Podcast Transcript

Episode 28: Historical and Intergenerational Trauma: How Understanding and Developing a Family Narrative Can Help Us Heal

[Bouncy theme music plays.] 

Sam: Hey, I’m Sam!

Ashley: Hi, I’m Ashley and you’re listening to All Bodies. All Foods. presented by The Renfrew Center for Eating Disorders. We want to create a space for all bodies to come together authentically and purposefully to discuss various areas that impact us on a cultural and relational level.

Sam: We believe that all bodies and all foods are welcome, we would love for you to join us on this journey. Let’s learn together.

Ashley: Hello, everybody and welcome to another episode of All Bodies. All Foods. Ashley and Sam are here and today we are joined by a very special guest, Dr. Carolyn Ross. We are gonna talk with her today about intergenerational trauma, and we just really felt like this was an incredible kind of topic to dive into with you all as I think it can shed some light on a lot of what we see working within the eating disorder community. So, Dr. Ross, thank you so much for joining us today.

Dr. Ross: Thank you, Ashley. I’m happy to be here.

Ashley: Yeah! So, I’m gonna share a little bit about you first and then I’ll dive into some questions if that feels okay. So, Carolyn Coker Ross, MD, MPH, CEDS is an African American author, speaker, expert in the treatment of eating disorders, trauma, and addictions. Dr. Ross is a graduate of the University of Michigan Medical School. She completed a residency in Preventative Medicine and a Master’s in Public Health at Loma Linda University, and a fellowship in Integrative Medicine at the University of Arizona. She is board certified in preventative medicine and in addiction medicine. Dr. Ross has been an international speaker and consultant on issues of mental health, trauma, and workplace productivity. Dr. Ross, presented at TEDx Pleasant Grove Talk on historical and intergenerational trauma in January of 2020, and she is co-founder of the Institute for Anti-Racism and Equity, which is a consulting group that offers trainings to organizations on diversity and equity in the workplace. So, again, we are so honored to have you here and just really look forward to learning from you today. And so, I would love to just kick it off with the question, Dr. Ross, of really what is intergenerational trauma? This is kind of a big question, okay? So, what is the, you know, kind of the broad overview? And maybe would you be also willing to share, like, kind of what got you into working in this field in particular, and looking at the effects of intergenerational trauma?

Dr. Ross: OK. That’s, so that’s two questions—

Ashley: I know!

Dr. Ross: You may have to remind me of the second one.

Ashley: Okay, okay. For sure.

Dr. Ross: Well, we should talk about what is intergenerational trauma. I think the exploration of that question began in the 1960s when people started looking at offspring of Holocaust survivors and finding that they had certain traits, like increased risk for post-traumatic stress disorder, depression, anxiety, and other traits that people who were not offspring of Holocaust survivors but had similar, you know, backgrounds, did not have. So, there’s been a lot of study in that and just trying to recognize, like, “How could somebody have the effects of trauma even though they themselves did not experience the trauma?” So initially, it was thought that, “Well, you know, like, offspring of Holocaust survivors, probably, maybe parenting is different, maybe their interactions with the children are different.” And that was called Social Learning Theory. But as we’ve gone on, we’ve been able to really find pretty definitive biochemical changes in offspring of Holocaust survivors and other groups that make us think that, “Ok, something horrible happened, i.e. the Holocaust, it may have changed the expression of certain genes, like the gene for depression or anxiety, and therefore that gene gets turned on by the trauma. And then when the person has children that turned on gene is passed to the next generation and even the next generation.” So, I think that’s kind of where it all got kicked off. And, you know, now there’s research that is even, you know, supporting this, a lot of it, in other groups that have experienced historical trauma. African Americans who went, you know, their— our parents and grandparents, great grandparents were enslaved, and now we see a lot of those effects on mental and physical health and offspring of the enslaved peoples.

Ashley: Mhm.

Sam: Hmm.

