3 KNOWING AND NOT KNOWING
The hunger, the pain, the depression—it always comes back.
It’s like a bird nesting in your head.
—CASSIE, TWENTY-TWO-YEAR-OLD MOTHER OF ONE CHILD
HOW TRAUMA CHANGES MIND, BODY, AND RELATIONSHIPS
Trauma is not only a critical physical insult. It is a response to an insult, as I explained in the introduction. Trauma can be a biological, psychological, and emotional response to a severely distressing incident, or a series of chronic or recurring deeply stressful situations such as rape, abuse, shootings, and stabbings. It can also be a physiological and psychological response to emotional neglect, racism, and misogyny. These trauma responses can fragment one’s sense of self. Again, violence can cause trauma responses in both the victim and perpetrator. It can cause a trauma response among people who witness the violence too.
Trauma is infectious, as people who hear about trauma or witness its effects can feel a type of empathic engagement with people who experience trauma called vicarious trauma. Research shows that up to 25 percent of therapists working with traumatized populations and up to 50 percent of child welfare workers have a high risk of secondary traumatic stress or related conditions of post-traumatic stress syndrome.1
Among children, traumatic experiences are sometimes referred to as toxic stress, which can be a type of overwhelming stress related to homelessness, hunger, neglect, abuse (sexual, physical, or emotional), or witnessing violence or drug addiction in the home or community.2 In the world of public health, there is an array of recognized experiences during childhood that are referred to as adverse childhood experiences (ACEs). ACEs can include exposure to physical, emotional, and sexual abuse as well as household adversity such as witnessing violence in the home, having someone in the family who attempted/completed suicide, or having a parent who was sent to prison. These experiences are associated with many major public health problems such as depression, anxiety, cardiovascular disease, diabetes, sexual risk-taking, and early death.3
Nadine Burke Harris, the first surgeon general of California and a pediatrician in the San Francisco Bay area, helped bring ACEs to greater awareness and understanding. Through her work as a pediatrician, she began to connect the dots of family trauma and societal trauma and how they affected children, their families, and communities. She explains the science in straightforward terms for how childhood exposure to violence, neglect, abuse, and family strife have a deep and lasting impact on a child’s nervous system, organs, and immune function through the stress response. This stress response manifests in what is commonly known as fight, flight, or freeze. These responses, when utilized beyond the original threat or ignited due to ongoing threat, wreak havoc in our bodies and in our society.4
Most nutrition and food security researchers ignore this research primarily because they focus on food and nutrition, without regard to people’s social contexts. They might be surprised to know that Vincent Felitti, who started the widespread use of the ACEs measure in 1998, learned about the importance of childhood sexual abuse in his clinic to treat obesity, a nutrition-related disease. Felitti found that there was a unique group of people who were initially successful at losing weight through his program but then tended to drop out and gain most of their weight back. On further investigation, when he compared those who regained weight fast to their counterparts who stayed in the program, the people who dropped out were far more likely to report childhood sexual abuse and related traumas. They explained their weight gain was a result of trying to cope with stress and depression, and also a form of protection against perpetrators. Felitti’s first study was small, but after he convinced researchers at the Centers for Disease Control and Kaiser Permanente to consider childhood adversity, they launched a study with over seventeen thousand people, the vast majority of whom were white and middle class. They found that ACEs were linked to every major chronic disease such as diabetes, being overweight, and cardiovascular disease as well as depression, alcoholism, and substance use.5 Since then, hundreds of studies have corroborated their results among many kinds of people.
I want to point it out again, so you do not skip the message: weight issues, diabetes, and cardiovascular disease are commonly thought of as diet-related diseases. But there is more to the story, much of it related to trauma.
Trauma affects health and well-being through physical, emotional, and cognitive responses to extreme danger. Our physical response to danger is an automatic, without thought, whole-body reaction to a threat that manifests through numerous neurotransmitters and hormone production reaching every organ system. The brain sends messages to the adrenal glands, which then release adrenaline that speeds up heart, blood pressure, and respiratory rates to increase alertness, vigilance, and strength. The message also goes straight to the groin and hips, thereby stimulating a response to flee, fight, or freeze. Simultaneously, in a terrifying incident, an opioid-like substance called dopamine is released to relieve pain. These are essential to survival in the moment of threat.
