A young man showed up in the Emergency Department complaining of abdominal pain. He was somewhat heavy set, puffy like a Pillsbury Doughboy, and smelled strongly of tobacco smoke. We started to work him up to determine the cause of the abdominal pain – the pain was fairly high up in the abdomen, and he talked about shoulder pain as well, so we included an electrocardiogram, on the chance that the pain might have something to do with dysfunction of his heart. While we were waiting for test results, he declared that he needed a smoke and proceeded to unhook the monitor leads and get off the stretcher. We remonstrated with him, told him that if he was having a heart attack, a smoke was just what he did NOT need, that smoking might well be the death of him. I will never forget him saying “I would rather die than give up smoking.” He went out, had his smoke, lay back down on his stretcher, and proceeded to do exactly what he said he would rather do: die. We of course called a code, but there was no resuscitating him. He was well and truly dead.
This episode happened over forty years ago, but I remember it as clearly as though it happened yesterday.
I could not resist buying a book entitled: “Even if it cost me my life”. The topic was constellation therapy – a way of treating illness or dysfunction in a person today which originated as many as three or four generations ago, and whose ripples continue to be felt until the healing finally occurs, in whatever generation the dysfunction finally stops.
Religions have their own doctrinal ways of dealing with this concept. The sins of the fathers are visited upon the sons unto the third and fourth generation. We baptize those of our ancestors who never officially received the sacrament of baptism, that they may finally enter the Kingdom of Heaven. Our scientists discover that nutritional deficiency in one generation causes lasting epigenetic changes even in the third generation down the line.
All of this is to explain my sense of curiosity about the number of patients I see in my office every week who have some horrific tale to tell about their childhood. Incest, physical abuse, emotional abuse – these tales come up again and again, as we go through our initial interview. It’s not exactly the kind of material that gets written down on intake forms – sometimes it is the very last thing the patient says, as they are about to leave the office. “Oh, by the way, doctor…” one of those stories that suddenly pulls the whole case together.
I began to wonder whether other physicians had the same experience, so I started searching the literature.
I found a host of articles about “childhood adverse events” that advocated programs to intervene in the child’s life before the child became a criminal, some that even advocated intervention in the parent’s life as well when the child was an infant and determined to be “at risk”. There were lots of articles about the association of childhood abuse and teen depression, adult heart disease and diabetes. But nowhere did I find anything in the peer-reviewed literature like the work of Louise Hay.
In a New York Times interview in 2008 we read about her life:
She was born in Los Angeles to a hard-luck mother who soon married Louise’s brutal stepfather. There was violence within the house and without: when she was about 5, Louise was raped by a neighbor. Ten years later she dropped out of high school, became pregnant and, on her 16th birthday, gave a newborn girl up for adoption. She moved to Chicago, worked at menial jobs and in 1950 left for New York, where she took on a new name — she was born neither Louise nor Hay — and was, to quote You Can Heal Your Life, the 1984 book that made her rich and famous, “fortunate enough to become a high-fashion model,” working showrooms for Bill Blass, Oleg Cassini and Pauline Trigère. In 1954 she married the English businessman Andrew Hay, with whom she “traveled the world, met royalty and even had dinner at the White House.”
When after 14 years of marriage Andrew Hay left her for another woman, Louise was devastated. But soon she found her way to the 48th Street home — it’s still there — of the First Church of Religious Science, one of many early-20th-century groups that heralded the transformative power of thoughts. “I heard somebody say there, ‘If you’re willing to change your thinking, you can change your life,’ ” Hay told me. “My jaw dropped. I said, ‘Really?’ And I, who had never been a student, became an avid reader.” What she read were metaphysical tracts by 1920s-era authors like Frances Scovel Shinn, who said that positive thinking could change people’s material circumstances, and the Religious Science founder Ernest Holmes, who taught that positive thinking could heal the body. In the early 1970s Hay became a Religious Science practitioner, leading people in spoken “affirmations” meant to cure their illnesses. She became popular as a workshop leader, and soon she moved beyond Religious Science, studying Transcendental Meditation with the Maharishi Mahesh Yogi at his university in Fairfield, Iowa.
