Leslie Ferguson

@leslieferguson | contributor
I’m a writer, editor, and educator living in the Greater San Diego area. I love how stories bring people together and make us feel less alone. When we unapologetically share our truths, we can expect a future thriving with community, kindness, compassion, and healing. My award-winning memoir, When I Was Her Daughter, about my journey through my mother’s madness, is available from Amazon and Barnes and Noble. Visit me at LeslieFergusonAuthor.com.
Monika Sudakov

The ACEs Questionnaire Is Missing These Types of Trauma

From 1995 to 1997, over 17,000 participants from within the Kaiser Permanente organization throughout Southern California underwent one of the most comprehensive research studies ever conducted attempting to link the presence of childhood abuse , neglect , and other trauma with negative health outcomes later in life. The ACEs study, or adverse childhood experiences, determined that there is a direct correlation between childhood trauma and chronic diseases including heart disease, cancer, diabetes, autoimmune diseases of all kinds, as well as a myriad of mental health conditions. The study involved the use of a questionnaire featuring 10 types of childhood trauma identified as most common within the sample community involved in the study. The findings indicated that the higher your ACEs score, meaning the more of these traumas you endured in childhood, the higher your risk for developing disease later in life. The questions included can be found here. While the ACEs Study revolutionized the ways in which the medical community viewed the impact of trauma on wellness thereby emphasizing the need for mental health care and better education about trauma amongst those involved with childcare of any kind, there are some limitations to the study and the inventory that need to be addressed in order for the true nature of the impact of trauma during childhood upon health later in life to be adequately understood. First, the demographics of the community that were interviewed for the initial study were predominantly white middle-class individuals with access to health insurance and therefore proper comprehensive health care. This doesn’t negate the study per se, but it does limit its usefulness on a broader scale. If nothing else, I believe it actually underestimates the cause and effect of childhood trauma on health later in life, particularly among minority populations which tend to be poorer, underinsured, and more vulnerable to innumerable stressors. Second, the original inventory of questions fails to take into account a myriad of traumas that are equally valid and likely just as damaging over time. These include but are not limited to: racial trauma, homophobia, transphobia, xenophobia, war, poverty, immigration, bullying, medical trauma, religious and spiritual trauma, intergenerational trauma, ableism, and pandemics. Some of these may be societal in nature but not only do they affect a child’s sense of security and safety, but they can also severely affect a caregiver’s stress and ability to be attuned and functional. Third, the questions are not specific enough to address more nuanced types of abuse and neglect , such as emotional incest and attachment disruptions. There is more and more evidence that indicates that even when from the outside children appear to be cared for — i.e., have housing, food, a good education, and parents who appear to be involved — what children actually experience behind closed doors can be far from idyllic. The ambiguity of this kind of attachment injury is difficult for children to recognize and often behavioral issues that arise from this type of trauma is designated as something stemming from within the child, like attention-sensitive/hyperactivity disorder (ADHD) or disruptive mood dysregulation disorder. In her book “Mother Hunger,” Kelly McDaniel astutely points out that the ACEs questionnaire fails to include “having an abusive or frightening mother” but does include witnessing a mother being abused which perpetuates a narrative that mothers are always victims and never the perpetrators of abuse . Additionally, it fails to recognize that men can be victims as well, which only reinforces a patriarchal view of the world where men are the aggressors and women the prey. My personal history of childhood covert incest and emotional neglect from my mother is a perfect example of how my experience isn’t encompassed by the inventory. I score a 5 out of 10, which is high enough, but my more impactful trauma isn’t reflected in the inventory as it was originally conceived. There is no way a questionnaire designed for widespread use by professionals across various sectors could adequately encompass the seemingly innumerable permutations that trauma takes. But, I do think it is time for an overhaul that is somewhat more involved and incorporates both less obvious types of abuse or neglect as well as societal ones. Too many of us struggle unnecessarily with undiagnosed trauma and chronic illness that doesn’t appear to have a source because we simply don’t have the vocabulary or awareness of how what we experienced as children was in fact trauma . This can lead to self-blame, comparative suffering, and loss of hope. If your trauma doesn’t fit the criteria of the ACEs questionnaire, that doesn’t mean it didn’t happen, that it wasn’t damaging, that it wasn’t bad enough to get help, or that you are overreacting. In the grand scheme of the developing world of a more holistic approach to trauma -informed medical treatment, we are still within the infancy of not just understanding how what happened to us and/or what we didn’t get affects us on a biological level, but the degree to which childhood trauma on both a micro and macro level determine our mental and physical wellness throughout our lifespans.