But if these biological processes continue beyond the threat, or if they are triggered even without a threat to a person who has previously experienced trauma, they can create major health problems. A lingering affect of trauma is chronic hyperarousal, meaning one is always on high alert, despite the level of threat. This is why sometimes people become very agitated over a small perceived threat. Triggering is a term that indicates the kind of experience that can be benign and unthreatening but can cause someone who has been previously traumatized to feel threatened. A trigger can be a sound, smell, or phrase, or the way a person looks at you, thus releasing a fight, flight, or freeze response in the body.
Usually, once a person is aware of their triggers—certain smells, words, or sensations—they can learn to recover from them and calibrate their response. If at a young age, however, a child has experienced sexual abuse or chronic abuse and violence, this adversity can have serious consequences over the life course because a child’s brain and limbic system are not yet developed in order to modulate arousal. Children without a soothing and trusted adult may, in fact, never gain the skills to be able to soothe themselves.
According to Bruce Perry, an internationally renowned childhood trauma specialist, this heightened unmodulated arousal can have lasting effects on brain and body functions and cause many medical and psychiatric conditions. Trauma can limit immune function and make someone more susceptible to infectious diseases. As well, trauma responses can create toxins in the organs that lead to depression, uncontrolled anger, cardiovascular disease, and poor nervous system function. In response, someone might self-medicate with alcohol, tobacco, and drugs. Such patterns of behavior pass down in the family through behavior and biology.
At the biological level, this transfer across generations is referred to as epigenetics, meaning the dynamics of environment and gene interaction. Genes that cause diseases and other health states can turn on and off depending on environmental conditions. In this way, memories, behaviors, illnesses, and reflexes are passed on through our genetic codes across generations. Some describe this as ancestral pain or memories in the body. Research among children of World War II–era Holocaust survivors has shown this biological transfer of trauma responses to be incontrovertible.6
But this focus on biological processes in response to an unspecific environment diverts attention away from the truth of the ongoing violence of our social structures and political systems. So I concentrate on behavioral responses to social, economic, and political structures. Focusing solely on biological reasons for children’s experiences discounts the influences of history as well as relationships with parents, neighborhoods, communities, and institutions. Trauma is rooted in relationships. Trauma responses are mirrored in our families, community, and society through systems of education, medicine, urban planning, social welfare, religion, charity, philanthropy, government functioning, and research.
Two other common trauma responses that help people survive threats are appease and dissociate. To appease is to protect oneself by pacifying, placating, or making oneself smaller to appear nonthreatening. This can become standard practice and a way of holding or recoiling one’s body. To dissociate is a form of self-protection where one can find ways to disconnect oneself from their emotions and physical sensations when escape is impossible. This dissociative response is literal, not metaphoric. Survivors of childhood sexual abuse have explained that to survive assault, they could leave their bodies and “go elsewhere.” Again, this is another practical gift of evolution.
Yet as Staci Haines observes in her book The Politics of Trauma: Somatics, Healing, and Social Justice, if this strategy becomes automatic despite the threat not being present, it can have long-term negative effects. Primarily it can “leave us compartmentalized and disconnected.” In Haines’s words, these trauma reactions are a way to help us “not feel the things we cannot tolerate.”7 As an extension, dissociation can cause us to close off so we have no feelings at all, as it did for Juleen after her father-in-law raped her.
But remember, for her self-portrait, Juleen painted her body with bright orange and green. That stress and terror were still running through her veins. This running in the veins is there regardless of Juleen’s expression of emotion. These trauma responses make their way into our bodies and can nest there, affecting our postures, organs, psyches, and relationships. They shape the way we interact with the world around us. They are, however, not limited at all to a single body, singular family, or even singular lineage. As Burke Harris argues, “Trauma is endemic of many communities, it isn’t just handed down from parent to child and encoded in the epigenome; it is passed from person to person, becoming embedded in the DNA of the society.”8
INTERPERSONAL VIOLENCE REFLECTS STRUCTURAL VIOLENCE
As a reminder, racism is an ACE, and is associated with cardiovascular disease, depression, anxiety, and food insecurity.9 What goes on in our homes, relationships, and bodies reflects what occurs in society. Historical and contemporary housing discrimination and systemic violence such as school funding policies, which ensure that schools in Black and low-income neighborhoods receive far less money per child than schools in white and affluent neighborhoods, create environments that facilitate the emergence of interpersonal, family, and community violence.10 This phenomenon is what Wendy Ellis and William Dietz call the “Pair of ACEs.”11 The pair is adversity in our society (adverse community experiences) and ACEs in the home. They use an image of a tree of adversity that has branches showing hardships such as homelessness, addiction, abuse, and food insecurity. The tree’s roots are in the soil of discrimination, poor housing, community violence, and limitations on opportunities to build careers and wealth.
