking and steadily declined.
“She drank herself to death,” Keylan said. She was buried in 2013 at the age of twenty-nine.
Amber seemed the member of the young generation of the Knapp family most poised for success. She was the first Knapp ever to graduate from high school and then took a job at a telecommunications company, managing databases and training staff to use the computer systems. Amber projects a firm intelligence and competence. In speaking to her, we were struck by her intellect and her interpersonal skills. She was self-possessed and articulate, and it was easy to imagine her as a lawyer or business manager. Amber took community college classes in computing that helped her get jobs in information technology, and she was soon thriving in the field.
“PowerPoint presentations and Excel and pivot charts and matrix analytics, that’s what I like to do,” she told us. “Exporting and importing data and putting it on slides and showing the executive staff how your company is running in what areas, and how much money is past due or not invoiced.
“I made a lot of money, had a really good job, really good benefits, everything,” she added. She married and had two children, and she was that rarity, a Knapp not on drugs. She was also making progress in the corporate world. For a time, she seemed to have escaped the Knapp curse.
However, when stressed, old patterns revived and childhood traumas resurfaced. In grief after her father died, Amber turned to anti-anxiety medications like Xanax, prescribed by her doctor. They helped, but she became dependent on them. After running out of them, she cast around for an alternative, and that’s when she smoked meth for the first time in her life, at the age of thirty-two.
“I was dead set against it my whole life,” she remembered. “I hated it. I’d seen what it did to everybody. My dad was a junkie who cooked meth and lost everything. You would think that that was enough.” Yet Amber found herself physically sick, anxious and depressed by her withdrawal from anti-anxiety medications, unable to sleep and desperate for relief. Meth helped temporarily: “It made me feel better, it pulled me out of my depression, it made me able to be a supermom.” Amber thought she had it figured out.
“In the back of my mind, and this is what most addicts will tell you, is that you don’t think you will be the one to lose control,” Amber said resignedly. “You don’t think that it’s going to consume your life. You think that you’re going to be able to be a functional drug user.”
Instead, Amber found herself hooked. She was soon in and out of jail, and eventually she pled guilty to felony charges of possession of heroin and meth. She lost her job, lost her health coverage and couldn’t get access to the drug treatment programs she needed. Even when out of jail, Amber was unable to find work because of her felony drug convictions. She lost her driver’s license, her marriage and her two kids, who were put into foster care. After one stint in jail, Amber stayed drug-free for a while and had a third child, a son, with her old high-school sweetheart; she thought the baby would help keep her off drugs. It didn’t work, and this son was taken away as well.
“I lost everything,” she told us. “It happened quickly.”
How did Amber let it happen? Surely, part of the answer is that she made awful choices, but research also suggests that addictive behavior is heritable, either through genetics or epigenetics, so that as the daughter and granddaughter of people with substance abuse issues, Amber was exceptionally vulnerable. Children like Amber and Andrea in chaotic households grow up with dysfunction, abuse, divorce, mental illness, neglect, economic hardship or parenting by people with addictions—all classic ACEs. Researchers have found that toxic stress impairs development of a child’s brain and leads to lower levels of education and, even decades later as adults, to higher unemployment, greater poverty and higher rates of cardiovascular, lung and liver disease, addiction and psychiatric disorders, even early death. The overall cost to society from child trauma and ACEs for medical care, special education, social welfare and criminal justice, not to mention loss of productivity, was $125 billion in 2008, according to the Centers for Disease Control and Prevention.
AS THE KNAPP FAMILY STORY suggests, there is a real cost to the failure of policies to support at-risk children. The kids pay a price, but so does the entire country. Several studies have found that child poverty costs the United States about $1 trillion each year in increased health, crime, prison and welfare spending as well as in reduced earnings. That’s about $8,000 per household annually. Most researchers find that each dollar invested in reducing child disadvantage would save the country at least $7. Crime is a particularly expensive consequence of child neglect: researchers calculate that the economic cost of a single murder is $3 million or more. Half of America’s crime is caused by 5 percent of the population, so a small number of dysfunctional and neglected youth impose a large financial and emotional cost on society—and for now kids in disadvantaged families are often steered more toward crime than college.