In 1977 or 1978 — she can’t remember which — Hay found out she had cervical cancer, and she concluded that its cause was her unwillingness to let go of resentment over her childhood abuse and rape. She refused medical treatment, she says, and with a regimen of forgiveness, therapy, nutrition, reflexology and occasional enemas, she claims she rid herself of cancer. There is, she says, no doctor left who can confirm this improbable story — “It was years ago!” — but she swears it is true.
Hay created a long list of symptoms with their attendant emotional causes – largely on the order of anger and lack of forgiveness or letting go of old hurts. Her most famous book, entitled “You Can Heal Yourself”, to date has sold over 40 million copies. It is still in print and available on Amazon.
Louise Hay is the perfect example of someone who experienced extreme childhood trauma and came out the other side – on the positive side – by devoting her life to helping the traumatized to heal.
How did she end up being so successful, with an apparently very satisfying life – albeit one without children or blood family? Apparently generational trauma does not necessarily have to result in dysfunctional offspring. There is hope for healing – but I suspect the hope lies in being willing to give up the anger and resentment that are natural accompaniments of the state of victimhood. Louise Hay herself said that her cervical cancer was caused by her unwillingness to let go of the childhood rape experience. Once she realized the connection and did let it go, the cancer apparently regressed and was no longer a factor in her life.
The Buddha is said to have remarked that holding on to anger is like drinking poison and expecting the other fellow to die.
Plenty of animal studies have shown the effect of environment on subsequent generations. “In essence, epigenetic modulation results in functional adaptations of the genomic response to the environment and is believed to play a fundamental role in early developmental plasticity.”  In other words, changing the environment results in changing the DNA expression – not the DNA itself, but the way it expresses itself – not only in the affected organism, but also in its offspring.
This happens not only in animals, but also in humans. “Adverse psychosocial exposures in early life, namely experiences such as child maltreatment, caregiver stress or depression, and domestic or community violence, have been associated in epidemiological studies with increased lifetime risk of adverse outcomes, including diabetes, heart disease, cancers, and psychiatric illnesses. Additional work has shed light on the potential molecular mechanisms by which early adversity becomes “biologically embedded” in altered physiology across body systems.” 
It's the old “nature vs nurture” argument, only now we see that it’s really both. Our genes determine our stature, to a certain extent, but not 100%. Childhood malnourishment will result in shorter stature, and often, initially, thinner bodies. However, those bodies are adapted to poor quality or quantity of nutrition. When later in life nutrition becomes adequate, those bodies tend to gain weight easily, hold on to that weight, and even develop physical illnesses such as diabetes as a consequence.
Childhood traumatic experiences can disrupt neural development – priming it for “fight, flight or freeze” instinctive reactions later in life. Those same experiences can result in chronic inflammation, as the body prepares to heal from wounds of war, or immune dysregulation, as the body tries with great difficulty to distinguish “self” from “not self” once the physical walls have been breached, as happens in cases of incest – and the incest need not necessarily involve physical penetration. It may simply consist in a parent living out their life dream in their child. The definition of “me” vs “not me” may be quite fluid, when the child does not get the experience of becoming an individual separate from the parent.
Chronic low energy, chronic fatigue, is also correlated with unresolved childhood and ongoing adult stress. When we are always poised for battle, our immune system gears up for survival – increased white cells to fight off bacteria introduced by the lion’s claws, increase platelets to deal with the inevitable bleeding from wounds, increased peristalsis to empty the bowel before battle, increased stress hormones to enable us to focus on the immediate threat, ignoring whatever else is around us.
Some go so far as to suggest that the absence of a caring and nurturing parent is likely to result in the absence of caring and nurturing in the offspring. An international society for developmental origins of health and disease has formed, seeking answers to the origins on adult illness in childhood. It is sad to realize that for most, the effect does not appear to attenuate with age. Some authors go so far as to suggest that many adult diseases like diabetes and heart disease be viewed as developmental disorders, based on family history.
The Holocaust survivor studies showed measurable effects of parental and childhood trauma in the death camps related to ongoing health dysfunctions. Children whose parents were raised in residential Indian residential schools in Canada were much more prone to depression than those raised in their own families.