The tree is a metaphor. But the true site of this intersection of ACEs and societal violence is in the body. In his book The Body Keeps the Score, Bessel van de Kolk describes how trauma reorganizes the way the mind manages our perceptions and ability to think. Our reactions in response to severe stress and danger manifest in our physical bodies, cognitive responses, emotional reactions, social relationships, and behaviors. Trauma fragments our thinking. It makes it difficult to stay healthy, have positive social relationships, perform well in school and on the job, earn enough money, and even absorb our food.12 When we recognize that US policy and societal disfunction also generate adverse community environments, we can see how our bodies keep the score.
By extension, the fabric of our society also keeps the score. Examples are police brutality, punitive educational environments, and soul-sucking public assistance programs. These systems make their way into our bodies, or soma, in a continuous feedback loop. Our soma is a way of understanding that our bodies are the medium through which we interact with our environments along with the ways we carry our history, relationships, and sense of well-being. Hence trauma is a somatic experience.13
I hope you can understand, now, what I had a hard time understanding at the outset of my research in Philadelphia. Violence travels from a societal level to the family one; it penetrates our soma, where we may want to harm ourselves (suicide or self-cutting), or even starve ourselves or harm others. To see violence at the root of hunger helps us remember that when a person admits to not having enough money for food, it is a sure sign that they have been deeply disrespected by our society and people around them. That disrespect can take the form of neglect, abuse, and indifference. They feel it in their bodies because it penetrates the bloodstream, immune system, and gut.
HUNGER AND VIOLENCE ACROSS GENERATIONS
After blank stares from colleagues in response to my growing attention to the relationship between violence and food insecurity, I felt compelled to start categorizing and counting. I thought data in numeric form rather than as narrative based on qualitative interviews would convince scientists and policymakers to take these connections seriously. Perhaps the numbers could be sharp enough to penetrate scientific numbness to the pain of hunger.
To quantify and characterize different forms of violence, we set up a second round to the original study of Witnesses to Hunger in Philadelphia. We returned to as many members of Witnesses as possible and asked about exposure to ACEs (something we could measure on a scale of zero to ten) and other forms of violence. We quantified levels of violence in relation to food security and depressive symptoms. Here are the results: most members of Witnesses reporting very low food security also reported extreme forms of violence such as rape and assault with a gun or knife. In contrast, those who reported food security rarely reported such violence.14
A few published studies, however, do not establish hard truths in the world of scientific research. Additionally, we only had forty-four people in the Philadelphia Witnesses group. This is a small sample. For a scientific finding to be broadly accepted, results have to be proven many times in different types of settings with large sample sizes.
One of the strengths of Witnesses was our shared relationships with each other. We heard about when a family’s SNAP benefits were cut or their Medicaid benefits had fallen through. We learned about their family relationships. We celebrated their birthdays, weddings, and pregnancies. We helped them access abortions and attended funerals with them. We were there when they reached out with suicidal intent, when their kids got a 100 percent on a test, when their Section 8 housing was approved, or when they were evicted. We were learning depth, breadth, and nuance as members of Witnesses navigated social services, education, health care, and other systems as well as how they interacted with loan sharks, neighborhood drug dealers, and nasty caseworkers at the county assistance offices. But to scientists who clung to their big sample sizes and “normal distributions” in large datasets collected by big research corporations, the fact that we had meaningful and heartfelt relationships with members of Witnesses was considered a weakness. There is a common understanding that as a person responds to a survey, they may be trying to please, hide from, or tell the researcher what they think they’re expecting to find. This is referred to as responder bias.
Trying to reduce that bias, we set up two other studies.
Knowing it would take years to accumulate a large enough sample, we added ACEs to the existing Children’s Healthwatch survey as an add-on at the end of the standard battery of questions. But because everything is reduced to numbers without context, the content still stays on the surface. Most of the time, the why and social context of an experience cannot be captured by the numbers. To ensure we had contextual understanding, we set up another simultaneous study where we recruited thirty-one new people who reported household food insecurity in the Children’s Healthwatch survey. In this smaller sample, we carried out qualitative and quantitative interviews (mixed methods) to learn more about child hunger. As you will recall from earlier chapters, parents will do almost anything to protect their children from these experiences, and if they cannot protect their children, they are unlikely to reveal this unless there is some modicum of trust and patience.