“Inequality affects the vast majority of the population, not only a poor minority,” argue Richard Wilkinson and Kate Pickett, a husband-wife team of epidemiologists in Great Britain who have studied precisely this issue. Skeptics disagree, saying that what matters in a society is not the inequality but the absolute income level of the poor, and that this is what we should focus on improving. Yet inequality in and of itself seems to be associated with damage to the social fabric—and not just for people who are poor. Wilkinson and Pickett found that even middle-class or affluent people are better off in a society that is more egalitarian, like Japan’s, and live a bit longer there, face less violence and have kids more likely to thrive. Violent crime and imprisonment are higher, economic output is lower and discontent is greater in unequal societies. Mental illness and infant mortality are two or three times higher in unequal societies. Teenage births, incarceration rates and homicide rates are up to ten times greater, and those, too, diminish the well-being of an entire society.
The Centers for Disease Control and Prevention found that in 2017, almost 32 percent of high-school students reported persistent feelings of sadness or hopelessness in the past year. In addition, 17 percent of high-school students said that they had contemplated suicide in the last year. Many people think we can’t prevent suicide, for if people want to kill themselves they’ll eventually succeed, but that’s incorrect. The American military has conducted rigorous research on strategies that reduce suicide risk by about half. Other researchers have found that suicide prevention programs for troubled teens reduce suicides by an even greater proportion. Successful strategies include helping people make crisis plans to turn to a particular person for help when they are thinking of suicide, and also therapy to help young people work through their issues. When Connecticut introduced an anti-suicide program called SOS, ninth graders in schools assigned to participate in the program were 64 percent less likely to attempt suicide than those in a control group.
There are no guarantees for success, but Amber and Andrea might have had a better chance with professional intervention in early childhood, when the brain can more easily create positive neural connections for healthy development. The aim is to work with parents and kids alike to make homes less chaotic or violent and more nurturing, to coach parents on reading to their children, to instill in children skills like patience, cooperation, self-denial and conflict resolution. These interventions have a good record of effectiveness.
Eight years ago in Richmond, Virginia, a study found that a high number of preschoolers who had been expelled from school had previously suffered early trauma. It was ACEs that likely led to disruptive behavior, so educators in Richmond turned to Kathy Ryan, a trained clinical child psychologist, to create Circle Preschool to address therapeutic needs of kids with ACEs. Teachers are specially trained to heal trauma using play-based therapy, and they also conduct weekly coaching sessions with parents. Now, Ryan is helping set up a teacher-training institute, as a first step toward scaling the approach. During our visit, the kids in the classroom were playing quietly. “We have a way of talking with them that is much calmer than typically you would hear in a school,” said Ryan. “We want to help them to develop a voice to talk about what’s going on for them inside.”
Circle Preschool can afford to take on only eight children at a time, so it’s an expensive intervention. But the results have been impressive. We watched a boy named Jay, who is now in the custody of his uncle, Timothy, playing quietly with a large train set. When Timothy and his wife, Rebecca, took in the boy a couple of years ago, Jay was an angry child, frequently screaming and yelling. He knocked over chairs and threw things at teachers and at elderly women who visited his day-care center; he threw toys in restaurants so it was hard to take him out with their other two sons. Then Jay entered Circle Preschool in September 2018, and four months later he had become a fun-loving, playful and charming child. “I’ve seen a big difference just in his behavior in everything, it’s amazing,” Rebecca told us. Timothy is more emphatic. “It was a total one-eighty.”
Some of the most-studied interventions for troubled children have been early childhood programs like Perry Preschool Project and Family Connects Durham, which turned out to have far-reaching beneficial effects. One simple program is Reach Out and Read, in which pediatricians “prescribe” reading during doctor visits and hand out free children’s books. It’s exceptionally cheap, at $20 per child per year, and many parents end up reading significantly more to their children. Unfortunately, while other countries are building up their early childhood initiatives, America is a laggard. Of thirty-six advanced OECD countries, the United States ranks thirty-fourth in the share of four-year-olds in early childhood programs.
It’s common for children to have one ACE, maybe two, and those who have three or more ACEs are at very significant risk for educational failure, mental-health problems and substance abuse; Amber and Andrea were both walking collections of ACEs. Yet only 4 percent of pediatricians screen for ACEs in children.
Dr. Nadine Burke Harris is trying to change that. California’s first surgeon general, she is leading development of nationwide, evidence-based protocols for interventions, including some that involve sensors for biofeedback to measure the biological stress response and neurofeedback to monitor brain electrical activity. Dr. Burke Harris, who has found that California’s highest prevalence of ACEs is in rural counties, has initiated a public education campaign that has so far reached 31 million families with messages about childhood adversity, how it impairs health and how to heal. Even Sesame Street is in on the act. It has a series on coping strategies for kids who have suffered traumatic experiences, with the Cookie Monster learning breathing exercises to calm down. A new law in California provides for statewide screening for ACEs, a model that all states should adopt.