Dr. Ross: So how I got interested was really just within my own family. You know, I started to realize that in every generation, we lost at least one really wonderful person to suicide, to drug addiction, to mental illness, you know, through all sorts of medical conditions. So, I was kind of determined to break that cycle, and as I started looking at my family tree and seeing how the trauma was everywhere, you know, different varieties of trauma, and how then those effects of trauma went from generation to generation to generation. Even in families that were intact, you know, in our family, highly educated, you know, loving parents. It wasn’t like you would think that, you know, we were living in poverty or whatever people’s opinions are. These, you know, we were middle class family, all the good things you can think of, and yet our kids were, you know, were dying essentially. So, I myself lost my middle son to suicide after a long struggle with depression, my youngest sister’s son has a mental illness and he’s no longer engaged with the family and his life has really kind of spiraled out of control. I had two brothers who suffered with substance use disorders. So, this isn’t something you would expect in a family like ours, and that’s why it puzzled me and made me want to look further and see, you know, what’s going on here. And then once I did, you know, I started with the ACE Study, which we all know about now, but I’ve been talking about the ACE Study for probably 15, 20 years, because that’s how long it’s been around. And I used to, when I was at the podium, say “How many people in the room know about the Adverse Child Experiences study?” And there would be one or two people, then I would go on and talk about it, blah, blah. And now if I do that, most people know about it. So that’s good. But the important part, the revolutionary part about the ACE Study was that it linked something happening, an adverse childhood experience happening, to a child under the age of 18, and how that then predicted their risk for certain— over 40 medical and psychiatric conditions, including ADHD, substance use disorders, depression, anxiety, as well as, which is a real shocker, heart disease, diabetes, you know, lung disease! And nobody would have guessed that, I don’t think. You know, when I went to medical school, that was not— trauma was never discussed. And it certainly wasn’t discussed as a cause of medical issues.

Ashley: That’s really interesting. Is it on the table now for medical providers going through school, do you know?

Dr. Ross: You know, I don’t think it’s on the table. I think that people are aware of the ACE Study, but I think there’s still a lot of resistance to, for example, saying, you know— you know how we have this whole thing in the medical profession where we say that, “If you’re living in a larger body, that in and of itself increases your risk for, you know, heart disease, diabetes, and so on and so forth.” The medical profession is still really, really wed to that concept of “weight equals health.” You know, the lower you are, the healthier you are. And I don’t know, I find that really disturbing.

Sam: We do too.

Ashley: Yeah, all of us professionals, everybody has to go through.

Sam: Yeah. Thank you, Dr. Ross for your vulnerability and for talking about this important topic, I know it will help so many people. We talk on this show a lot about weight stigma and how— I mean, would you say that weight stigma in and of itself is a trauma that can be passed on then down the generations?

Dr. Ross: Well, the main traumas that we’ve looked at have been in children, so under the age of 18. But having said that, as you say, you know, we know that many of our children, so many of my patients in the Anchor Program with Binge Eating Disorder were bullied, you know, really seriously bullied as children. So, in that way, yes, it definitely can be one of the traumas that could possibly be passed on.

Sam: Right. It’s really, it’s so fascinating. And I’m wondering, you know, when you were talking about, you know, epigenetics in your TED talk, and how these genes— it’s not that the genes change, but it’s the expression of the gene. So, it’s really like an on and off switch, and certain experiences can turn it on and off, I’m wondering how far down generations can this go, you know? Or how far back?

Dr. Ross: Yeah, there was a super interesting study in animals about this, and they taught, they exposed a group of mice to the smell of cherries, and every time they exposed them to that smell, they got a little electric shock. So, you’re pairing the smell of cherries with, you know, a trauma, basically.

Sam: Right, right.

Dr. Ross: And so, what they found is when the mice had, I don’t know what you call them, children? But baby mice and then grandbaby mice, those baby mice and grandbaby mice had never been exposed to the electric shock. However, every time they exposed them to the cherries, they got anxious and—

Sam: Oh, wow.

