A couple of years ago when I got into a cab I’d ordered the driver said, ‘You’re Carol Craig from Milngavie. You lived round the corner from us.’ He was right. As I looked at the very overweight man sitting behind the wheel I could just about see the wee boy who lived over the back.
In the course of the thirty minute journey my driver could only talk about the fortunes of those who grew up with us in Milngavie’s council estate. It was a litany of premature death, heart problems, cancer, disability and alcoholism. It was easy to see that the ill health of our generation really troubled him and that he was desperate to know why we had fared so badly.
In the past year I’ve had numerous discussions with another man from Milngavie whom I also knew when we were young. Scott (not his real name) also wanted to talk about the deaths and poor health of our generation. However, he and his family were so struck by how many of the children raised in their street had died that they did some calculations. The results are startling.
If I had met these men a decade earlier I would have felt concerned and troubled by the fate of my peers but ultimately I would have thought that what was happening to them had little bearing on my own story. Now in my mid 60s, and suffering from various debilitating complaints, my perspective has changed. When I look at my own and my older sister’s life I see the impact of our childhood. It has not led to our premature deaths but, for years, it has undermined our health and the quality of our lives.
Tears for fears
When I wrote The Tears that Made the Clyde in 2010 about poor health in the city I was aware that the culture I described surrounded me in childhood. My father grew up in Maryhill and my grandparents still lived there when I was young. I dedicated the book to my two Glaswegian grandmothers. Nonetheless writing the book in a leafy West Stirlingshire village meant that many aspects of that Glasgow story felt far removed from my own life. From my reading of research into well-being I was aware that I was blessed with all the important factors for physical and emotional health – optimism about the future, a strong sense of meaning and purpose, easy access to a beautiful natural environment, financial security and close relationships with family, friends and colleagues. In short, subconsciously I felt that the health problems of people living in Glasgow had little direct relevance to my own life.
Nor did I think that health figures for Scotland had much significance for me. Scotland has the worst health in Western Europe for men and women. It is now lower than in many former Communist countries. Scotland’s health is improving but slower than in other nations, particularly those in Eastern Europe. Our poor health can be seen both in our low life expectancy figures and the age at which people become affected by long term conditions. In other words, our healthy life expectancy figure is also low. The health of poor people in Scotland is particularly bad and Scotland is among the countries with the widest health inequality gap in Europe.
The Glasgow Centre for Population Health (GCPH) is the organisation in Scotland which has done most to uncover the extent of Scotland’s health challenges. Their research shows that after controlling for poverty and inequality (factors well-known to undermine health) Scotland has proportionately 5,000 more deaths each year than England. In one GCPH study researchers compared Glasgow, Liverpool and Manchester, remarkably similar cities in terms of poverty and inequality. This shows that Glasgow has 30 per cent higher premature mortality than the English cities. What’s more, this morbidity is not confined to poor Glaswegians: even middle class Glaswegians do not fare as well as their counterparts in Liverpool and Manchester.
My taxi driver is not alone in his desire to know why. Various people, including myself, have advanced various hypotheses to account for this ill health. David Walsh, GCPH’s lead researcher has examined scores of these hypotheses and found many of them to be either implausible or unsupported by empirical evidence. In the summer of 2016 Walsh, and three other researchers, published a new GCPH paper in which they present their own explanatory model for Glasgow’s, and Scotland’s, ‘excess mortality’. It is supported by thirty top medical people and social researchers in Scotland. It is an impressive work and Walsh et al convey the problem powerfully. However, when I understood their explanations for Scotland’s health problems – New Towns Policy, for example – I was perplexed. I simply couldn’t align my own perceptions and experiences with what they were arguing.
At the time of reading this new GCPH paper I was in the midst of helping Scott log the deaths of his childhood peers. I was also in the midst of dealing with some of my own negative childhood experiences. My parents had died three years earlier. I was very close to my mother and her death gave me permission to confront the various ways I had suffered as a child, some of which I outline in later chapters. This would have been too painful for my mother to bear and I just couldn’t have faced it while she was alive. I also had mounting health problems and had been suffering from severe insomnia for almost five years.
Adverse childhood experiences
From our own ‘lived experience’, to use a fashionable social science term, Scott and I both believe that the answer to our peers’ ill health is to be found in our childhood and youth. We both suffered from various types of maltreatment and we know that many of our peers did too. There is now a wealth of evidence to support our contention that these events hold the key to the deaths or ill health of those we grew up with. This is to be found mainly in the developing research and literature related to ‘Adverse Childhood Experiences’ or ACEs as they are known.
If I had to use one word to describe my upbringing it’s ordinary. I grew up in the 1950s and 60s in an ordinary Scottish working class family. I was part of the post war baby boom so there were lots of youngsters my age. Thanks to the huge amount of building that took place after the war many of us grew up in new houses, often in new housing estates. Many of us took for granted things our parents had only dreamed of. Back and front doors. Gardens. Swing parks. Green spaces.