“I’m not trying to wrap our kids in bubble wrap and baby them from every outcome…but to help our little people go through the world and understand how to take on challenges,” said Dr. Burke Harris. “The big question that we’re facing as a nation is whether or not there will continue to be opportunity for everyone in America.”
The United States has about 13 million children living in poverty. Of those, about 2 million may live in “extreme poverty” by global definitions (in households earning less than about $2 per person per day), when looking at their cash incomes. These kids would be considered extremely poor if they lived in Congo or Bangladesh, yet they’re here in the United States. We don’t want to overstate the comparison—Congolese kids can’t typically access food stamps, hospital emergency rooms or church pantries and soup kitchens—but it is still staggering that by formal definitions some American children count as extremely poor even by Bangladeshi standards. The presence of extremely poor children in America, far more often than in other advanced countries (Germany has virtually none), is partly a consequence of the 1994 welfare reform that eventually cut off benefits for some families: it was meant to hit deadbeat adults but has been devastating for their children as well.
Welfare policy is complicated, with good intentions sometimes having unintended consequences. But there are effective ways to help children, from home visits to early childhood education programs. Anti-poverty efforts for the elderly have been a huge success, with the share of seniors below the poverty line plunging by two-thirds since the mid-1960s. But we sometimes spend more in public money on hospitalizations for an octogenarian than on a child’s entire education. Let’s be blunt: America as a nation is guilty of child neglect. We have punished children, mainly because they don’t vote. Meanwhile, other countries offer home visitation, paid family leaves and monthly cash allowances for families with children to reduce disadvantage.
Angus Deaton, the Nobel Prize winner in economics who with fellow Princeton professor Anne Case did the critical work on “deaths of despair” in America, says that the revelations of extreme poverty in America have led him to recalibrate his personal giving to donate more at home: “There are millions of Americans whose suffering, through material poverty and poor health, is as bad or worse than that of the people in Africa or in Asia.”
It’s perhaps telling that the United States for years was, embarrassingly, the only country in the world besides Somalia and South Sudan that had not ratified the Convention on the Rights of the Child. That has now changed: the United States is the only nation that hasn’t bothered to ratify it. Maybe that’s a symbolic matter, but here’s something profoundly real: children make up almost one-third of Americans living in poverty, and on any given night some 115,000 children are homeless in the world’s most powerful country.
SINCE AMBER AND ANDREA MISSED that childhood window to get help—as so many like them do—were there ways to assist them as adults? Employers usually fire workers who are in trouble, costing them their health insurance, rather than send them into treatment. But employer attitudes may be changing, partly as addiction encroaches more into the workplace. In a 2017 survey of five hundred mid-to-large employers across the country, 70 percent said they had been affected by prescription drug use, for example, through employees missing work, testing positive for drugs or using pain relievers at work. In an indication of their willingness to help, a similar percentage also said they would like to help employees return to work after treatment.
At age thirty-nine, Amber Knapp was trying to start over. We met her at a park near the halfway house she was living in, and she brought a breathalyzer that could detect the scent of alcohol; midway through our conversation, on schedule, she had to breathe into it. She explained that if she failed a drug test or a breath test, she would return to prison for twenty-six months.
After having worked as a corporate manager, Amber found it mortifying to be a felon struggling with addictions. She said that her goal was to build a five-year track record of being sober: no drugs, no alcohol, no run-ins with the law. That would give her more job options, including a return to information technology.
As part of her probation, Amber Knapp had to use a breathalyzer at regular intervals to show she had not been drinking. Her daughter looks on. (photo by Lynsey Addario)
When Amber reflected on her roller-coaster life, she attributed it to the shadow of her childhood. “When you’re raised in chaos and you’re around chaos a lot, your body adapts to the chaos,” she said. “I was actually creating the chaos to feel normal.”
Amber turned to her daughter, a strikingly beautiful fourteen-year-old, and shook her head. “Don’t do it,” she said somberly. “You’re more prone than somebody who doesn’t have addicts as parents.”
We left Amber feeling hopeful. She was so smart and self-aware that she seemed to have a fighting chance to put her problems behind her, return to the corporate world and become the mom she aimed to be. We messaged a few times about photos and other issues, and then she stopped responding. Finally, her daughter answered our texts: Amber had been arrested for failing a drug test and was back in prison for another couple of years. The kids were back on the tightrope. They weren’t quite sure what would happen to them, and the world around them had just reverted to chaos.