Dr. Ross: Had a reaction. So that’s already two generations that we know of. And the studies in Holocaust survivors are also showing the same, that grandchildren, who again have not been exposed to the trauma, and even some of their parents, you know, who were never told about their own parents trauma in the Holocaust. You know, many of the Holocaust survivors have never spoken or didn’t ever speak to their families about what happened to them, and yet their children and grandchildren had these, you know, issues. It’s not even— because some people say, “Well, maybe it was vicarious traumatization.” You know, if somebody’s, if your mother’s telling you about horrible things that happened to her during the Holocaust, but that for the most part didn’t happen.

Sam: Wow.

Dr. Ross: So, it’s pretty interesting.

Sam: So, it seems like you don’t really need any exposure at all to sort of inherit the sort of emotional dysregulation or, you know, these trauma responses. And I imagine there’s a lot of folks listening to this episode and they’re having an AHA moment. It’s like, “Ok, this is actually starting to make sense.” I think it’s fascinating.

Dr. Ross: Well, when you, when you look at people with substance use disorders and sometimes— you know, I agree with Dr. Gabor Mate who said that substance use disorders have their roots in trauma. And honestly, I firmly believe eating disorders do too. But when you look at people who may have substance use disorders, and then they wonder to themselves, because they often have been told it’s genetic, “But, well, my parents didn’t have— my parents didn’t even drink, you know, or my grandparents didn’t even drink,” but maybe it was farther along the chain that happened. Or something happened directly to them. But I think for people who have had that experience of wondering, like, “Why? You know, why me, why am I experiencing this?”, when they understand about intergenerational trauma, it often does give them that relief of knowing, “Well, I’m not a bad person,” or “I didn’t do this to myself, I shouldn’t, there’s no reason for me to feel the stigma or shame of this.” You know, I think that can help them too.

Sam: Absolutely, yeah. Well, it’s so interesting. I don’t know if this has happened with you, Ashley, but I, you know, when I’ve worked with folks with eating disorders, sometimes they’ll come in to session and they think, “Maybe I have a trauma I don’t remember!” And they get really kind of hooked on this idea that “We have to uncover something that happened in my past.” But in fact, maybe nothing happened. Maybe this is really just epigenetics.

Dr. Ross: Yeah, right. I think that’s the other way it can help people, is to stop grappling. Because we all know about the false memory stories from the past. So, you know, I always tell my patients, “If you have trauma it will surface, you don’t have to look for it. You don’t have to search for it will come up.” And I think it’s really important that, because I think we’ve lost this desire to know about our parents and grandparents, I think it’s really important to start having conversations with your parents and grandparents about their lives, because you may discover something you never knew, you know? Many grandparents and great grandparents immigrated to the United States. As we know, there were no Americans here other than Native Americans until people came from Europe and other places. So, what was that immigrant experience like for them? You know, what— I was speaking on the east coast and a guy raised his hand and said, “Yeah, I remember—” His grandfather immigrated from Poland, he says he remembers being teased and bullied because of his last name and because of being, you know, all those negative things that have been said, those terms that were used for people who immigrated from certain parts of Europe. And that was very traumatic for him and for his, you know, his parents. So, it’s not just one group of people, but anyone who is— definitely anyone who has experienced historical trauma, there’s a high likelihood. And I just want to make the distinction here because it can get confusing, like, “What’s historical trauma and what’s intergenerational trauma?” And historical trauma really is trauma that’s been placed on a specific group because of who they are as a minoritized, historically minoritized group. So, the violent colonization of Native Americans, you know, that’s a historical trauma. The enslavement of African Americans, the Holocaust. So, historical trauma is not just one event, it’s something that happens over time. And, you know, I think slavery is a good example because it happened over, you know, a couple hundred years, so many generations of African Americans, their ancestors were enslaved, and their children were enslaved, and their grandchildren, and so on. So, I think when you— and those aren’t all of the groups, you can look at the Japanese internment during World War II. So, any group that’s historically marginalized probably has historical trauma, and in the US, those three groups, you know, or four group,s are the biggest ones. Yeah.

