Nobody Talked About My Uncle Johnny – Lingering Questions About Adverse Childhood Experiences…

I never knew my Uncle Johnny.  He died when he was 7 years old – many years before I was born.  He was the second of 8 children born to my paternal grandparents.  They were immigrants from Croatia and Austria.  Croatia was of several countries that eventually combined to form Yugoslavia and then became Croatia again when Yugoslavia broke up.  As I tried to follow my grandparent’s timeline in the 1920, 1930, and 1940 census my grandmother’s country of origin was listed as Croatia-> Yugoslavia-> Yugoslavia. I am trying to piece that all together from the usual genealogy sites.  Nobody in my family ever talked about Johnny.  I did not know he existed until 4 months ago.   I was trying to find information about my paternal grandfather and landed on the census that showed he had 3 children – 2 aunts familiar to me and Johnny.

We always knew that my father had a brother who died in childhood. We did not know how old he was when he died, but we knew it was a gruesome death.   I was told that “he was held over a fire by two kids and burned to death.”  I was also told that child’s name was George and my father and subsequently I was named after him.  I also heard a version of the story that he was named Nick after my grandfather.  I had an uncle who had Nick as a middle name.   

Once I found out that Johnny existed, I sent an email to the Wisconsin Historical Society to track down what happened to him and the date he died.  In Wisconsin you cannot get a death certificate unless you know the exact date of death. I was sent newspaper clippings from several Wisconsin newspapers. The basic story in those papers was that Johnny went down to a local coal dock to see an airplane with several other boys.  There was a bonfire next to the plane.  He sustained severe burns, and died 2 days later in a hospital.  In the hospital he told his father that he was pushed into the fire.  Subsequently there was another story that he was held over the fire.  The Police Chief investigated what happened.  Some of the boys were questioned. Several of them were named in the newspaper.   After the article about his death, there are no further articles about the outcome of that investigation or whether the death was ruled accidental or a crime.  

As a physician from an acute care hospital just the thought of what happened to Johnny evokes anxiety, anger, and hopelessness.  There was no burn care in 1925.  I did psychiatric consults on the burn unit at our modern trauma center for many years.  Burn care is emotionally demanding for both the patients and their physicians. Early on, one of the burn surgeons told me that he had informed consent discussions with severely burned patients and gave them all the option to choose no care except pain relief. It is difficult to imagine what the care must have been like in 1925 for my 7-year-old uncle during his last days. There were several statements about my grandfather seeking justice – but I am not sure whether that happened or not. 

There is a story that the boys involved did not do well as adults and that one of them may have died by suicide. At this point I cannot corroborate the outcome of the police investigation.  The local police department does not have records that old. I have requested the extended fact of death certificate to see if a specific cause of the severe burn injury is listed.  Local officials were initially unable to locate that death certificate until I discovered that the names of decedents were frequently misspelled – even official records (3,4).  I located a gravestone in the local cemetery marked John Dowson.  I sent that to the Register of Deeds and she was able to locate the death certificate under the name John Dosson. Given the age, date of death, and size of the town – it could not be anyone else.  It is also the first time I saw his date of birth.  

Given the historical limitations what were the potential impacts on the family?  Trauma is an overworked word these days in psychiatry and psychology.  Recent advocates of explaining nearly all psychopathology in terms of trauma and providing trauma informed care seem to have ignored the history of the field.  To cite a few examples – sexual trauma in children has been described back into the 19^th century by psychiatrists (1).  The trauma and biological effects of being raised in orphanages (psychosocial dwarfism) was described by psychiatrists (2).  Combat related trauma and PTSD was so well described that several of my mentors were placed in accelerated psychiatric residency programs to make sure the US Military had enough psychiatrists to treat the psychiatric complications of World War 2.  It is worth noting that before shell shock or the stress of combat was not seen as an etiology.  Soldiers exhibiting those symptoms were seen as morally deficient. In other words – the soldier was seen as flawed and combat exposure was incidental. In the early days of correcting that diagnosis the most frequent diagnosis in the German army was psychopathic personality suggesting an intrinsic susceptibility to overrespond to life threatening stressors.   