CHILD HUNGER
Part of the household food security measure assesses the depth of hardship among the children from the primary caregiver’s point of view. If a family with at least one child agreed only to a few questions indicating their child’s nutrition suffered, the reference child was considered “food secure” (even if they were in a household where the caregiver themselves had indicated the household was “low food secure”—remember that is food insecure). If the parent said “yes” to more than three of the child-focused questions about their children’s nutrition, including to a question indicating their “child did not eat for a whole day,” then the child was considered to be “low food secure” (that is, food insecure at the child level). Reports at this level are rare for many of the reasons I outlined in chapter 2: parents protect their kids as much as they can, and also fear that if they admit they cannot feed their child, the people from protective services will take away their children. The national rate of child “low food security” in 2020 was at 6.8 percent; “very low food security” was at 0.8 percent.15
To set up the mixed-method study, we recruited from families unknown to us. If a parent, foster parent, or grandparent indicated their household was food insecure, our team looked more closely to ensure we recruited an equivalent number of people who reported child hunger versus those who were similar without reports of child hunger. We kept our recruiters and the follow-up interviewers separated. This ensured that, when we interviewed a parent, the in-home interviewers did not know whether the family reported their child was food insecure or not. We only knew they were eligible for the study because, at the household level, they were “food insecure.” This would reduce any tendency to ask leading questions as well as reduce interviewer bias.
We asked about memorable life events across the life span. Those who study trauma and human development understand that when violence occurs at certain developmental stages (such as before age five, before language is fully formed and the brain is still growing and trimming neurons, or during early adolescence, a time of even more body and brain growth along with changing self-awareness), it can have devastating consequences that last a lifetime. If trauma occurs at other times when a person is not in a major complex stage of development, the violent experiences may not be as devastating.
We sought to understand how the type of violence and timing of it might be related to the severity of food insecurity. To do this, we interviewed people in their homes or at other locations they chose. We asked about lifelong trajectories, and the relationships between food insecurity and violence among previous generations. Holding our clipboards with paper surveys, we asked questions from the formalized measures on food security, housing security, and public assistance participation, knowing these were repeat questions that the interviewee had already answered in the hospital emergency room. This repetition helped corroborate the original interview and situate their economic experiences during the survey. Then we asked questions from the ACEs questionnaire. See appendix 2.
At the survey’s end, we put down the clipboard and pressed record on the audio equipment to do a semistructured interview around a time line of lived experience. With a pencil on a blank piece of paper we drew out a time line that started at age zero and went up to their current age with a notch for every five years. We began asking questions based on their responses to the food security and ACEs measure. For instance, if they previously said “yes” to the emotional neglect question:
Did you often or very often feel that … no one in your family loved you or thought you were important or special? Or your family didn’t look out for each other, feel close to each other, or support each other?
During the audio-recorded session, we would then ask,
In the survey, you answered “yes” to the question about whether people made you feel as if you were not loved. How old were you when you felt this, and what was going on in the household during that time?
As we listened, we would draw lines with key words in the areas across their life span. This was a mutual process between us (the interviewers) and the interviewee. These jointly created diagrams indicate who the story was about, the other people who were involved, from which generation in the family, and at which time points they occurred across the life span. We would learn about the caregiver’s childhood and could then draw lines to their mother, grandparents, or their own children as they described their experiences with each generation.
People brought us to their earliest memories.
As we filled out the diagrams, listened to the interviews, and transcribed the audio files, it became clear that hunger was not a single incident that had occurred in the previous twelve months as the survey questions indicate. Rather, it was like a chronic, menacing experience that had repercussions rippling back in time across generations and went far beyond nutritional deprivation.16
Jocelyn, a twenty-year-old Black woman and mother of one child who reported household “very low food security,” “child low food security,” and an ACE score of nine (very high), described her early experiences of hunger as being related to her childhood when her parents struggled with drug addiction:17
We barely had food.
I don’t even know if food stamps existed.
They probably did, but my mom worked at [a fast-food restaurant]
—not to mention the fact that she was still getting high.…
We was always hungry.
The only time I’ve learned really eating
is when my dad used to drop us off at this lady’s house down the street.
She used to babysit us.
That’s the only time we really ate.…
In the morning we had to have oatmeal.
Before she sent us back with our dad,
we used to have cut-up hot dogs and baked beans.
So that’s the only time we would eat.
Jocelyn was a slight woman. As she talked, she sat at the edge of the sofa in her dark living room. She never took off her down coat and hugged her arms around herself as she talked. Hunger was compounded by other types of challenges.
When I was really little,
I was so hungry
That I couldn’t help myself
I actually ate the giant paint chips
off all the windowsills.