Ashley: Dr. Ross, I’m curious, so you kind of brought this up a little bit ago talking about, like, even talking with substance use, but with eating disorders too, where really, like, a lot of the root of this may come from trauma. I was reading an article earlier this week that said 50% of individuals diagnosed with an eating disorder are also diagnosed with PTSD. I’m curious if it’s more, honestly, but at least they have both of those dual diagnoses. And I’m just curious for our listeners— so, we have professionals listening to us, we have community members, we have support people, we maybe have past clients, you know. So, really for our broad range of listeners that are with us today, could you speak more to where you might see that intersection or that play out within the eating disorder community of the PTSD diagnosis or the trauma coming up, and how we might see that as eating disorder providers?

Dr. Ross: Okay! I think— I wanna just mention that not everyone who’s had trauma develops PTSD. And so even though your statistic of 50% is, you know, startling, there are probably a lot more people who’ve had trauma. And I think Timothy Brewerton’s article stated something to the effect that, “People with eating disorders, whether they be male or female, whether they be young or old, no matter what their, you know, racial or ethnic background, the majority have experienced some traumatic experience.” So, I think when we look at the broad range of traumas, and not all of them reaching the level of PTSD, you can see that. Sadly, in our field, the eating disorder field, you know, again, there’s been, for decades, a denial that trauma had anything to do with eating disorders. All of the research was on genetics and, you know, personality characteristics, and all of this other stuff. And I don’t think that it’s been fully accepted in the eating disorder world that trauma is— trauma is really the main event. And some of us have been talking about this for decades and been poo pooed and, you know, told, “Well, you know, depression is, it’s not related to trauma,” or “This person doesn’t have PTSD, so trauma isn’t significant,” or whatever the excuses were. But I still think there’s a lot of resistance in our community to recognizing and treating trauma effectively. You know, if you look at treatment facilities across the nation, there’s just a handful who will say that they truly do treat trauma. And there’s— that handful has been pretty much the same handful, you know, as when I worked at Sierra Tuscon, and that was 20 years ago. So, I think without a real acknowledgement of that— and it’s even worse in the substance use disorder treatment world. You know, they’re all about abstinence still and not so much about trauma. And when we look at our results, we need to ask ourselves, “Are we really doing all that we can do to help our clients? Are we doing all that we can do so that when they leave our facility, they have the tools they need, they understand their trauma background, they’ve had trauma specific treatment, and so on.” I have a patient now who was in treatment for six months, which is a huge luxury these days, but never once was she asked about trauma. For six months, never once.

Sam: Wow.

Dr. Ross: And she has significant childhood trauma. So, I mean, to me, it’s getting to the point where that should be considered malpractice. Because we have the studies now, we know that this is important, and there’s really no excuse for us not to really address it. You know, speaking of treatment, I think one of the biggest issues is understanding, “How does trauma lead to an eating disorder?” So, the way that, you know, the way that I work with my clients is recognizing that, if you think about a child who’s been traumatized, whether they’ve been physically, or emotionally, or sexually abused, or they have a caretaker who’s depressed or chronically ill, or whatever the things are that we know from the ACE Study cause trauma. So that child, let’s say a child who’s been being abused or neglected, in their mind, they have to make sense of it. But they usually come up with, because children are so egocentric, they come up with, “Something’s wrong with me.”

Sam: Yeah.