One important distinction to be made is the one between parental stress and parental psychopathology. It is sometimes difficult to make that distinction, since severe parental stress (e.g. with experiences of the Holocaust, for instance) may indeed result in parental psychopathology. For example, fight or flight reactions express themselves differently in different people, due to native temperament, vicarious suffering because of descriptions of parental trauma, the degree of parental ability to forgive the perpetrators, anger at the perpetrators expressing itself as anger at those around the parent, resulting in direct parental trauma to the child. It is this parental psychopathology due to stress that Constellation Therapy aims to address.
The Chinese have a saying: “Treat the mother, treat the child.” I was taught this phrase when we discussed treating infants with acupuncture – the idea was that whatever symptoms the infants appeared to have were treated on the mother’s body by acupuncture, and the results would translate to benefit to the infant. Contemporary social medicine is beginning to pick up on that concept, developing programs to treat the mothers of infants perceived by health care workers to be at risk of later dysfunction.
Activation of the HPA axis by stress in the parent results in increased blood levels of cortisol by the adrenal glands. High levels of cortisol over time produce a change in physiology – increased inflammatory changes, increased blood sugar levels, increased vigilance. Eventually either the organism adapts to the stress, and cortisol levels return to baseline, or the organism stays in high-stress mode, and the organism adapts to the higher levels of hormones as best it can. Sometimes that best results in development of high blood pressure, depression, anxiety, diabetes, heart disease… The list of potential illnesses due to continued activation of the stress response system is nearly endless – although not all correlations have been proved statistically.
In its wisdom, the maternal body transmits only about 20% of its blood cortisol level to the developing fetus, so there is a buffer of sorts against severe maternal stress.
Maternal stress can and does cause the fetal brain to rewire itself, such that exposure to increased levels of steroid hormone – whether synthetic or natural – results in lower volume of the pre-frontal and frontal cortex (the area of the brain which enables us to make executive decisions) and the hippocampus (that part of the brain that translates peripheral sensation to emotional and physical response). No wonder those children are so prone to dysfunctions like depression and PTSD. And their ability to “think” their way out of the dysfunction may well be limited by the demonstration that their brains have a thinner cortex – where the nerve cell bodies are located – on both sides of the brain, right side more affected than the left side. Typically, we think of the right side of the brain as more associated with intuitive thinking, the left side with logical thinking. If they are less able to access intuitive skills, they may be unable to make the leap between logical thinking and intuitive understanding of potential causes of their dysfunctions.
Is there, then, no hope for those who have been abused in childhood? Are they doomed to repeat the trauma endlessly through the generations? Clearly, this is not the case. How a given person responds to trauma depends on many factors including “genetic dispositions, epigenetic processes, stress-related hormonal systems and immune parameters”
Louise Hay made a list of physical ailments and the emotional dysfunctions from which they spring. On a bioenergetic level, the list is helpful. Whether there will be cure of the physical body if the emotional conflicts are resolved is another matter. Sometimes yes – we hear of miraculous “spontaneous” cures of very severe illness. Sometimes no – there may be cure on the emotional and perhaps generational level, without cure of the physical body itself.
In the end, our bodies truly do believe what we tell them. I had a patient many years ago who came to me for relief of chronic pain. The pain began when she was in a car accident which was not her fault, but she was in enough pain that she was unable to get out of the car. The driver of the other car came over to her and shouted at her to get out of her car, that she was not injured. She shouted back to him that she was severely injured and would probably never be able to walk again. And sure enough, her pain became sufficiently severe that despite multiple Xrays showing no bony injury, she was still in a wheelchair when she came to see me three years after the accident. When she told me the story, I asked her if she actually heard what she had just told me. She interpreted my question to mean that I thought she was malingering, and I never saw her again. I hope that one day she did get out of her wheelchair, when she was ready go give up the anger and forgive the other driver.
Forgiveness, letting go, trusting the Universe to give the other person everything they deserve – these are all techniques for not drinking the poison, but rather pouring it out on the ground as fertilizer.
