Morning Zen

Making a National Case for “Good Trouble” to Heal Mental Health Disparities, Based on Good Science

January 14, 2021

PART 1, reducing ACES for $7.00 per Child

Unless you’ve been living under a rock or are Rip Van Winkle or a male-chauvinist piglet (a term from my college days in the 1970s), you know that children, adolescents, and adults who are Black, Brown, Red, or some mix of that have a higher risk for psychiatric disorders, related physical illnesses, lower lifetime income, and other harmful disparities.

If you doubt that, send me your email. I will send you enough references to read for the next year. After reading those studies, you have the notion that this is “fake science,” then there is nothing I can do to cure your prejudice, ignorance, or both. To understand the science of historic disparities affecting the decedents of Slavery, you have to understand the concept of evolutionary bottlenecks I’ve illustrated.

I know a bit about all this as a scientist and a descendant. Yep, this white looking guy is a descendant of Slavery, and there are millions of us—based on Ancestry.com. I have the historical deeds and documents of my slave ancestors. My descendants’ story is inspiring and emotionally moving. Yes, I have some genetic legacy effects of the slave trade, like high blood pressure, despite being thin, athletic, and eating well. I’m 5’10”, 132 pounds, and can easily run a 5K, do 100 pushups, etc., at age 72. And, I have had a type of rare cancer that pretty much only happens among folks who have African American genes.

This column and future columns are not about the past. They are about using the best science in the world to build a better present and future for all our children, and especially those with historic disparities that harmful biological and behavioral effects.

I am sparing the liberal “woke” apologies in this case, the peevish or fretful complaining about hearing the issue raised yet again of historical trauma. It’s still a problem. Also, please nix the white privilege of ignoring the medical, social, and political facts that continuing structural racism that harms the health and wealth of black, brown, red, and poor white kids. I’ve worked in Baltimore schools since 1990, and schools all over North America, including Far North and Far South.

As a scientist and a descendent, I am arguing for repairing the health harms that still exist—just as the descendants of the Holocaust survivors and even imprisoned Confederate soldiers experienced [1]. I’m OK, but millions of descendants are not. And yes, a lot of white families got the shaft, too. The same things we would do to repair the historic harms to black, brown, and red kids work for white poor kids, too. Remember, better than 50% of America’s children right now will have a psychiatric or behavioral disorder by age 18—based on incredible science cited in multiple U.S. Institute of Medicine Reports on the wellbeing of America’s children since 1994 [2]. If you don’t believe in Government Reports, well, then look up the Wall Street Journal front-page story [3]. Every other kid in America has a significant mental, emotional, or behavioral disorder. That’s a very obnoxious, evil fact—more columns about why later, with the science.

There will be vocal folks—generally on the extreme right—who argue that this whole issue is over-wrought or even fake about the lasting effects of Slavery and racism. Unless you are an obsessive nerd like me, you would not know the story of Confederate soldiers who were captured and imprisoned in awful conditions for a long period of time. 

Consider a landmark study of children born after the US Civil War (1861–1865) to survivors of Confederate prisoner of war (P.O.W.) camps [1], who were shorter-lived, because of their fathers’ experiences and the mechanisms behind paternal transmission via sperm and epigenetic effects [1]. The experience of the Confederate prisoners of war has an ironically similar impact as the current incarceration of African American males probably have on their children.  

How is this possible? Remember this absolute fact: humans are the main predator of other humans. Hey, it is laid out, right there in Genesis: when Cain slew Abel.

Paternal sperm are modified by the environment that signals long or short life with “D.N.A. messages” [4]. My paternal grandmother often said, “What goes around comes around.” The bad news is that it still happens today in Black, Brown, Red, and White communities all over America who struggle to survive socially, physically, and spiritually. 

The Good News is that the United States of America has the best practical, cost-effective, and fast-acting proven behavioral and medical science—easily accessible via the U.S. Institute of Medicine founded by Abraham Lincoln (www.pubmed.gov). That hard-won prevention science is cost-effective and scalable to whole states, provinces, and even countries. 

Why haven’t all Congress members, Cabinet, Governors, senior federal officials, members of state legislatures, and other movers and shakers have not heard of this practical, scalable science? Why hasn’t the practical, proven, and cost-effective science been written into law or federal agency plans? It’s simple:[§] The combined total revenue for all 13 major pharmaceutical companies over eight years was about $3.78 Trillion. 

Psychotropic medications for children are the largest single expense of Medicaid [5, 6], and it grows about a billion dollars a year. More and more pills are not curing our children and their futures. Hey, with nearly 4 trillion dollars in revenue, you can buy almost anything or anyone, just saying.

