In his semi-autobiographical book Poverty Safari Darren McGarvey reports that when he talked to the media and spoke at meetings, people wanted him to tell them about ‘his dead mum’.
Darren’s personal story is acutely dramatic and it’s easy to see how the media would be drawn to its more sensational elements. But humans, as a species, think and communicate in stories. So, Darren’s dramatic tales of his childhood and adolescence were bound to have a compelling effect on listeners.
In contemporary Scotland there’s a rising tide of interest in the effects of Adverse Childhood Experiences (ACEs). These refer to a growing body of research on the negative effects of household dysfunction on a child’s life. These effects don’t simply undermine the child’s physical and mental well-being. They can also affect that individual’s mental and physical health for their whole life. McGarvey doesn’t ever directly mention ACEs but he certainly understands some of the science underlying this research and Poverty Safari undoubtedly helps readers to understand the significance of childhood experiences on mental and physical health.
The ACE research
As a result of their research the two doctors at the heart of the ACE concept, Anda and Felitti, drew up a questionnaire which asks respondents ten questions about their experience of household dysfunction until their late teens. Were they hit, sexually abused, emotionally/verbally abused, or emotionally neglected? Did their parents split up? Was their mother beaten up? Did someone in the household abuse alcohol or drugs or suffer from depression or take their own life? Was someone in the household imprisoned? And were their physical needs (for food and shelter) catered for? Respondents get a point for each yes.
The story Darren recounts of his childhood and adolescence involves many ACEs. His mother was an alcoholic and a hard drug user. McGarvey was often physically abused by his mother. He was also verbally abused and humiliated. His emotional needs for love and affection were not routinely met. He often went hungry and could go to school not properly dressed. And his parents split up.
The ACE questionnaire is not a precise instrument and is simply trying to measure the amount of ‘toxic stress’ to which a young person was subjected. Darren does not say anything about his mother being hit but he does recount watching his siblings being physically abused. For example, he recalls ‘a child being tied to a chair for being cheeky’ and ‘a baby being booted across the floor for crying by the faceless male drunk she had in occasionally’. Incidents like these would have a similar effect to watching your mother being beaten. Also, his mother’s drink and drug habit was so acute, finally leading to her death at the young age of 36, that this is akin to a parent having a mental health problem or committing suicide. So according to McGarvey’s story he scored at least 8 ACE points.
This is a conservative estimate of the amount of toxic stress McGarvey endured. The ACE questionnaire only looks at ten common causes of household dysfunction. It doesn’t include factors which also have this impact on young people but which occur outside the home such as community or peer violence (something Darren McGarvey reports he suffered from) and homelessness, (which he also experienced as a teenager). Nor does the ACE questionnaire give extra points for the severity of the adverse experience. It’s certainly clear from Darren’s story that things happened to him that no child should have to endure.
According to the ACE research there is a very clear ‘dose dependent’, graded relationship between adversities and future outcomes in mental and physical health, addictions and violence to name only a few of the damaging effects. Some of the figures are startling. For example, studies show that only one per cent of those with an ACE score of zero have ever tried to commit suicide but someone with a score of 4 or more is 1220 times more likely to attempt suicide. The American research shows that a child who scores 7 or more ACEs grows up with a 360 per cent higher chance of developing heart disease. People with an ACE score of 6 or higher are at risk of their lifespan being shortened by 20 years. This is a figure that Scots should pay attention to since we have one of the worst, but as yet unexplained, premature death statistics in Western Europe.
ACEs may also explain our problems with drugs and alcohol. An ACE study in Wales has shown that someone who scores 4 or more is four times more likely to be a high-risk drinker and 16 times more likely to have used crack cocaine or heroin than someone who scores zero. Higher ACE scores reveal even more staggering correlations with health-harming behaviours. For example, a boy with an ACE score of 6 has a 4,600 per cent increase in the likelihood of using illicit intravenous drugs, such as heroin, later in life than someone who scores zero. Violent behaviour also correlates with ACEs. The Welsh study shows that individuals who scored 4 or more ACEs were 15 times more likely to have committed violence against another person in the last twelve months than someone who scored zero. McGarvey’s life is testimony to these trends. When he was in his late teens he became an alcoholic and a user of hard drugs.
ACEs and toxic stress
But why should ACEs lead to substance misuse and have such a profound effect on mental and physical health? The answer is ‘toxic stress’. Our stress response involves the release of certain hormones. It is designed to be activated when there is danger, then switch off when that danger has passed. But when a child grows up in a fearful, unpredictable environment their stress response can stay permanently on. Stress hormones have a profound effect on the developing brain and immune system. They can set the child up for future, if not current, ill health. The term ‘toxic stress’ is used to convey the idea that this is a particularly injurious type of stress because the child has no escape. They can’t flee or fight. They can only freeze.
ACE researchers use the term ‘hypervigiliance’ to explain how stress becomes the dominant state and it’s a term Darren uses to explain what happened to him:
The hypervigilance that had helped me to navigate my difficult childhood was now turning like a screw in the back of my waking mind, making it almost impossible for me to feel relaxed. Drugs relieved me of this burden. They soothed those difficult emotions. They did exactly what they were designed to do: they killed the pain. And they were so effective that life without them quickly became too difficult to bear. Before long, a life without drink or drugs was too abstract to contemplate.