Dr. Ross: And then they carry that. So, then they think, “Well, what’s wrong with me? Well, you know, nobody loves me because I’m fill in the blank— because I’m fat, because I’m, you know, to this or not enough that. You know, I’m too weak or I’m not good enough.” And these are— I didn’t make this up, these are the things my patients tell me, and over the years I’ve heard the same story. So, you know, something happens, they make sense of it, and that leads to this belief that is their operating system. “I’m not good enough.” So, if I’m not good enough, do I go for that career goal of mine? If I’m not good enough, do I look for the husband or wife or partner who’s, you know, really great, or do I settle for something else? If I’m not good enough, do I manage my money well? Or, you know— so, all of these aspects of life can be affected then. But the biggest thing is that when that operating system is running, it causes distress, anxiety, emotions come up. And so, from childhood, we have to deal with those emotions even though we don’t know what they are. So, we deal with them in whatever way we can. Either we shut down, or we become people pleasers, we overeat, or we don’t eat. And so for me, that’s the sequence that happens. Something happens, we make sense of it, it leads to a core belief and we have to deal with the emotions related to that core belief, and how we do that is where our pathology, our psychopathology shows up.

Ashley: That might be a pattern that someone engages in. I mean, really until they can find, you know, that clarity or moment of awareness that, “Oh, OH, I might be stuck in this.” And that is also a pattern that can potentially be passed down intergenerationally.

Dr. Ross: Absolutely. But I think when they’re able to connect the dots—I mean, I know from my experience that a lot of eating disorder treatment is about, “Well, you know, let’s put you on a great diet and let’s, you know, get back to normal weight,” and all of that kind of stuff. But how do you do that when someone’s brain is telling them “Danger, danger, danger!”

Ashley: Right.

Dr. Ross: “Eat this so that you don’t feel,” or “Don’t eat this so that you don’t feel.” So until we deal with the underlying causes, some of the behavioral therapies that people are trying are eventually doomed to fail. And in all treatment facilities there’s a super high failure rate. I mean, for addiction treatment, it’s a 90% failure rate at one year, I don’t think it’s that much different for eating disorders. So, people just keep cycling back, you know, using up all the money and then when they run out of money, they just do whatever they do, people die, and nothing changes. So, this isn’t, like, a frivolous thing. This is something that… understanding the effects of trauma can really save lives.

Sam: Yeah.

Ashley: Could you speak to, kind of in that same vein, could you speak to, I think the term you’ve used before is “psychic numbing”? Maybe the pattern that has been passed down. Could you explain to us what that is and how that might show up?

Dr. Ross: Yeah, I often talk about one of my clients who came to me because she was abusing alcohol and when I took her history and, she revealed that her mother was a Holocaust survivor. And so, I started talking to her about her relationship with her mother and, you know, many people who have gone through the Holocaust, you know, dealt with their emotions by just shutting it down. And so she described her relationship with her mother as being very emotionally abusive and/or neglectful. So, whenever she, you know, she bumped her knee, her mom would, “Say suck it up!” You know, she broke up with the boyfriend, “Suck it up. You don’t have a problem, this isn’t a problem. Just suck it up.” And I don’t think it’s in any way intentional, and it’s not just survivors of Holocaust who’ve done that, but that’s what psychic numbing is. It’s not being able to express your emotions. You know, I’m sure her mother loved her but wasn’t able to express that because of her own experiences. And when she parented, so she had already had a history of having had a gastric bypass surgery and then the alcohol came in, and then when I asked her about her children, is she close to her children. No, because she parented the same way her mother did. So, when her children had something go wrong, they go to the dad, they don’t go to her. And they probably experience her psychic numbing parenting style as being neglectful or abusive as well. So, it was always just “Suck it up,” you know.

Sam: Oh, wow.

Dr. Ross: And I know there are a lot of people I’ve talked to who can relate to that and understand that, you know, that was the way people coped. So she, the mother of my patient, survived the holocaust. And that’s no mean feat, you know,

Ashley: Right.

Dr. Ross: So to be able to, I think, also recognizing that psychic numbing affected two generations is important because at some point you could interrupt that.

Ashley: Right.

Sam: Right. Do you remember what it was like when you helped your client have that AHA moment that this psychic numbing was a pattern and here’s an opportunity to break it.

Dr. Ross: Yeah. Well, not everybody’s ready to hear that.

Sam: Yeah, so true.