Community Voices
Community Voices

Notes on Being #Fine

<p>Notes on Being <a class="tm-topic-link ugc-topic" title="Fine" href="/topic/fine/" data-id="5c1a5f4118e78d00f5a1259e" data-name="Fine" aria-label="hashtag Fine">#Fine</a> </p>
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Community Voices

Notes on Being #Fine

<p>Notes on Being <a class="tm-topic-link ugc-topic" title="Fine" href="/topic/fine/" data-id="5c1a5f4118e78d00f5a1259e" data-name="Fine" aria-label="hashtag Fine">#Fine</a> </p>
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Community Voices

Notes on Being #Fine

<p>Notes on Being <a class="tm-topic-link ugc-topic" title="Fine" href="/topic/fine/" data-id="5c1a5f4118e78d00f5a1259e" data-name="Fine" aria-label="hashtag Fine">#Fine</a> </p>
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Notes on Being #Fine

<p>Notes on Being <a class="tm-topic-link ugc-topic" title="Fine" href="/topic/fine/" data-id="5c1a5f4118e78d00f5a1259e" data-name="Fine" aria-label="hashtag Fine">#Fine</a> </p>
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When I say “I’m fine,” what I really mean is…

<p>When I say “I’m fine,” what I really mean is…</p>
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Notes on Being #Fine

<p>Notes on Being <a class="tm-topic-link ugc-topic" title="Fine" href="/topic/fine/" data-id="5c1a5f4118e78d00f5a1259e" data-name="Fine" aria-label="hashtag Fine">#Fine</a> </p>
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Write a haiku about your health.

<p>Write a haiku about your health.</p>
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Mia Ferrer

