I chuckle when I hear this phrase: “To a man with a hammer, everything looks like a nail.” The quote is attributed to Mark Twain. It has a lot of meaning to the brain. It applies to those who are engaged in the battle against childhood trauma as well.
Once we gain knowledge about ACEs, and start our advocacy to help by promoting ACEs, the world starts to look like it is consumed by trauma. But that’s not the case. Our brain goes to work, and all of a sudden we are consumed by the knowledge through an illusion bias. (I include myself in that group.) We pay more attention to signs of trauma and start to attribute society’s ills to it. We see more and more signs of it everywhere. We listen or read the views of others and we choose sides. Once we become an advocate for our side, everything on the other side looks like a nail and we start to hammer—mindlessly. How can we step back and see the rest of the toolbox?
The best advice I ever read came from early pioneers in the United States Lean Management movement, John Shook and Mike Rother. [LINK HERE] The authors teach us to step back and look for connectedness to the part you are looking at. In business, everything starts with a customer wanting 'something', and that’s where we start to look. If we want to meet that customer's needs, we have to look back at every part of making that 'something'. It’s referred to as systems thinking, and was a lifelong passion for Dr. W. Edwards Deming, a giant in the field of management.
I have a conversation with my first son regularly. We have talked about going into business together, and he is worried about finding customers. I tell him that there are 330 million people in the United States, and we really only need to attract a very small number of them as customers. We will talk about musicians, specifically rappers, and I will ask how many downloads do they need in order to be successful. He will tell me that 200,000 is a great number and rappers who attract that big an audience make millions. A family practice physician really only needs a patient panel of 2,000 to 5,000 to make a good living.
If we consider our customers those who have ACEs, then we know the number is approximately 70% of the population. And if we want to target the ones who have serious problems, we can narrow that down as well. I refer to this as “stratification.” One of the best examples I have seen of stratification is a graphic prepared in Washington State showing the distribution of ACEs in an average classroom of 30 students. Twenty percent of the students on an average classroom have 5 or more ACEs; 33% have 4 or more. And here is where serious issues manifest with frequency. It’s also where behaviors start to aggregate. Behaviors aggregating refers to multiple symptoms, behavioral and health, in one person. They don’t manifest all the time, but they appear sporadically, whenever we activate.
So with stratification and aggregation, we are ready to learn to see, that is, if we can overcome our brain’s desire to accept what we already know. What I ask people is to let go of their belief structure temporarily. You can always go back to it, but for now, don’t have a knee-jerk reaction to what you see or hear. Clear your mind and start to ask questions. What we want is to look back from our customer and their needs to how we meet them. What you will find is that you have to stratify your customers and aggregate their needs (according to need and symptoms). I have done this for specific symptoms to illustrate the concept. For example, in my blog about suicide attempts, I stratify the target population for intervention by looking at the number of suicide attempts in categories 5, 6 and 7+ ACEs. That turns out to be about 6% of the original studied ACE population. Then I apply that calculation to the demographically highest risk portion of the population, males between the age of 14 and 35. The calculation allows me to understand who the customer is for suicide intervention service.
Now let's look at another example from education, which the graphic from Washington State addresses. Because most educational systems are reactive (notice that nurses and psychologists are the first employees to be cut in a budget crisis), the customer base tends to sort itself out. Lincoln High School in Walla Walla, WA, is an excellent example. Traumatized kids (those in the 4+ range—our 33% of the population) react three ways in the absence of intervention. They fight, and get expelled or steered to an alternative high school; flee and drop out; or freeze and don’t exhibit the signs of being a problem child and are subsequently ignored because of the perception that they are well behaved. Each category self selects their path. And none of the paths are fun ones to take, fraught with danger and a potential slide to serious problems and issues.
Our current healing culture is full of silos attempting to treat symptoms, and each has their own die-hard supporters and funding stream. They look upon their focus with a hammer and everything becomes a nail from their perspective. Expanding your thinking to looking at a system can give you greater insights into how to approach healing. I encourage everyone I talk with to stop, back, clear your mind, and use some of your thinking ability to consider other ways of thinking and being.
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