Over the span of my career I taught and practiced detailed phenomenological assessments that included every possible context that psychiatric disorders or symptoms occur in.  It was quite a shock when I started hearing about trauma informed care and started to see the iatrogenic problems associated with it. In the population I was treating at the time there were a significant number of immigrants from Africa, Russia, and Asia.  I routinely worked with 15 different language interpreters.  Many of the immigrants had been exposed to war and torture.  The prevalence of torture victims was so high that there is a  Center for Victims of Torture in Minnesota that was established in 1980.   

Despite those clear correlations the relationship between stressors or trauma and psychopathology is complex.  One of the primary problems is oversimplification. It is well known that people subjected to the similar catastrophic stressors do not respond in the same way (5,6)   This is due to several biological, environmental, and psychological factors that are typically called resilience.  More resilience translated to less maladaptive stress response.  In some cases, the stress response is very transient to nonexistent.  In others it follows a predictable course and in some it does not resolve without treatment.  The emphasis on identifiable stress response syndromes – Acute Stress Disorder and Post Traumatic Stress Disorder does not capture all the effects of these events.  It is clearly possible to have your life impacted by this kind of an event and not develop these full syndromes.

There have been efforts to more clearly correlate adverse life experiences with both physical and mental health.  The Adverse Childhood Experiences (ACEs) inventory was developed by the CDC and used to look at childhood adverse experience with subsequent problems.  The checklist is listed below and it was designed to be given only to adults over the age of 18. Inspecting those questions and the scoring it is apparent the focus is on physical, sexual, emotional, and verbal abuse and neglect.  There are four items on the lack of availability of a parent due to substance use, mental illness, separation or divorce, and/or incarceration.  The adverse experiences are all originating in a parent, caregiver, or person living in the same household.  Nothing about bad accidents originating outside the family or the death of a parent or sibling.

 The original CDC study of the ACES checklist was studied in a HMO sample (6) half of the 9,408 respondents reported at least one childhood exposure and a quarter reported more than or equal to 2 exposures.  This study also looked at correlations between ACES and adult risk behaviors and diseases and concluded there was a graded relationship.  That set the stage for subsequent studies that made similar claims.          

In the case of my Uncle Johnny – what was the impact of his death on the family?  Why was his name never used in discussions with his siblings?  Did it matter if the cause of death was never adequately resolved?  Did it lead to effects that are not typically considered as adverse childhood experiences?  None of his siblings knew his name.  The names passed on to the next generation were not accurate.  Why were his death and the associated circumstances never talked about in the family? 

Every family has characteristics that family members think about.   I can think of a few for mine.  We lived an isolated existence.  A typical family outing was a drive in the countryside.  We did not socialize with anyone.  Once or twice a year my father’s brother or brother-in-law would stop by.  Once or twice a year – we would stop by to see one of my father’s coworkers or a guy he used to play baseball with.  I did not know about the baseball connection until I found a picture of his team online – 40 years after he died. 

We would visit my maternal grandparents often.  It was one of the few places my father would smile.  He was typically very serious and showed emotions only during times of stress or if he was listening to opera or a comedian on TV.  I once asked him if I could play Little League baseball and he said: “As long as you know you are playing it for you and not for me.”  I got a similar reaction when I tried to give him a fishing rod for Father’s Day: “You just want me to take you fishing.  I don’t fish because when I was a kid we had to fish every day for food.”  His family home was right next to the coal dock where I usually went fishing.  The only consistent story we heard about his childhood was what it was like to grow up during the Great Depression.  One of the last events my father attended was a banquet for my high school football team.  It was an undefeated season and I was one of four sophomores.  He was at the event and seemed to enjoy himself – but never said a word about it to me.

