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The most important thing I didn’t learn in medical school is about adverse childhood experiences, also known as ACEs.

To be sure, if I had understood them then the way I do now, I would have been a better and more compassionate physician. Importantly, I would have avoided lots of mistakes.

What kind of mistakes, you ask?

I was pretty much a failure taking care of smokers, drinkers, drug addicts, and morbidly obese people. People who were chronically depressed or in chronic pain were not helped by me either.

I never understood that addictions to food, drugs, alcohol, and cigarettes, are imperfect solutions to the effects of toxic stress resulting from adverse childhood experiences. Toxic stress sets up pathways in the brains of traumatized children, pathways which persist into adulthood. We don’t outgrow these pathways, so as we get older, we try “home remedies” to treat them.

My mistake was to try over and over to get people to “give up” cigarettes, alcohol, pills, or overeating without addressing the reasons these things provide comfort. I was never taught that the stress receptors in our brain that are soothed by these substances are set up in early childhood. Our early experiences create memories which become structural realities in our brains. To try to address chronic pain with pills simply compounds the problem by adding a new one: addiction.

I failed to find out what kind of pain people were facing.  I was not taught to ask the right questions. The ACEs questions.

Drs. Vince Felitti and Rob Anda found the connection between adverse childhood experiences and chronic illness in adults during research on insured middle class people. When I learned this, I became intrigued. Could this information help me understand health disparities better?

Indeed, it did, leading my career away from caring for one patient at a time and towards caring for people. Lots of people. A neighborhood of people, a community of people.

I learned that there is hope accompanying learning about ACEs in our community.

Resilience can overcome the effects of toxic stress. As adults, we can’t undo the early childhood trauma we experienced. But, our ability to develop resilience starts in early childhood and never goes away.

We can develop resilience in ourselves, and we can help others develop it in themselves.

In fact, if you suffered ACEs as a child and are living an adult life free of addiction and chronic illness, you have someone to thank for it. Someone helped foster your resilience.

Our understanding of ACEs and the developmental effects of them have revolutionized the way communities think about young children.  Investments in pre-school education, health care for children, and addressing behavior problems in school have been found to be not only wise but enriching. Yes, community money spent early saves enough to make a community prosper later.

A lot is happening in Gainesville and Alachua County, where I live, to avoid trauma in pre-kindergarten children and their families. Gainesville4All teams are addressing important social structures and supports for young children, Peace4Gainesville is enhancing systems understanding of adverse childhood experiences and resilience, Partnership for Strong Families is providing supports to vulnerable families, and our County Commission is poised to make significant strategic investments in preschool children.

For older children, Alachua County Schools are coordinating with law enforcement to reduce disproportionate contact of minority youth with juvenile justice, and the River Phoenix Center for Peacebuilding is fostering reconciliation and enhancing resilience in those experiencing trauma.

This month, our local papers, the Gainesville Sun and the Guardian launch a multipart series with noted journalist, Jane Stevens. She will bring us up to speed on the current understanding of early adversity and its effect on early childhood brain development. Jane has been writing on this topic for more than a decade, and will share content from and  Join us on this journey to learn about toxic stress and the power of resilience to overcome it.

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“Blue Knot Foundation has a key role to play in the building of community capacity in care provision to those who have experienced childhood abuse and trauma in any environment.”

NIALL MULLIGAN Manager, Lifeline Northern Rivers

“I think Blue Knot Foundation is a fantastic support organisation for people who have experienced childhood trauma/abuse, for their families/close friends and for professionals who would like to learn how to more effectively work with these people.”

Psychologist Melbourne

“It's such a beautiful thing that you are doing. Helping people to get through this.”


“It was only last September when I discovered the Blue Knot Foundation website and I will never forget the feeling of support and empathy that I received when I finally made the first phone call to Blue Knot Helpline, which was also the first time I had ever spoken about my abuse.”


"At last there is some sound education and empathetic support for individuals and partners impacted by such gross boundary violations.”


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Phone: 02 8920 3611
PO Box 597 Milsons Point NSW 1565
Hours: Mon-Fri, 9am-5pm AEST

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Phone: 1300 657 380
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