Dr. Ross: I try to give a little information here and there. But, you know, many people are very resistant to that. And unfortunately she was one of those. So, you know, my goal I feel is to educate people, not to blame them, not to shame them, but just to let them know, you know. Because her children were also experiencing some of the same problems she was with addiction, and depression, and anxiety, et cetera. So for me, you know, like I said, I can’t make someone change their lives, I’ve tried that many times over the 30 plus years I’ve been in practice. I think people can use information in different ways. So, it may not be that she comes back to me and says, “Oh my God, that was an AHA moment that changed my life!” But maybe a year from now, or five years from now, when her children or her grandchildren are showing these signs, maybe that’s when she wakes up. At least she has that seed that was planted of understanding, “Okay, here’s what’s happened to me and here’s what’s happening to my kids.”

Sam: It’s always so amazing when moments in therapy can blossom even years later. And I like to remind clients of that, and it’s happened for me personally too, where it’s like in therapy you think of something your therapist said five years ago. And it’s like, “OK, I get it now! I’m ready!” And I don’t know, I think that’s such an amazing thing.

Dr. Ross: I’ve done a lot of training of therapists and I remember the young therapists would come into supervision sessions and say, “Oh my God, I had the greatest session with my patient! She had this amazing insight about her relationship with her father! And da da da…” and she gives me the whole thing. And then I’ll say, “Okay, well, how many times did she binge this week? Or how many times did she purge?” Because insights are great and they’re fun, but they don’t change behavior.

Sam: Right.

Dr. Ross: Almost never do they change behavior. However, like you say, the seed is planted. So, my other story is when I was at Sierra Tucson, I would get letters from my patients years, sometimes even 10 years after they saw me. And eventually, my nurse created this huge board with all of these notes, and the theme of the notes was, “I hated you when you told me this, or I got really angry when you told me this, but now I see that you’re right.” So, I put that in my office because I had to remind myself to, you know, you have to do the hard work whether people like it or not.

Ashley: Well, what you said earlier about, you know, not shaming or blaming or any of that, I mean, part of our work that we do is helping people uncover patterns, or gain these insights, or gain these bits of awareness. And when they have that and they can also acknowledge maybe some of the patterns that in some respect maybe feel helpful, but when we can take an objective look at that and see that’s not helping at all, but it feels so helpful. So, it’s like a security blanket and they wanna hold it, and they don’t want to let it go, you know. I mean, that makes so much sense, especially if that is the security blanket keeping them from the yuck of the trauma.

Dr. Ross: Yeah. Well, I think you raised a good point and that’s why that sequence that I was saying to you is so important, because it’s kind of like the pattern spreads out to all areas of your life, and there can be a million triggers to the pattern that make your survivor self want to go into fight or flight. And the sooner you interrupt the pattern before you get to the core belief of, “I’m not good enough” or “I’m unlovable because blank, fill in the blank,” and then after that comes the behavior. So you’ve gotta, if you think of it as a circle, bigger emotions, body sensations, core belief and then behaviors, you wanna interrupt that pattern before you get down to, “I’m not good enough” or “I’m already binging and purging.” And to do that, you have to build off ramps to that circle. You know, remember those roundabouts that are in certain cities?

Ashley: Oh, yeah.

Dr. Ross: That’s how I think of it, as the roundabout. You know, they’re like five exits off the roundabout. Oh my God. On the east coast, they can drive you crazy.

Sam: Yeah.

Dr. Ross: So you’ve got to find an exit, and the exits are the skills that you learn. You can only get off the roundabout if you’re able to manage your emotions and recognize the pattern early before you get down to, you know, the behaviors.

Ashley: Yeah.

Sam: I love that visual, getting off the off ramp and taking that exit.

Dr. Ross: My son calls the roundabouts “the circle of death.” And it, you know, it actually applies in this context as well, because people keep going through those same patterns and they think it’s different because, “Well, the last time you told me about the pattern, it was because I, you know, lost my job. But this time it’s because I had a fight with my partner and that’s different.” But no, it’s not different because the pattern is the same. So, that’s the hard work because it’s really boring work. Insight work is, “Oh! Everybody’s happy and beautiful!” But this kind of work is, you know, it’s tedious. But it’s the most effective, being able to recognize that pattern, “Oh, I’m in the pattern. Ok. What do I need to do?”

