A 12-year-old child witnessing her mother being stabbed to death, a baby fed with drug-laced milk, children detained and cramped in immigration detention and children being molested at a young age – these are some of the extreme examples of news headlines that highlight the realities of some children in Malaysia. But, trauma need not be as severe, a family breakdown or emotional needs being ignored are enough to leave a dent in a child’s well-being. A dent that sinks its teeth deep into adulthood, leaving lasting scars and challenges.
At the forefront of providing trauma-informed mental health services, Anum Sofea Muhamad Fadzli, a clinical psychologist at Thrive Well, a social enterprise pioneering and innovating trauma-informed mental health solutions in Malaysia, recalled one of the earliest cases she had at the centre.
A woman in her late forties, Adeline* seemed well on the surface, but her eyes hid her sorrows. A little lost in finding her way in the world, she walked into the doors of the centre to seek help, having nowhere else to go after escaping a violent spouse with her children. Adeline had turned to alcohol to cope and experienced frequent anxiety attacks, which exacerbated her underlying chronic medical condition[1].
But that wasn’t the start of her sense of helplessness and spiralling self-blame.
She told me that she had always been scared and timid growing up, having no adult around her that she could rely on for warmth and safety. – Anum Sofea, clinical psychologist at Thrive Well
What Adeline* experienced and has been haunted by into her adulthood is termed Adverse Childhood Experiences (ACEs) by psychologists and those in the mental health sphere. Coined in 1998, ACEs refer to “potentially traumatic experiences that occur in childhood (up to 18 years old) and can have negative effects on a person’s physical, emotional, and mental health throughout their lifespan.”
ACEs are traumatic events that occur before a child turns 18. These experiences include verbal abuse, parental neglect, or exposure to mental illness in the family. The impact of ACEs can accumulate over time, influenced by factors like onset, duration, severity, and protective factors. Children who face multiple ACEs are at a higher risk of physical and mental health challenges in adulthood.
Childhood Trauma Can Affect Adulthood
Called a “chicken” by her stepmother, Adeline* had lost a parent and suffered physical and alcohol abuse at home. At school, she was bullied.
When you hear that, you realise that a lot of the time, people who are experiencing difficulties are unable to get out of their difficulties easily because of their experiences during their childhood. – Anum Sofea, clinical psychologist at Thrive Well
However, ACEs do not just affect emotional well-being, the implications are numerous and far-reaching.
Anum has seen ACEs in so many of her clients, and Adeline* was just one of many. An American showed that 70% of people had at least one ACE, and 48% had four or more[2].
In Malaysia, the exact number of people affected by ACEs is still unknown. A recent local study found that ACEs were quite common among university students, with rates ranging from 2.6% to 39.3%[3]. As more research is done, the long-term impacts of childhood trauma are becoming clearer.
The effects of childhood trauma can last a lifetime. Older adults who went through multiple childhood adversities are much more likely to face elder abuse after turning 60, even when considering other factors[4].
Alarmingly, the effects of ACEs are cyclical, as parents with ACEs may pass the baton of trauma to the next generation. Parents with ACEs may struggle to create a safe and loving home for their children, often relying on harsh parenting methods.
While trauma and adversities could be wired down to our very biology, there are ways to heal, and there are ways to prevent more of these traumas from continuing to be passed down to our children. – Anum Sofea, clinical psychologist at Thrive Well[1]
Patience And The Right Support Can Ignite Hope
In Anum’s experience, clients with multiple ACEs often require more patience and support, as these experiences can lead to complex difficulties addressed in therapy sessions.
When I work with clients who have experienced multiple ACEs, like two or more, I know they’ll need extra patience and support. Each person’s journey is unique, and some may have protective factors that help them cope better. – Anum Sofea, clinical psychologist at Thrive Well
With adequate internal and external resources and a supportive environment, effective healing can occur. Adeline*, for example, began to thrive after seeking help, proudly declaring herself an eagle soaring above past traumas and becoming a role model for her children.
Once she found work, she began to feel confident in herself. This newfound confidence positively affected her children, who were happy to see their mother working and no longer drinking at home. This shift helped her to understand that she was not as hopeless as she previously thought. – Anum Sofea, clinical psychologist at Thrive Well
How To Prevent ACEs
Tackling ACEs requires more than just mental health practitioners. These experiences span infancy to age 18, making it a responsibility for everyone: neighbours, teachers, social workers, and community leaders in high-risk areas.
Psychological help is not always the immediate priority. Some distressed individuals may need other forms of assistance first, like removing them from harmful situations or providing financial aid to parents. Sometimes, entire communities need interventions for safety and support. – Anum Sofea, clinical psychologist at Thrive Well
“The earlier, the better” is crucial for long-term recovery. Ideally, a systemic approach involving various stakeholders can break the cycle of trauma for future generations.
To address ACEs effectively, awareness is key. Screening and assessment are crucial for recognising and referring individuals to appropriate services. Therapists must be trained to understand ACEs and approach psychological issues from this perspective. Preventing re-traumatisation involves creating policies ensuring safety and support, from local plans to educational initiatives and broader systemic changes at a federal level. – Anum Sofea, clinical psychologist at Thrive Well
Prevention of ACEs starts with a transformative theory of change. Awareness of ACEs itself helps to improve the prevention of these problems and also shifts the focus to community solutions. It would require a sense of community responsibility, and collaborative efforts to work together to create a supportive environment that minimises the prevalence of ACEs.
Practical Steps For Someone Affected By ACE
Dr Nadine Burke Harris uses an analogy to explain ACEs: imagine a community where a contaminated well is causing people to get sick. Doctors treat the sick but don’t clean the well. Others must step in to clean the well and educate the community about its dangers. Similarly, addressing the root causes of ACEs requires collective effort beyond just treatment. – Anum Sofea, clinical psychologist at Thrive Well
Changemakers can play a crucial role in preventing and addressing ACEs by engaging in community efforts and providing the necessary infrastructure. Early detection through online screening and collaboration with community members are vital steps.
Initiatives like neighbourhood watch programmes and creating safe environments can significantly mitigate ACEs. Access to specialised psychological support, such as therapists trained in ACEs, is essential for long-term healing.
As community members, we all have a role to play. Directing individuals to hotlines like Talian HEAL, Buddy Bear Careline (specific for children), or Talian Kasih to report abuses or concerns, or simply being supportive, can make a difference. For those who have experienced ACEs, seeking psychological support is crucial.
Together, we can create a safer environment for children and help adults impacted by trauma to heal and thrive.
*Name has been changed to protect privacy and identity.
Explore our sources:
- M.Fadzli, A.S. (2023). Healing the Roots: Understanding Adverse Childhood Experiences and Building Resilient Communities. Thrive Well. Link
- Anda, R.F., Dong, M., Brown, W., D., Felitti, J.V., Giles, H.W., Perry, S.G., Valerie, J. E. & Dube, R. S. (2009). The relationship of adverse childhood experiences to a history of premature death of family members. BMC Public Health. 2009; 9: 106. Link
- Majid, M., Ab Rahman, A., & Taib, F. (2023). Adverse Childhood Experiences and Health Risk Behaviours among the Undergraduate Health Campus Students.Malays J Med Sci. 2023;30(1):152–161. https://doi.org/10 .21315/mjms2023.30.1.13. Link
- Asyraf, M., Dunne, P.M., Hairi, N.N., Mohd Hairi, F., Radzali, N. & Choo, W.Y. (2021). The association between elder abuse and childhood adversity: A study of older adults in Malaysia. PLOS One. Link
