Fritzi Horstman grew up on the Upper West Side of Manhattan – not as posh as it is now, she says, but still a respectable, middle-class neighborhood. By the time she was 16, she had become a “juvenile delinquent, doing drugs and running around.”
What happened? And why was her ACE score 8, when she finally assessed it nearly 40 years later?
Domestic violence underscored her childhood and teen years, she says. Her father was an alcoholic and her mother a “rage-aholic” who abused her and her younger sister emotionally, verbally, and physically.
Those traumatic childhood experiences had severe effects on her behavior and health. But decades before she understood the link between ACEs and her behavior, she initiated a dramatic turnaround on her own.
“When I was 16,” she says, “I got a ‘D’ on my ‘Huckleberry Finn’ paper.
“That woke me up,” she continues, “so I wrote an essay about the stress and violence in my home,” since her parents were still fighting and about to separate.
In addition to making a complete turnaround in her schoolwork, Horstman also tried to get her life under control by starting two businesses that year: a cookie business and a pin business.
“In the ‘80s, people wore ridiculous things. I sold pins on an umbrella, on the corner of 57th and Madison. I made a lot of money and eventually had two people working for me.” She bought feathers and other ornaments from the Garment District in lower Manhattan and used them to decorate the pins.
With her grades now under control, she applied to Vassar College. In her admissions essay, she took the daring step of writing about how she had survived the constant presence of domestic violence in her home. The college not only accepted her but also provided financial aid.
Trauma wouldn’t let go
The future filmmaker thrived at Vassar, where she majored in drama and English. She was president of her senior class and gave the class speech at graduation. Yet the trauma of her past childhood still held its grip. She was bulimic during her college years. “When you are that traumatized,” she explains, “you will do anything to feel something. Trauma numbs. [Bulimia] gave me a sense of control.”
Always wanting to become a filmmaker, an art that requires control of everything from casting to directing and production, she moved to California, where she eventually directed a feature – a romantic comedy called “Take a Number” – that aired on HBO. She made a few documentaries over the years and did demanding post-production work to earn a living. In 2018, she won a Grammy award as the producer of “The Defiant Ones,” a documentary on Dr. Dre and Jimmy Iovine, well-known record producers and entrepreneurs.
Horstman says she learned about the 1998 landmark CDC-Kaiser Permanente Adverse Childhood Experiences Study in 2015, but it didn’t really sink in until several years later when she read “The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma”, by Bessel van der Kolk, M.D.
“That book changed my life,” she says. “It told me I was traumatized and that my behavior has nothing to do with who I truly am.”
The ACE Study of more than 17,000 adults linked 10 types of childhood trauma to the adult onset of chronic diseases, mental illness, violence, being a victim of violence, difficulty in holding a job, and financial issues, among other consequences.
The study found that ACEs are remarkably common — most people have at least one. People who have four or more different types of ACEs — about 12 percent of the general population, but more in communities in people of color and/or white people where policies keep them impoverished — have a 1,200 percent higher risk of attempting suicide and a 700 percent higher risk of becoming an alcoholic, compared with people who have no ACEs. Many other types of ACEs —including racism, bullying, a father being abused, and community violence — have been added to subsequent ACE surveys. (ACEs Science 101; Got Your ACE/Resilience Score?)
The epidemiology of childhood adversity is one of five parts of ACEs science. The other parts include how toxic stress from ACEs affects children’s brains, the short- and long-term health effects of toxic stress, how toxic stress is passed on from generation to generation, and research on resilience, which includes how individuals, organizations, systems and communities can integrate ACEs science to solve our most intractable problems.
Around the same time that she read “The Body Keeps the Score”, Horstman volunteered at Kern Valley State Prison, in Central California. Moved by the incarcerated men’s similar ACE experiences, she launched a nonprofit, the Compassion Prison Project. Its mission is to transform prisons through compassionate action based on an understanding of the impact of ACEs.
A survey the project conducted of 2,200 prisoners found that 64% have an ACE score of 6 or more. “It’s really high, and with that many ACEs, it increases the risk of reducing your life expectancy by 20 years.”
Using her theater skills, the filmmaker created a physical exercise for the prisoners based on ACEs called the Compassion Trauma Circle. In her short documentary, “Step Inside the Circle,” filmed in February 2020, you see 235 prisoners, all men, stand in a large circle in the courtyard of a maximum-security prison in Lancaster, California.
Horstman, who stands inside the circle with a microphone, asks anyone who was frequently verbally abused by a parent to step inside the circle, and most of the men do. She continues asking about each ACEs trauma, including one about whether your family lived in extreme poverty. After each prisoner takes a step inside, the circle tightens until almost everyone finds themselves close to the center.
By this time, many prisoners have tears in their eyes as they recall the traumas they have experienced, some opening up for the first time. In response to the circle, Horstman leads everyone to raise their arms and shout, “There is no shame!”
“Everybody in prison is my client,” she says. “The trauma is really key.”
Since the COVID-19 lockdown, she’s developed a COVID curriculum called Trauma Talks, which includes a workbook and a video series. As part of the series, she talks about her own trauma and offers strategies for developing resilience.
The impact of her curriculum on prisoners has yet to be quantified, although Horstman said that of the 30 men in one class, two stopped using heroin and one revoked his DNR order. She adds that because they have spent so much time in prison, “Most of these men have done a lot of work on themselves.” So far, though, she and her team at Compassion Prison Project haven’t had the opportunity to debrief the 235 men who took part in the trauma curriculum.
In addition to her workshop curriculum, Horstman also hosts a podcast, where she interviews prison officials, thought leaders, and trauma experts. One of her first podcasts was with Dr. Vincent Felitti, who, along with Dr. Robert Anda, conducted and published the seminal ACE Study.
As for the impact of understanding ACEs in her own life, she says: “I started to realize I needed to look at my behavior and at my own thoughts. I was completely numb. I was disassociated.”
As a mother herself, she became hypervigilant, describing herself as ”a mother on edge.” Her work with prisoners has helped her achieve clearer direction. “Now I’m more available to my family and to my project,” she says, which includes more than a dozen team members and more than 100 compassion ambassadors who support the organization’s efforts.
“I’ve got a whole prison system to fix,” she says.