(She swept her arm across her and above her head in front of her to portray herself as a young child reaching to the windowsills and pulling off the paint chips.)
It was so bad I got lead poisoning.
She related lead poisoning to her struggles in school, where she often got into fights, including one involving the police. Out of frustration over this incident at her school, her mother sent her to live with Jocelyn’s father and stepmother. In her words, this is how it went:
When I was around ten, she got tired of me.
She kept saying I was, like, bad;
something was wrong with me.
So she just finally sent me to my dad
and while I was there, I got a stepbrother.
Basically, it started with him touching me
and then he had sex with me.
I was still ten,
but it was like two months into me being there.
A month later I just, like, said that I didn’t want to do nothing.
I just started acting out.
But besides [my stepbrother], that was the best part of my life,
like besides everything else,
I got taken care of.
I always had something to eat.
Afraid to tell her father and stepmother about being raped by her stepbrother, Jocelyn chose to go back to her mother’s house, where she continued to be abused and neglected. She eventually told her mother and a counselor that she had been raped and was hospitalized for suicidal depression at age thirteen.
Similar devastating patterns occurred among almost half the participants who reported very low food security and indicated their child was experiencing child food insecurity, whereas those who reported low food security, the milder form, had significantly less reports of rape and abuse.
Cassie, a self-assured and highly reflective Black woman who reported food insecurity for her young child, explained how depression, pain, and hunger nested in her head. I asked her to share how violence and hunger are related. She reprimanded me:
You cannot ask a person,
“Why are you stressing?”
You cannot ask a person,
“Why is there so much violence here?”
You cannot ask a person,
“Why are you hungry?”
All three go together.…
I could be here like,
“Okay, I’m stressing because I don’t have no food,
and it’s violent because I’m fighting my husband
because we need money.”
Shrugging her shoulders, Cassie insisted that hunger, stress, and violence are equivalent.
IF A PERSON SAYS YOU’RE NOTHING, YOU’RE NOTHING
Remi was a twenty-two-year-old Black woman who gave slow and thoughtful responses while her toddler sat on her lap and patted her chest, neck, and hair. As she answered the household food security questions, my heart sank. Her “yes” without qualifications to each question indicated her household was very low food secure, and, by the end, that her child was low food secure. Her ACE score was nine.
She became more animated as we drew out her time line. She explained she was abandoned by her mother at age five. She was raped at age six by members of the family with whom she was left, and was emotionally and physically abused by her grandmother, who took her in at age seven. Remi attempted suicide during childhood. She suffered from depression and had difficulty managing her anger. At age fifteen, her grandmother kicked her out of the house. Ever since, she was living “house to house.” Despite these experiences, she was able to graduate from high school at age twenty-one. “But,” she said, “it’s a struggle to find work.” She described the effects of childhood experiences on her self-esteem and job prospects, and therefore on her ability to provide for her daughter:
If a person always says you’re nothing;
you’re nothing.
Then for a while, I used to think I’m not anything.
So maybe that’s how I don’t have a job,
because I’m thinking I’m nothing.
I’m not ever going to have a job.
I’m “not going to be shit,”
like my grandma said.
So it’s like maybe that’s a part of how I don’t have a job
or I couldn’t finish school.…
Because I can’t find a job, I cannot feed my daughter.
How am I supposed to?
I cannot buy her what she needs.
Remi explained how abuse affected her behavior in school, getting her into trouble as well as making school and life circumstances throughout adolescence extremely challenging. She traced her difficulties in school and inability to find or maintain a job to being mistreated.
[My grandmother would] be like,
“You can’t come downstairs to eat.
You only can eat when I say so.”
And I’d be, like,
“Grandma, I’m hungry.”
“You heard what I said!”
And then she’ll try beating me or she’ll throw something at me.
Or when I had gotten of age,
she put me out.
You don’t put anybody that you love out.
I’ve been on my own since I was fifteen
—sleeping outside,
not knowing if I’m going to wake up tomorrow,
not knowing anything.
Remi portrayed a life of chronic homelessness coupled with hunger and deep depression.
In most interviews, we learned about four generations: the mother’s child, the mom we interviewed, the mom’s parent(s), and her grandparent(s). This generational piece is important as most research on food insecurity only provides evidence of household food insecurity as if it occurred in the last thirty days or one year. We found that current reports of food insecurity stemmed from previous hardship during the caregivers’ childhood, suggesting hardship of their parents. Their hardship was rooted in their childhoods and thus their parents, and so on.18 To see a graphic depiction, see appendix 3.