This is such a succinct explanation of one of the reasons why ACEs can undermine lives. Many people who suffer from multiple ACES can never relax and switch off. The constant feeling of pain leads so many to self-medicate. They turn to the numbing effects of drugs and alcohol, something we can see in the ACE data.
McGarvey also argues that hypervigilance is an issue for many people in Pollok. He maintains that day to day violence is common for many living there but that even when there is no reason to be fearful ‘the state of hypervigilance keeps you on alert regardless, making daily life considerably stressful.’ These feelings of anxious expectation of violence or trouble are then heightened by day to day feelings of insecurity which emanate from poverty.
The existence of emotional stress, how it affects us and what we do to manage it throughout our lives, is one of the most overlooked aspects of the poverty experience.
The class dimension
He points out that everyone, regardless of class, can experience stress and that sometimes stress can be positive as it motivates people to take action. He also acknowledges that middle-class people can also suffer from stress- induced illnesses. McGarvey paints a positive picture of life in Glasgow’s west end, for example. He went there as a young lad to attend therapy and the way he describes his first visits is memorable. He immediately thought the atmosphere on the busy street was oddly that of ‘relaxation’ – the pavements were clean, docile dogs went by on leads (unlike the feral hounds he was used to), and people dressed to suit themselves and not because they are ‘afraid of being stabbed’.
But household dysfunction can lurk behind the tranquil exterior of houses in more up market neighbourhoods. There too it can undermine children’s lives. This is one of the central messages in my new book Hiding in Plain Sight where I explore what it was like to grow up in Milngavie’s upmarket council estate in the 1950s and 60s. Few people suffered from the type of extreme experiences that Darren recounts in his own life. There was little violence in the street but nonetheless the health of some of my peers has been poor. For reasons I outline in the book, I put much of this down to ACEs.
In a recent blog entitled ‘It happens in Nice Middle Class Families Too’ Mairi Stones describes living in a big house in a village in a family that owned a yacht and two cars. Her father ran his own successful business employing over a hundred people. They had all the things that money can buy including lovely annual holidays. But ‘hidden beneath this façade of loveliness lurked some giants’. She now knows they would be called ACEs but she has always just thought of them as her ‘dysfunctional alcoholic upbringing’. She discloses that she lived with ‘physical, emotional and sexual abuse’ and witnessed domestic violence.
Stones reminds us that deprivation takes many forms. Even though she grew up in a family with a ‘cushion of cash’ she was deprived of feelings of love, protection and security. The result was ‘devastating’. What’s more, as a rich girl she perpetually doubted her right to feel unhappy with her lot. This reinforced her poor sense of self-worth.
Research in the UK shows that ACEs affect people from all classes. However, those though who score 4 or higher tend to come from poor backgrounds. That said all of us interested in ACEs have to maintain a balanced perspective. Alleviating poverty and better and more generous public services have a big role to play in reducing ACEs. So such changes are of fundamental importance. But it is also important that professionals don’t focus on ACEs in a way that suggests that the problem is all about poor kids. It isn’t. It simply isn’t true that it is only the poor and those living in deprived communities who grow up with adversities.
In my book I argue that bringing up children is Scotland’s Achilles heel. Historically, many of us have suffered not just from harsh punishment but also from the emotional abuse and neglect which is endemic in our culture. This is hard to accept but we won’t see improvement in health or other social indicators until we start looking closely at children’s experiences.
Hope and resilience
Darren McGarvey suffered acutely from a variety of ACEs. His is a tragic story but it also offers hope. Despite what happened to him he has grown up to become a creative, original thinker. An astute social commentator. And we must always remember that ACEs do not completely predict someone’s destiny. Resilience also matters.
If we examine McGarvey’s story we see that he survived because various people helped to foster his resilience. School was not only a safe space. It allowed him to come into contact with people who looked out for him and showed they were interested in his welfare. Despite his dysfunctional mother, who was also a victim of her own upbringing, there were other people in Darren’s family who gave him support and encouragement. Later he received some helpful psychological therapy. A few years in the Fire Station project for homeless young people also helped enormously.
I think it telling that Darren McGarvey ends Poverty Safari on the subject of child-rearing. He writes:
Today, I realise that the best contribution I can make to society is to raise a healthy, happy secure child. Today, I realise that the most practical way of transforming my community is to first transform myself and, having done so, find a way to express how I did that to as many people as possible.
He’s aware that many on the left will see this as a cop out but he’s ready with his reply. Of course, the left must continue to argue and campaign for structural change, he tells us, but no real change can happen unless poor people begin to feel powerful in their own lives.
Indeed, Darren McGarvey ends his book with a challenge to us all. Personal change, he asserts, ‘is the most radical thing a person can do’. And for many that means changing not just their lives but the way they bring up their children.
The first part of Carol Craig’s two-part review of Poverty Safari was published here in January
Poverty Safari (Luath Press) is available in bookshops and online via Amazon, i-Tunes etc