Sam: Mhm. Exactly.

Ashley: So, Dr. Ross, I have a question about kind of family and support people. So, if you’re working with somebody that is kind of figuring out— they’re in this roundabout, they’re working to get off, you know, to take one of those off ramps before they get to the negative core belief in the behavior. How might you, or do you incorporate family and support people in that, or how would you invite your client to incorporate their support people in their healing process?

Dr. Ross: Well, in the good old days, you know, we used to have family week in therapy and that’s what we do. I don’t think we have as much access to the families anymore in treatment, although I think it’s very useful. You know, my work is mainly with the client nowadays, and working with the client to deal with their families. So, you know, I was at a conference and someone said, “Well, you know, we don’t have that much time, and how can we do all this work,” and so on. I have clients that I’ve been seeing on a monthly basis for 10 or 15 years and one month, they may come in and say, “Well, you know, I’m still pissed off at my dad because he threw me out of the house because I was using.” And so that’s when we work on, you know, when that comes up, that’s when we work on it. And the next time it would be, “Well, my partner and I had a fight,” or “Well, my son is doing this,” and over the period— And this is the major flaw in our treatment approach these days, and this is why I started the Anchor Program. I left a treatment center that— I always loved working in treatment centers because I love being part of a team. But I was so frustrated that people would come in for 30 days or even a little more, and then they would leave never to be heard from again. Because, as you know, if this is the hard work, it has to be reinforced every single episode of, you know, adversity, or life change, or life stress, we have to keep reinforcing this. And when you work with people over the long run, that’s the only time that you’re gonna see long lasting results. I mean, we’re fooling ourselves to think that, you know, a 30, 60, 90 day treatment is really gonna be long lasting. So, it’s really important. I know when I worked at Sierra Tucson, we had relationships with extended care facilities and we actually tracked our patients for two years after discharge from the program. And they did much better because we directed them into, “Okay, go here and you stay here for six months and then you’re gonna go to IOP.” And I mean, I’ve run into patients from 30 years ago who followed that regimen and are doing amazingly well now. But it takes time. Insights never change behavior, but constant reinforcement does.

Sam: Yeah. One question that is coming up for me, you know, for folks who have had adverse childhood experiences, have been through trauma, maybe they want to be a parent, or maybe they’re a new parent, is there a way to prevent or reduce the harm of intergenerational trauma? What guidance would you have for folks out there who might be wondering that?

Dr. Ross: The most important thing is to heal the parent. So, sometimes we wanna, “Okay, well, let’s get the kids in therapy,” and so on. The most important thing is work with the parent and with their feelings, with their trauma, with their fears. And what I hear most often is that parents see the in their children things that they did themselves, either being emotionally disregulated or being aggressive as a child. All of those things are signs of, you know, intergenerational trauma effects. So, if you work with the parent on how to manage those things, and if they know how to manage their own fears, that’s where you’re gonna get the most bang for your buck. I mean, I think education for children who are older. I remember at Sierra Tucson we used to bring the children in for a week as well, and they would do their activities while the grownups were doing theirs. I think it’s great for them to learn about this stuff. But the real work has to be focused on the parents, because you know, they’re gonna be there every day, the therapist is not. So heal the parents, they can heal the children.

Sam: That makes sense.

Ashley: Yeah, I love… you were mentioning, like, family groups, we do that at Renfrew, weekly we have the family groups. And I just love that for the psycho-ed piece, really, for the parents, the support system, everybody coming in. Because again, if you’re working with the client, but the client is— well, and often is, a part of a larger system at home, right, if we’re not actively helping them navigate that environment, I mean, every bit of work that we’re doing, you know, kind of locally, right, it’s not gonna work. It’s not gonna stick.

