ACEs scores and trauma tourism

The culture of pain consumption

The ACEs (Adverse Childhood Experiences) questions were developed as a tool in the early 1990s for use in a collaborative study between Kaiser Permanente and the CDC to "[investigate] childhood abuse and neglect and household challenges and later-life health and well-being.” The first major findings were published in 1998, but the impacts of that article didn’t enter mainstream conversation for roughly another decade.

Since the early 2010’s, the conversation around “trauma” has become vast and overwhelming. The phrase “trauma-informed” has crashed into every nook and cranny, as local, state, and federal service agencies scramble to implement “trauma-informed” practices, whether or not they truly understand their efforts. “Trauma-informed” has become a throw-away phrase, and labeling organizations as such tells us little about their actual understanding of the impacts of trauma and how to best counter those impacts.

Perhaps the most ubiquitous and repellant practice related to the study is the introduction of the ACEs questionnaire (or “quiz,” as NPR called it in an unlinked article) into common usage during intakes or group activities, possibly also as a diagnostic or treatment tool.

These questions were developed for use in a large, anonymous study with willing participants who agreed to share sensitive information about themselves. Because the originators of the study were gathering information about childhood abuse and dysfunction, the questions are in a yes/no format, and the wording is direct and specific, designed only to elicit information and not tend to the emotional needs of participants. I may not like this kind of approach, but in terms of gathering information, it is a common format and the study participants were volunteers.

In the last three years, discussion about ACEs scores has crept into the public (i.e. non-confidential) thinking and language of service providers, referencing scores as diagnostic information, part of intake processes, or even as an icebreaker for some types of teambuilding and “bonding.” These questions, designed to gather data on a large scale, are poorly suited for working with people one-one, and even more unsuited to group environments1. It should not be a surprise that this research tool has been misappropriated, but that misappropriation highlights a profound ignorance of how trauma impacts the body and brain. (see Van Der Kolk, Burke-Harris, and Menakem)

Using these questions as part of an intake process is irresponsible and callous. They provide no useful information, beyond knowing whether someone was subject to one or more traumatic experiences (a given for any person on the planet). The score itself is subject to question because people may not remember, or may have normalized what happened so they do not think of it in the framework of the question. For others, even reading the questions can be upsetting and potentially re-traumatizing. Using any kind of question about trauma history in a teambuilding environment is truly appalling, verging on trauma tourism.

I use the phrase “trauma tourism” (most often defined in the context of actual tourists visiting sites of extraordinary mass trauma) to describe the behavior of a group of people avidly listening and watching as individuals recite things that happened to them. Once the recitation is complete, they turn their attention elsewhere, leaving the person to cope with any emotional or physical aftermath alone.

If you have been forced (either implicitly or explicitly) to divulge your pain in ways that haven’t served you, I am sorry. That is another thing that should not have happened to you. If you are someone who has witnessed these types of behaviors in your organization or group, please make the effort to interrupt the practice.

It is cruel and reprehensible to use a person’s traumatic experience as a way to force them to ‘trauma bond’ with other people. In these spaces, trauma porn2 and trauma tourism are are commonly accepted as “connection building,” although little or no attention or care is offered after people have shared their traumatic experience. Even less care is offered to those who might suffer secondary or tertiary trauma as a result of hearing these painful recitations.

Trauma tourism demonstrates a nauseating lack of compassion, combined with a fundamental misunderstanding of the nature of trauma. Constantly consuming the pain of others cannot help but lead to serious ill-being and unwellness in trauma tourists, or those who seek trauma porn. Groups and organizations that seek bonding experiences predicated on consuming traumatic experience are likely dysfunctional and unhealthy, and should immediately re-evaluate their approach.

Trauma resolution, integration, or healing (a word I use with caution) cannot happen when people are constantly asked or expected to recite and relive those experiences. While the impacts of trauma can absolutely be addressed through thoughtful , supported storytelling exercise and practice, trauma tourism and misuse of ACEs questions and scores are not thoughtful or supportive.

1

A caveat to this critique is that some people have found going through the questions useful for themselves, to better understand their own histories. My critique is not aimed at the ACEs questions themselves, or that they are publicly available.

2

The rise in mobile phone cameras and viral video footage has created a culture of trauma porn, a fascination with the suffering and pain of others.