Makeup and Your Mental Health

It is 2012. I am 15 years old, sliding into my seat in my high school chemistry class. The girl one desk over to the right and one desk up is a year older than me. Her name is Hannah, and she’s pale-skinned, she has blonde hair, she wears liquid glitter eyeliner, and she is usually involved in most of the school activities. We have been going to the same schools for six years, at no point in which I think we’ve ever spoken to one another. Today, though, she turns and speaks to me, inexplicably. “You know, you wear too much eyeliner. My mom’s a makeup artist, so it just bugs me.” My mother (who I do not live with) is not a makeup artist. She teaches after-school activities for low-income children. I live with my two older brothers and my father, who is also not a makeup artist. He is a civil engineer. I don’t know how to respond to this. I am starting to squint at her under my glasses, through my thick, black winged eyeliner. It is the only piece of makeup I ever wear, because it is cheap, fast and dramatic on its own. (Plus, I had discovered with delight, if you mess up, there is a simple, ingenious solution — just draw over the fucked-up wing and make it bigger.) The dark-haired, brown-skinned boy sitting to my left saves me from trying to figure out how I’m supposed to answer this. “It’s emo,” he says helpfully. Me and Salil are on more familiar terms. We’re not really friends, but we joke around a bit in class, and sometimes he sends me messages on Facebook. Sometimes there are objectifying messages about girls. I laugh along and sometimes make sardonic, self-denigrating and misogynistic comebacks, because this is a common, typical way people joke in 2012. Later, I will learn that this is called toxic masculinity. I know he says it as a sort of backhanded defense of me, so I nod and laugh along and affirm sarcastically, “Yeah, it’s emo.” (I don’t really think I am emo, but I understand that if you wear thick black eyeliner, people will call you this sometimes as a joke, though it is not necessarily considered to be a bad thing.) Class starts. Class ends. School goes on, and I am still applying my thick, black cat-eye every day throughout. Years pass. But there is something that makes me remember this specific interaction in more vivid detail than most interactions I’ve had. It is possible that this was due to, as they say, the Audacity of This B*tch. It wouldn’t be the last time. In 2014, I am 18 years old. I am in my business class in my second year of community college. The professor runs a class project where each group simulates being the owners of competing bakeries. My groupmates mostly do not care about it. They speak some words and nod for a minute when I talk, then turn back to each other and start gossiping about something else, and so I inherit the task of physically doing most of the project. I am used to this; I am good at this. I don’t mind it much. It is not difficult and I don’t care much about the other things they talk about. My group gets second-place with my Mumbo Jumbo Bakeshop. A year later, I am working as a barista for a “dessert lounge” called Frost. When I become the store manager for the main location, I start buying crisp blazers and pencil skirts. I begin spending a half-hour every morning putting on a full face of makeup. The black eyeliner is still there, but I am also buying foundation, blush, highlighter, bronzer, spending hundreds of dollars every few months to maintain this visage. I am looking up “contouring” tutorials on YouTube. Every day I come to work a 19-year-old masquerading as a manager. I am wracked with anxiety every time I address my older employees, but I think that I at least look like I know what I’m doing, probably, and that thought helps my voice stay level even while my heart is palpitating tangibly in my chest. Later, a couple of baristas will tell me on different occasions they appreciate that I am “really chill,” that I have a comforting presence that puts them at ease. I will laugh at the irony. When I begin going through severe mental health issues in 2016, I stop wearing makeup, more often trading in the blazers and wedge heels for the standard, dark work uniform and non-slip shoes. I begin going to therapy. I am 20. My superiors hold a managers’ meeting where the male vice-president of the company mentions in front of everyone that they had been noticing “some people” (i.e. one of the females — me) not wearing makeup, that it was unbecoming, and that “you need to be selling yourself, not just the product.” A couple of the other male managers begin debating the ethics of telling someone to wear more makeup, to no clear resolution, and I sit there, stone-faced and silent. I have been struggling to find the will even just to get out of bed in the morning lately, and no longer can find the time to put on all that makeup. I hadn’t really thought this was something anyone at work would actually go so far as to demonize, though. It wouldn’t be the last time. My mental health steadily worsens. Sometimes as I get ready in the morning I am crying thinking about being stoic enough to get through another day. I can’t hold back the tears as I am putting the fucking makeup on, but I catch them with my fingertips as they form at the edges of my eyes, tipping my head back so the mascara doesn’t run. I grit my teeth and keep applying the pink blush to my cheeks. I become adept at crying without visibly messing up the makeup. No one notices it, but they do notice I am late. The district manager at my next workplace — this one is a small, dimly-lit, vegan donut chain called Mighty-O Donuts — says it more explicitly to me. She pulls