If things got a little out of control – my father got angry.  I remember when one of us fell down a staircase.  He was clearly upset but it was mostly anger.  At times it came across like he was blaming the person who had the accident.  I found a box of rifle cartridges in the old horse barn modified to be our garage.  I put them in the trash burning pile that he attended next to our house every other night.  I still remember him dancing around when those cartridges went off. He showed plenty of restraint when I admitted doing it and that was the end of it.  I went out the next day and found the exploded cartridges in the ashes – the brass peeled back in a flower petal design.

There were many more situations that occurred between my father and I that I would consider unusual in retrospect.  There were only 5 children in our family and I cannot imagine what it would be like with three more. We lived “paycheck to paycheck” but never ran out of food.  There was not a lot of joy in the household. I worried about him and still have the mental image of him walking home in knee deep snow from work.  I worried because he told me that deep snow could get pulled into the air intake of his diesel locomotive and kill the engines.  In that blizzard he was leaning into the wind, covered in snow, wearing a flimsy fishing hat, and no gloves.  I was the only one up waiting for him at 11PM.  He walked in smelling like diesel oil and Lucky Strikes and shook off the snow.  He was freezing.  I was happy to see him.       

As I think about my Uncle Johnny and my family of origin there are more questions than answers.  Would things have been different for all of us if he had not been killed? Would my father have been a happier guy?  Would we have been less isolated?  Would the paternal side of the family have been less fragmented?  Can a catastrophic event like that have intergenerational effects?  There are only suggestions described by statistics at this point.  Studies like the impact of violence on mothers in families and the unique stressors that immigrants experience.

In an ideal world - the people closest to the incident have the greatest ability to process it and frame it for future generations.  They may not have the ability to do that but make no mistake about it – that is a very difficult task.  

 

George Dawson, MD, DFAPA

 

1:  Esquirol JE.  Suicide in Dictionnaire des Sciences Medicales.  A Group of Physicians and Surgeons (eds).  1821: 219-220

French psychiatrist Jean-Étienne Dominique is credited with suggesting that suicide was associated with mental disorders and was not the result of moral weakness and therefore not a sin or a crime.  In this initial report he described and attempted sexual assault by the father on a 16-year-old daughter resulting in several suicide attempts.  I could not access the original Dictionnaire des Sciences Medicales - but found this interpretation in Peter Gay’s Freud – A Life for Our Time – page 95 footnote.

2:  Spitz RA. The role of ecological factors in emotional development in infancy. Child Development. 1949 Sep 1:145-55.

3:  McGivern L, Shulman L, Carney JK, Shapiro S, Bundock E. Death Certification Errors and the Effect on Mortality Statistics. Public Health Rep. 2017 Nov/Dec;132(6):669-675. doi: 10.1177/0033354917736514. Epub 2017 Nov 1. PMID: 29091542; PMCID: PMC5692167.

4:  Gamage USH, Adair T, Mikkelsen L, Mahesh PKB, Hart J, Chowdhury H, Li H, Joshi R, Senevirathna WMCK, Fernando HDNL, McLaughlin D, Lopez AD. The impact of errors in medical certification on the accuracy of the underlying cause of death. PLoS One. 2021 Nov 8;16(11):e0259667. doi: 10.1371/journal.pone.0259667. PMID: 34748575; PMCID: PMC8575485.

5:  Geoffrion S, Goncalves J, Robichaud I, Sader J, Giguère CÉ, Fortin M, Lamothe J, Bernard P, Guay S. Systematic Review and Meta-Analysis on Acute Stress Disorder: Rates Following Different Types of Traumatic Events. Trauma Violence Abuse. 2022 Jan;23(1):213-223. doi: 10.1177/1524838020933844. Epub 2020 Jun 26. PMID: 32588756.

6:  Copeland WE, Keeler G, Angold A, Costello EJ. Traumatic events and posttraumatic stress in childhood. Arch Gen Psychiatry. 2007 May;64(5):577-84. doi: 10.1001/archpsyc.64.5.577. PMID: 17485609.

7:  Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med. 1998 May;14(4):245-58. doi: 10.1016/s0749-3797(98)00017-8. PMID: 9635069.