Looking back everything about life for me as a child seemed middle of the road. The environment was neither urban or rural. We weren’t poor but we weren’t rich either. We knew our neighbours but there was no great sense of community. We sometimes went to church, and I attended Sunday School, but religion was marginal. I’m embarrassed to admit that the major influences on my life came from the telly (The White Heather Club, Sunday Night at the London Palladium, Coronation Street, Z Cars …) or from popular culture. But I think that was true of lots of people which brings me back to feeling very ordinary.
Nowadays my sense of being ordinary has taken on a sinister aspect. I am now aware that I experienced a lot of toxic stress in my young life. Via pain, I’m still feeling the consequences decades later. Did lots of Scots of my generation (and others) suffer too – many of them much worse than me? Is this what’s driving Scotland’s poor health statistics?
Sadly, that’s the conclusion I’ve reluctantly reached after reflecting on my own and Scott’s experiences of growing up in Milngavie and then beginning to discuss these issues with friends and acquaintances. I have been bowled over by some of the stories people told me. When I put these stories alongside my growing understanding of how stress in childhood damages health, and my knowledge of how modern Scottish novels and films are awash with childhood adversities, I had an epiphany: childhood suffering is the key to Scotland’s ill health. In fact it is so evident – staring us in the face almost everywhere we look – that we could say it is ‘hiding in plain sight’.
Of course, childhood adversities happen in all countries and cultures and they remain a hidden source of mental and physical ill health everywhere. Scotland isn’t different in this regard. But prevalence of Adverse Childhood Experiences varies from country to country – culture, particularly the consumption of alcohol and drugs, has a significant effect. It is perfectly plausible, though painful to accept, that the Scots have experienced more ACEs than people in other Western countries.
Some people whom I asked to read the first draft of this book found the content painful. A few cried. Readers can find the subject harrowing because it stimulates them to think either about their own painful childhood or the distress suffered by loved ones or clients. Thinking about adversities in childhood can be particularly difficult for parents as it makes them contemplate the negative events in their own children’s lives.
Releasing the child in us
As I knew this book would be a hard read for many people I regularly wondered whether I should be writing it. I studied positive psychology for long enough to know the value of positive emotions such as optimism, hope, forgiveness and gratitude. I know too that it is good for our physical and mental health if we can tap into good, not bad, memories when we think about the past. And here I am dwelling on all these negative experiences.
But even positive psychologists acknowledge the importance of negative emotions for well-being. Pessimism is sometimes appropriate and it’s unwise to forgive or feel gratitude towards someone who continues to abuse you. More importantly, suppressing memories absorbs a great deal of psychic energy and cutting off from our feelings, stops us from leading rich, fulfilling lives. Even if we don’t want to feel the pain from the past or confront what’s happened to us as we age, these feelings can muscle their way into our lives unbidden. We can start to feel anxious or depressed or have what people used to call ‘a nervous breakdown’. To help cope with bad feelings we may turn to alcohol or other substances to help numb the pain thus multiplying our difficulties. So, acknowledging what’s happened to us in the past can be a positive strategy, particularly if we then take steps to release painful emotions. Indeed as is clear from classical story structure we can only grow as individuals when we struggle to overcome challenging experiences and feelings.
For over two years now I’ve had to devote a huge amount of time and resources to my health just so that I can lead something like a normal life. But in the past few months I’ve been spending more time doing things which are known to help repair the damage of toxic stress and I’m beginning to see results. And this is the good news. At any point in our lives we can heal. But to take steps to heal we have to admit there is a problem.
I hope that this book will encourage others to talk about their lives and what happened to them in childhood. In the 1950s and 60s many of us were abused as children, (not necessarily sexually) both at home and at school. I think we should talk openly about the fact that what many of us had to endure wasn’t right. We were often treated badly by parents (and teachers) not because they were bad people but because they didn’t know any better or because they were simply repeating what had happened to them as children. Often they just couldn’t help themselves. But while it is good to forgive this doesn’t erase the hurt or the damage many adults inflicted, sometimes unwittingly.
In the next few years Scotland will become more involved in talking about Adverse Childhood Experiences. The research is powerful and internationally it is becoming a fashionable focus in public health. But, given the importance of this research to understanding health in Scotland, it is vitally important that this isn’t just a professional exercise. We need to be involved as individuals and in our various civic groups. We need to speak up for ourselves and other children from Scotland’s past. We need to fathom out how to protect subsequent generations. As a society we need to recognise how a good childhood, free of toxic stress, forms the basis of future physical and mental health. And as a country we need to admit that nurturing children has never been one of Scotland’s strengths.
This is the introduction to Carol Craig’s new book, Hiding in Plain Sight, just published by CCWB Press (2017) and available to order online from www.postcardsfromscotland.co.
Photo of Glasgow tenements by Nick Hedges for Shelter Scotland and used in the Make Life Worth Living exhibition in Edinburgh in 2015