This depth of experience that people described helps us begin to see that violence across the generations is associated also with historical, social, and political experiences, which I address in following chapters.
VIOLENCE IN NUMBERS
Simultaneous to analyzing transcripts of interviews on child hunger two to three hours long, four to six days a week, the center’s Philadelphia Children’s HealthWatch team interviewed people in the emergency room. The setting at St. Christopher’s Hospital is context rich, but the survey contains “yes” or “no” questions, or “how many,” “how much,” or “when.” So people’s responses are reduced to a number: zero, one, or two. Often, full stories emerge; sometimes there are tears—mom’s tears or the baby’s—but the survey instrument is a tight mesh sieve, straining out anything quantitative researchers consider extraneous, tears included.
More than two years had passed since we added the ACEs questionnaire to the dry sieve of the Children’s HealthWatch survey, and we finally had enough data from 1,255 caregivers. A doctoral student in epidemiology and member of our research team mathematically accounted for whether a person was more likely to be food insecure if they were depressed and had high ACEs. If you have read everything in order so far, this should seem like common sense to you. But we performed the statistical tests with the large sample to assess whether the associations were beyond “chance.”
We found that mothers reporting depressive symptoms and at least four ACEs were more than twelve times as likely to report low food security and almost thirty times as likely to report very low food security when compared to those who had no depression and zero ACEs.19 These results demonstrate that the odds of food insecurity are astronomically high for those reporting depression and high ACEs when compared with people who have low to no ACEs and no depression.
We added another dimension to our statistical inquiry. We asked of the data, Does nutrition assistance from SNAP or WIC make the relationship between depression, food insecurity, and ACEs less severe? We found that even when families participated in SNAP or WIC, the strong relationships between childhood adversity and food insecurity persisted.
To repeat, ACEs, depression, and food insecurity are linked. This does not mean that everyone who reported low food security had high ACEs and depression; it just means they were more likely to report it. It also means that SNAP and WIC benefits do not change the relationships between violence, depression, and food insecurity.
LACK OF LOVE
I glossed over what each specific ACE shows us. My science mind jumped right over a dark hole of pain and sorrow. It is common practice among scientists to dissociate, or bypass context, to make a “scientific” case. Sometimes we feel that if we can prove something by numbers, it will make more sense, be more accepted, and establish credibility. It cuts out complexity.
But reviewing the outcomes of the statistical tests between ACEs and food insecurity was a gut punch.
To slow this down, I show you how each ACE was associated with food security severity.20 Figure 3.1 shows rates of food security for each ACE reported. Mothers reporting low food secure and very low food secure show increased percentages for each ACE when compared to mothers who reported they were food secure.
Prevalence of ACEs by food security status (n = 1,255). Data drawn from Jing Sun et al., “Childhood Adversity and Adult Reports of Food Insecurity among Households with Children,” American Journal of Preventive Medicine 50, no. 5 (May 2016): 566, https://
This question captures emotional neglect: “Did you often or very often feel that no one in your family loved you or thought you were important or special?” You will see that 56 percent of the people who reported emotional neglect were very low food secure. This is an extremely high prevalence compared to the original Centers for Disease Control and Kaiser study among over seventeen thousand people in which the prevalence rate for emotional neglect was about 15 percent.21
Seeing lack of love in numeric form should bring us closer to understanding this: household food insecurity in its severest form is an indication that a person was more likely to be neglected, mistreated, and exposed to severe hardship—lack of love included.
We cannot ignore this lack of love right in the middle of the data.
SEARCH BEYOND THE LIGHT
Our group was not the only one whose research was showing clear lines between violence and food insecurity. In the early 2000s, Cheryl Wehler and colleagues found that mothers who experienced sexual assault in childhood were over four times as likely to report food insecurity than women who had not been assaulted.22 Others demonstrated that child hunger was more prevalent in households in which mothers reported higher odds of post-traumatic stress syndrome and substance use. Another study found mothers in persistently food insecure homes had significantly higher rates of depression and/or a psychotic spectrum syndrome, or had experienced domestic violence.23 Yet when most researchers attempt to characterize the causes of food insecurity and its health effects, they rarely, if ever, touch on the published evidence of violence and discrimination. Perhaps it is too painful, chaotic, or demanding of a different type of attention. Perhaps most scientists are unwilling or incapable of understanding or addressing violence.
If scientific results have proven the association over and again, why are most scientific articles describing the overall causes and consequences of food insecurity ignoring solid evidence of violence? Why don’t more people know about this relationship and try to act on it?