I have always been curious about why people go in to the healthcare professions. Many of my colleagues, for instance, focus on autism because they have an autistic child. Many Lyme literate doctors either have Lyme disease themselves, or have family members with Lyme disease. One study showed that 68% of healthcare workers had experience of childhood trauma, 33% of them before the age of 13. The study’s conclusion was that Childhood adversity is common among healthcare workers and is associated with a greater number of life events, more psychological distress and impairment. What the study did not address was why those particular people went in to the healthcare profession in the first place.
The incidence of suicide in physicians is rising at an alarming rate.
Few studies are available concerning healthcare professionals and adverse childhood experiences. One suggests that childhood trauma is a predictor for adult substance abuse. One study, although not directly concerning healthcare workers, talked about particular gene methylation patterns as markers for stress and depression. Conceivably such markers might be used as a preventive measurement in healthcare workers, allowing for intervention before suicide becomes their only perceived way out of their intolerable situation.
 Bocock, Philip N., and Kjersti M. Aagaard-Tillery. "Animal models of epigenetic inheritance." Seminars in reproductive medicine. Vol. 27. No. 05. © Thieme Medical Publishers, 2009.
 Berens, Anne E., Sarah KG Jensen, and Charles A. Nelson. "Biological embedding of childhood adversity: from physiological mechanisms to clinical implications." BMC medicine 15.1 (2017): 135.
 Bower, Julienne E., Alexandra D. Crosswell, and George M. Slavich. "Childhood adversity and cumulative life stress: risk factors for cancer-related fatigue." Clinical Psychological Science 2.1 (2014): 108-115.
 Crosswell, Alexandra D., Julienne E. Bower, and Patricia A. Ganz. "Childhood adversity and inflammation in breast cancer survivors." Psychosomatic medicine 76.3 (2014): 208.
 Perry, Bruce D. "Childhood experience and the expression of genetic potential: What childhood neglect tells us about nature and nurture." Brain and mind 3.1 (2002): 79-100.
 Developmental origins of health and disease: brief history of the approach and current focus on epigenetic mechanisms. Wadhwa PD1, Buss C, Entringer S, Swanson JM. Semin Reprod Med. 2009 Sep;27(5):358-68. doi: 10.1055/s-0029-1237424. Epub 2009 Aug 26.
 Clark, Charlotte, et al. "Does the influence of childhood adversity on psychopathology persist across the lifecourse? A 45-year prospective epidemiologic study." Annals of epidemiology 20.5 (2010): 385-394.
 Shonkoff, Jack P., et al. "The lifelong effects of early childhood adversity and toxic stress." Pediatrics 129.1 (2012): e232-e246.
 Bombay, Amy, Kimberly Matheson, and Hymie Anisman. "The impact of stressors on second generation Indian residential school survivors." Transcultural psychiatry 48.4 (2011): 367-391.
 Bowers, Mallory E., and Rachel Yehuda. "Intergenerational transmission of stress in humans." Neuropsychopharmacology41.1 (2016): 232.
 Hausner, Stephan. Even if it Costs me my Life. Gestalt Press 2011, ISBN: 978-0-415-89805-8
 Stillman A. Childhood adversity & lifelong health: From research to action. J Fam Pract 67:11 (November 2018).
 Davis, Elysia Poggi, et al. "Fetal glucocorticoid exposure is associated with preadolescent brain development." Biological psychiatry 74.9 (2013): 647-655.
 Enduring psychobiological effects of childhood adversity. Ehlert U. Psychoneuroendocrinology. 2013 Sep;38(9):1850-7. doi: 10.1016/j.psyneuen.2013.06.007. Epub 2013 Jul 10.
 Levine BH. Your Body Believes Every Word You Say. Aslan Publishing, 1991, ISBN 0-944031-07-2. Available on Amazon.
 Maunder, Robert G., et al. "The prevalence of childhood adversity among healthcare workers and its relationship to adult life events, distress and impairment." Child abuse & neglect 34.2 (2010): 114-123.
 Baklazec, Agnieszka, and Elizabeth Pace. "Healthcare professionals, substance use and adverse childhood experiences." Addiction science & clinical practice 10.2 (2015): O3.
 Bakusic, Jelena, et al. "Stress, burnout and depression: A systematic review on DNA methylation mechanisms." Journal of psychosomatic research 92 (2017): 34-44.