Dr. Ross: Yeah, exactly. Well, I’m really— that’s one of the things I like about Renfrew is the treatment is really thorough. So, yeah, that’s important. Just helping your client understand the family dynamics, and where those came from, and how they fit in, and what their part in it is. It’s really important.

Ashley: So, I’m curious, if something, you know, if any of our listeners today maybe have heard something that is landing with them, like, “Oh, I’m curious if I have intergenerational trauma, I’m curious if some of these patterns are, you know, generations of dealing with, managing these bigger yucks that have happened, you know, in past lives,” what might be a first good step for somebody to take, that this feels like it’s hitting home with them today?

Dr. Ross: Hm. That’s a great question. I know you’ve watched my TEDx talk, and I’ve had so many people come to me after watching that. So, I would recommend that as a first step. And then I also recommend in the talks that I give to do a family tree and just draw out, you know, the traumas that you know of. And also start collecting a narrative from parents, grandparents, whoever’s still alive, on the kinds of experiences that they’ve had, and put that in your tree and see what’s going on. And I think that really will give you the beginnings. And then if you feel that there is a lot of intergenerational trauma, you know, you wanna look for a therapist who has some trauma training and work with them to interrupt. I wouldn’t recommend my approach, which was I sent the ACE quiz to everybody in my family and demanded that they fill it out and send it back to me. But they’re used to me, so…

Ashley: Right.

Dr. Ross: So yeah, but that was really interesting. And I do think taking the quiz yourself, which is online, the Adverse Child Experiences quiz is online. It’s great. Take that quiz and that’ll give you your score, and any score above four is considered, you know, serious. And even lower scores, you know, because not everybody is as resilient as, you know, other people. So if you have a score of even two or three, you know, you might wanna ask yourself, do I need to work on this trauma?

Ashley: And some of the questions could be, “Did your parents get a divorce,” some of the questions are “Do you have a parent in jail,” right? I mean, it ranges.

Dr. Ross: Yeah, I mean, they’re not scary questions at all, you know, they’re pretty factual kind of point blank question like that. And the quiz will take you literally 5 to 10 minutes to do, and then you have your score, and then you know, “Okay, like, if I have a score of six, I probably need to look at this, you know, get some help.”

Ashley: So, what I also hear you saying in that really is if this didn’t land with you, if anything that we’ve talked about today feels like it’s pinging at you, there are some action steps. We can watch your TEDx, which we’ll put in our link when we send out the podcast, Dr Ross; we can take the ACEs questionnaire, and we can do that family tree that you’ve mentioned. Look at the past generations and our experiences and where we’ve come from.

Dr. Ross: Yeah. And I really want to reinforce just developing that narrative from your family before it’s lost, because, you know, many of us don’t have grandparents anymore. But just starting wherever you can to collect your parents and grandparents stories, because you’ll be amazed at what you learn, you know.

Sam: Well, thank you so much, Dr. Ross. This was an amazing conversation and I really think it’s gonna be so informative, and it’s just gonna help so many people. So, I really thank you for coming on.

Dr. Ross: You’re very welcome, it was my pleasure. Thanks for your great questions too.

Sam: And thank you to our listeners for listening to All Bodies. All Foods. We hope you enjoyed this episode with Dr. Carolyn Coker Ross on the topic of intergenerational trauma and eating disorders. If you enjoyed this episode, you can support us by subscribing, rating, leaving a review, or sharing with others. If you want more, you can follow us on Facebook, Instagram, Twitter and TikTok, our handle is @RenfrewCenter. For free education, events, trainings, webinars, resources and blogs, head over to our website www.RenfrewCenter.com. And if you have any comments or questions you’d like us to answer in a future episode, you can email them to [email protected]. I hope you join us next time on All Bodies. All Foods.

Ashley: Thank you for listening with us today on All Bodies. All Foods. presented by The Renfrew Center for Eating Disorders.

Sam: We’re looking forward to you joining us next time as we continue these conversations.

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