 

Strangely enough, the National Institute of Health (N.I.H.) and the Centers for Disease Control (C.D.C.) have funded proven strategies that can nuke most of this mental, emotional , behavioral, and psychiatric problem among America’s children. The quality of many prevention studies greatly exceeds any evidence for the effectiveness of pediatric psychotropic medications—costing less money and with lifetime benefits. Consider just one example.

The country is afire about Adverse Childhood Experiences. People breathless ask me, “Do you know about A.C.E.’s?” Of course, I do as a child psychologist and prevention scientist. I also do as a child who had five serious A.C.E.’s.   

Dear readers, do you know that serious child maltreatment (physical and sexual) can be prevented for $7 per child in a state—with a ridiculously simple strategy proven by the Centers for Disease Control [7]? It was not therapy, not home visits, not medication! It was a relatively simple promotion of proven strategies that helped families deal with common behavioral problems that trigger child maltreatment. As a prevention scientist, my colleagues and I fundamentally knew this and what to do in the 1980s—40 years ago. It was not about the problem of maltreatment, which was never mentioned at all in the prevention efforts. It was about helping families have practical, proven simple strategies that solved everyday parent-child conflicts like getting ready for school, doing chores, completing homework, or getting ready for bed.

Is this proven strategy being used widely in America to prevent and reverse child maltreatment and A.C.E.’s? Hell, no. Should it be? Heavens yes! 

It could easily be done at a national level, but it is a wholly different approach than focusing on case-finding, home visits, and the courts. Other countries use this population-level prevention approach, but not America—even though American science proved it worked.

Would such a strategy disseminated nationally help reverse historic disparities? Absolutely! And it is just one of many proven strategies that change our country and the world for the better. Now is the time, now is the time. NOW!

Future columns will provide additional proven examples, which will build America’s children back better as fast as possible, given both past problems and the epidemic’s effects.

* * * *

References

1. Costa, D.L., N. Yetter, and H. December, Intergenerational transmission of paternal trauma among US Civil War ex-POWs. Proceedings of the National Academy of Sciences of the United States of America, 2018. 115(44): p. 11215-11220.

2. O’Connell, M.E., T. Boat, and K.E. Warner, eds. Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities. Committee on the Prevention of Mental Disorders and Substance Abuse Among Children, Youth, and Young Adults: Research Advances and Promising Interventions. 2009, Institute of Medicine; National Research Council: Washington, DC. 576.

3. Mathews, A.W., So Young and So Many Pills: More than 25% of Kids and Teens in the U.S. Take Prescriptions on a Regular Basis, in the Wall Street Journal. 2010, The News Corporation: New York.

4. Donkin, I. and R. Barrès, Sperm epigenetics and influence of environmental factors. Molecular Metabolism, 2018. 14: p. 1-11.

5. Soni, A., The Five Most Costly Children’s Conditions, 2006: Estimates for the U.S. Civilian Non-institutionalized Children, Ages 0-17., A. Center for Financing, and Cost Trends, Editor. 2009, Agency for Healthcare Research and Quality: Rockville, MD. 20850. p. 5.

6. Soni, A., The Five Most Costly Children’s Conditions, 2011: Estimates for U.S. Civilian Noninstitutionalized Children, Ages 0-17, A.f.H.R.a. Quality, Editor. 2014, Agency for Healthcare Research and Quality: Washington, DC.

7. Prinz, R.J., Toward a population-based paradigm for parenting intervention, prevention of child maltreatment, and promotion of child wellbeing, in Preventing child maltreatment: Community approaches, K.A.D.D.L. Coleman, Editor. 2009, Guilford Press: New York, NY, U.S. p. 55-67.

[§] https://truecostofhealthcare.org/the_pharmaceutical_industry/

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About the Author

Dennis Embry

Dennis Embry is a prominent prevention scientist in the United States and Canada, trained as a clinician and developmental and child psychologist. He is president/senior scientist at PAXIS Institute in Tucson and co-investigator at Johns Hopkins University and the Manitoba Centre for Health Policy. Dr. Embry serves as a National Advisory Council member and Chief Science Advisor to the Children’s Mental Health Network.

The Child Welfare League of America has recognized Dr. Dennis Embry as one of the 100 Champions for Children. As part of CWLA’s 100th-anniversary celebration, they chose to recognize the exceptional commitment of individuals, organizations, and corporations who serve as champions for children and those who work on their behalf. Dennis Embry has devoted a lifetime of service on behalf of young children and their families.

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