It takes time for concepts that upset the standard paradigm to emerge. For instance, it took the scientific community many years to recognize that post-traumatic stress syndrome was treatable. It took psychiatrists a long time to understand that child abuse was real, and had devastating health consequences in the immediate and long term.
Sometimes when people talk about scientific confusion, they describe the “streetlight effect” or “drunkard’s search.” This is a kind of bias that happens when people search for answers in the easier places. To make this plain, I’ll use a story. Stories about misguided approaches to solving problems appear in many cultures and traditions; let’s take one from Sufism, a mystic tradition of Islam.24 There is a fool who looks for things only in places where there is light—perhaps under a streetlight—even though the seeker knows what they are seeking can only be found in the dark. Here’s a modern-day version:
It’s nighttime, you’re driving along on the highway, but you’re feeling a bit sleepy and need to stretch. You arrive at a rest stop and see a person looking for something. You stop and inquire.
“Do you need some help finding something?”
“Yes!” the person says, “I lost my keys to my car!”
So you help them look around.
You look for a while in silence.
After no success, you say, “Can you describe again where you think you lost them?”
“Yes,” they say, pointing toward the forest at the side of the road. “It happened when I was walking my dog over there, in the woods.”
“So,” you ask, “why are you looking here, if you know the keys are in the woods?”
The person answers, “Well, there’s light here and it’s all dark over there.”
This allegory describes most of us working on food insecurity. We know that societal dysfunction and historical discrimination are key to understanding food insecurity, but many refuse to study or acknowledge these dynamics—because it is dark out there! Not only does darkness make it hard to see, but many of us are afraid of the dark. I gently insist, however, that in the darkness there is wisdom. Let’s stay in the darkness as it may hold the key to our ability to evolve.25
KNOWING AND NOT KNOWING
Dissociation is an adaptive coping instinct and skill for when one cannot fight or flee violence. One dissociates from overwhelming emotions and bodily sensations. It is a type of fragmentation that can later be associated with amnesia or forgetting. In contemporary terms, it is a form of compartmentalizing or ignoring. This is what Dori Laub and Nanette Auerhahn, psychologists who worked with survivors of the World War II Holocaust, called “knowing and not knowing.” It is a type of split in our consciousness. They depict this process of dissociation as a “massive trauma that cannot be grasped because there are neither words nor categories of thought adequate to its representation. Knowledge of trauma is also fiercely defended against, as it poses a momentous threat to psychic integrity.”26
So to survive, we deceive ourselves.
This dissociative trauma travels from mother to child, to the children’s children, and throughout generations. We embody these traumas individually, in our families and communities, and through conditioning from our cultures and social relations.
Resmaa Menakem explains that among entire populations such as descendants of people who were enslaved and descendants of enslavers, the specifics of the original traumas are forgotten. Though the original trauma experiences may be forgotten, they still have intergenerational effects. As a result, our trauma responses—that is, our behaviors, beliefs, and practices that are linked to the original traumas—are still present and real today. As I explained in the introduction, traumas can be so deeply somaticized that they escape cognitive attention. As a result, our trauma responses get mistaken for culture.27
If trauma is unaddressed, it festers and haunts in ways that are sometimes visible, and at other times not. It becomes a type of amnesia or worse. Larry Ward argues that “we have spent the last five hundred years becoming so skillful in denying our atrocities and projecting the shadows of America’s racial karma onto the bodies of nonwhites that we are like people suffering from traumatic brain injuries and amnesia.”28
In the United States, many communities are operating with this dissociative engine of knowing and not knowing. This means that our historical trauma of genocide, land theft, and hundreds of years of colonization, enslavement, and cultural, social, and bodily destruction comes back to haunt all of us in the day-to-day.
NOTES
1. Robyn Trappany, Victoria White Kress, and S. Allen Willcoxon, “Preventing Vicarious Trauma: What Counselors Should Know When Working with Trauma Survivors,” Journal of Counseling and Development 82, no. 1 (Winter 2004): 31–37.
2. Hillary A. Franke, “Toxic Stress: Effects, Prevention and Treatment,” Children 1, no. 3 (November 3, 2014): 390–402, https://
doi .org /10 .3390 /children1030390. 3. Centers for Disease Control and Prevention, “About the CDC-Kaiser ACE Study,” April 6, 2021, https://
www .cdc .gov /violenceprevention /aces /about .html. 4. Nadine Burke Harris, The Deepest Well: Healing the Long-Term Effects of Childhood Trauma and Adversity (Boston: Mariner Books, 2018).
5. Vincent Felitti et al., “Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study,” American Journal of Preventive Medicine 14 (1998): 245–258.