me aside, and says that since I had worn makeup during my interview with her, she had been expecting I would wear it daily, and that as a manager, my bare face is “unprofessional.” She tells me this as she is wearing yoga pants and a hoodie in front of me and a negligible amount of makeup on her own face. “Well, it’s different for me because I’m pregnant, but I always at least put on a little mascara or something.” I stare blankly back at her for a moment. I feel tired. “OK. I will work on it [my face].” The night before National Donut Day, the busiest day of the year, the baker dies by suicide. His name was Daniel. He was two or three years older than me, with brown hair always covered by a cap when I’d seen him. I had only interacted with him on a few occasions, but I remember he was slightly soft-spoken and very funny. The owners memorialize him in one email, and no one says a single word about the timing. They bring someone else in to help bake the donuts that day. And business continues. My mental health steadily worsens. I cannot get myself out of bed. When I finally do, I spend 10 minutes blurring the imperfections on my face and darkening my eyelashes as I was instructed. I am chronically late. I get fired from this job and the next. I opt not to pursue being a manager anymore, and take up being a barista at a busy little waterfront bakery-cafe in Edmonds called Red Twig. My manager here runs both the front and back-of-house, as well as the operations for the whole cafe, and she keeps minimal direct contact with the baristas and cooks, aside from monthly meetings. We create our own work culture independent of direct supervision, for the most part. Sometimes I clock in a few minutes after the hour. Each time, I am burning with guilt and shame. No one ever says a word, though. It is 2017. I am 21 years old. Sometimes I wear light makeup, when I feel like it, when I have the time; sometimes I don’t wear any. Sometimes it’s nothing but thick, black winged eyeliner. As time goes on, I wear makeup less and less often, and eventually it becomes something of a rarity. No one says anything about my face — except a few of the customers. Some of the women I make easy chitchat with make sweet, earnest side comments like, “By the way, I just want to tell you, you are really beautiful,” as they stand behind the counter, waiting for me to finish crafting their lattes and frothing a little heart or a feather on top of the delicate foam. My heart drops a little bit in my chest. I feel relief and warmth. I feel seen. “Thank you. I’ve had other places of work reprimand me for not wearing makeup, so that is really nice to hear.” “You don’t even need to wear makeup. You are lovely,” they tell me, without hesitation. Not so coincidentally this was the workplace where I felt most comfortable being myself, where I was happiest, where I connected most with my coworkers and my customers, and was able to heal the most. I stop going to therapy. (A few months later, my dad’s health insurance plan stops covering it.) I move to Bellevue in 2019. My next place of employment is a French dessert shop called Lady Yum, and it has several glamorous women working behind the counter with flawless makeup, exquisitely curated outfits, brimming with confidence. Here I wear makeup daily, and even dresses sometimes, an unheard-of event for me — not because anyone said I had to, but because I feel good, and I am surrounded and inspired by this ultra-femininity. It is fun, though it feels more like playing dress-up every day than actually presenting my own self. I laugh and gab, pop bottles of champagne, buy bright colors and big statement earrings, and play along. My dad dies on the store’s fifth anniversary. I am 23 years old. My brother tells me he is dead over the phone as I am sitting down in the back kitchen, wearing a flowing purple dress I’ve never worn before and a stupid paper crown on my head that my boss had given all of us to wear in celebration, rainbow disco lights wheeling overhead in the lobby. Later, I would find out he had likely died around 8 a.m., about the time I was getting ready for work. This was enough to estimate that I was probably putting on my makeup, trying on outfits, pinning on my earrings, as my father was convulsing alone on the floor. His heart probably stopped as I was testing my smile in my reflection. I stopped wanting to play dress-up as much after that. “So, are you doing OK?” Lady Yum’s male operations manager asks me a few weeks later. I am still wearing a dress on that day; navy blue, black belt cinched around my waist, galaxy-studded earrings, but I had stopped wearing any makeup since my dad had died. I give some collected, noncommittal answer. It is half-honest and very professional. He replies: “Well, based on your presentation, I would say that you weren’t.” I am setting up a display case of macarons as he says this. I laugh darkly at the old familiarity of it and shake my head as I keep stacking cookies. “Thanks for letting me know,” I say to him, and then a customer comes in. Thinking of my dad, I still cannot get myself to stare into a mirror applying powder to my face and painting my eyelids different colors, but I start putting on more jewelry after that. Six months later, after weeks of uncertain chatter, COVID-19 reaches the United States. It begins in Kirkland; the very city of the Lady Yum shop where I work. All the shops shut down in March 2020. I am 24 years old. I go home from work. Suddenly, everyone is wearing masks that cover most of their faces. The women on my social media say, “I don’t mind wearing a mask. It’s kind of nice not having to wear too much makeup.” I do not go back.