6. Rachel Yehuda et al., “Holocaust Exposure Induced Intergenerational Effects on FKBP5 Methylation,” Biological Psychiatry 80, no. 5 (September 2016): 372–380, https://
doi .org /10 .1016 /j .biopsych .2015 .08 .005. 7. Staci Haines, The Politics of Trauma: Somatics, Healing, and Social Justice (Berkeley, CA: North Atlantic Books, 2019), 17, 75.
8. Burke Harris, Deepest Well, 132–133.
9. Dylan B. Jackson et al., “Adverse Childhood Experiences and Household Food Insecurity: Findings from the 2016 National Survey of Children’s Health,” American Journal of Preventive Medicine 57, no. 5 (September 13, 2019): 667–674.
10. Larry Ward, America’s Racial Karma: An Invitation to Heal (Berkeley, CA: Parallax Press, 2020).
11. Wendy R. Ellis and William H. Dietz, “A New Framework for Addressing Adverse Childhood and Community Experiences: The Building Community Resilience Model,” Academic Pediatrics 17, no. 7 (September 2017): S86–S93, https://
doi .org /10 .1016 /j .acap .2016 .12 .011. 12. Adrian L. Lopresti, “The Effects of Psychological and Environmental Stress on Micronutrient Concentrations in the Body: A Review of the Evidence,” Advances in Nutrition 11, no. 1 (January 2020): 103–112, https://
doi .org /10 .1093 /advances /nmz082. 13. Haines, Politics of Trauma.
14. Mariana M. Chilton, Jenny R. Rabinowich, and Nicholas H. Woolf, “Very Low Food Security in the USA Is Linked with Exposure to Violence,” Public Health Nutrition 17, no. 1 (February 22, 2013): 73–82, https://
doi .org /10 .1017 /S1368980013000281. 15. Alisha Coleman-Jensen et al., “Household Food Security in the United States in 2020,” Economic Research Report (US Department of Agriculture, September 2021), https://www.ers.usda.gov/webdocs/publications/102076/err-298.pdf?v=5244.
16. Mariana Chilton, Molly Knowles, and Sandra L. Bloom, “The Intergenerational Circumstances of Household Food Insecurity and Adversity,” Journal of Hunger and Environmental Nutrition 12, no. 2 (May 4, 2016): 269–297, https://
doi .org /10 .1080 /19320248 .2016 .1146195. 17. Usually, researchers describe zero to three ACEs as “low ACEs,” and four or more as “high ACEs.”
18. Chilton, Knowles, and Bloom, “Intergenerational Circumstances of Household Food Insecurity and Adversity.”
19. Jing Sun et al., “Childhood Adversity and Adult Reports of Food Insecurity among Households with Children,” American Journal of Preventive Medicine 50, no. 5 (May 2016): 561–572, https://
doi .org /10 .1016 /j .amepre .2015 .09 .024. 20. Many studies that include ACEs simply group the ACEs together. It is commonly understood that each ACE can overlap with others and the cumulative number of ACEs is likely more important than looking at a singular ACE.
21. Centers for Disease Control and Prevention, “About the CDC-Kaiser ACE Study.”
22. Cheryl Wehler et al., “Risk and Protective Factors for Adult and Child Hunger among Low-Income Housed and Homeless Female-Headed Families,” American Journal of Public Health 94, no. 1 (January 1, 2004): 109–115, https://
doi .org /10 .2105 /AJPH .94 .1 .109. 23. Maria Melchior et al., “Mental Health Context of Food Insecurity: A Representative Cohort of Families with Young Children,” Pediatrics 124, no. 4 (October 2009): e564–e572, https://
doi .org /10 .1542 /peds .2009 -0583. 24. Abraham Kaplan, The Conduct of Inquiry: Methodology for Behavioral Science (New Brunswick, NJ: Routledge, 1998).
25. Zenju Earthlyn Manuel, Opening to Darkness: Eight Gateways for Being with the Absence of Light in Unsettling Times (Boulder, CO: Sounds True, 2023).
26. Dori Laub and Nanette C. Auerhahn, “Knowing and Not Knowing Massive Psychic Trauma: Forms of Traumatic Memory,” International Journal of Psycho-Analysis 74, pt. 2 (April 1993): 287–302.
27. Resmaa Menakem, My Grandmother’s Hands: Racialized Trauma and the Pathway to Mending Our Hearts and Bodies (Las Vegas: Central Recovery Press, 2017).
28. Ward, America’s Racial Karma, 62.