Overcoming Intergenerational Trauma to Promote Healing: Moving Through Grief, Loss, and Love

A Catalyst Conversation with Dretona Maddox, RN, PHN, LCSW

Founder and Executive Director, Purposely Chosen, Inc.

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Catalyst Center held a series of conversations with diverse providers and trauma survivors from varied sectors to discuss how to address Adverse Childhood Experiences (ACEs), human-centered approaches to healing, and cross-sector collaboration to mitigate the toxic stress response and curb the cycle of intergenerational trauma.

From nursing to social work, to stabilization home and teen advocacy

Q: Tell me about your work and what drew you into this particular field.

What drew me to that work was really my connection to this population, and personal and lived experience. I didn't initially know that my life would take this turn. My professional career started off as a nurse, and I've been a nurse for the past twenty-seven years.  I got into some sub-acute care for children with disabilities… but I think it was really more so about my sister, who had cerebral palsy.

My mother had placed my sister in a facility when I was younger. And my mother died when I was four. My sister was nine at the time. And I was wondering, why does she cry so much? I knew that she was in a wheelchair. I knew that she was not able to verbally communicate the way that we could communicate, and she would just cry. And I often wondered, but I was too young to really understand.

As I continued my career in nursing, I got an opportunity to work for the NICU, the Neonatal Intensive Care Unit. We called it the big house because it was a level three trauma unit, and it had 70 beds for these micro preemies. So, I got an understanding of the decision-making phase of when a parent had a child that was premature and it's a split second decision to preserve life. You know, the kid could grow and mature and develop healthy, even after being in the NICU. You either graduate, or you could have these severe conditions, like cerebral palsy and other disabilities. At the time, I was satisfied. I thought, “This is it. I'm at the big house. This is my life. This is what I'm supposed to do.”

I now have a full understanding of my mother's process with choosing to preserve life for my sister, but then the task of caring for her proved to be more difficult. And that's why she ended up in a facility. And I had begun my career working with kids with disabilities in this facility, so it made a full circle. And then I met a 17 year old girl who had twins, and she was faced with a decision to preserve life on the little girl who was considered floppy, in medical terms, or not normal. And I felt that it wasn't the right decision. She was 17 years old. I didn't think that she should have that responsibility to make a life decision for her child, because she didn't really understand the full complexity of it. They terminated life. It took four and a half hours for this baby to take her last breath. And it was life changing. It was absolutely life changing. I decided in that moment that I didn't want to be a nurse anymore. In the capacity that I was in, I felt that if this is what we were about, then I don't want any part of it, because I had to hold this baby as she gasped her last breath and looked at me, you know, for dear life, and there was nothing I could do other than give her palliative care and medication that was ordered by the doctor. So, she took her last breath.

But what stuck out to me is that I felt a strong feeling that it was the social worker's responsibility to give the mom resources, and she didn't do that. And I don't know why I really had an opinion about that particular teenager, she was too young to make that decision, but I did make a connection with my own life. I had strong inclinations, and I told my husband I would change careers. I was looking through a nursing journal and thought, “I will be a social worker.” At the end of the journal, it said “nurse social work practitioner,” where they were recruiting registered nurses to become a social worker, and I'm like, “This is it. This is going to be it for me.”

I went on in my career, graduated, and was doing very well, and got an opportunity to work at a foster family agency where I was the administrator, and they asked me to open a stabilization home for kids that transition from a foster home into a higher level of care to stabilize them. And I'm like, “I can do that!” You know, I was homeless. I was a homeless youth. I have the passion, I know what it's like, I can do this. They sent me a needs assessment, and the first thing I see for our particular region was a maternity home for pregnant and parenting youth. I had to pull over in my car because I was crying. At that moment, my 15 year old self came flooding back to me, when I was homeless and lived in a place where this lady just took in kids, she didn't call social services, but she took in kids. I was 15 and found out I was pregnant after I got stable in this home, and the lady said that I couldn't be there because I was pregnant. I asked her, “Well, what am I supposed to do?” and she said, “You can leave, or you can get rid of it.” So, at 15 years old, I made the decision—a 15 year-old’s decision—to abort my child, for a roof over my head.

Making that decision affected me greatly, but I kept it close to my heart. Then when this moment happened, it awakened all of that. And I was like, “Never again will a kid have to make the decision to terminate life of her child, just for a roof over her head.” I now have maternity homes for pregnant and parenting teens called Perfectly Chosen. These pregnant and parenting teens are in the foster care system, and they keep their babies, and we equip them with everything that they need to be the best parents that they can be, so they don't have to tell that story.

The need to be seen, heard, and validated through childhood adversities

Q: What do ACEs stand for, and what do they mean to you?

ACEs stand for Adverse Childhood Experiences (ACEs). I experienced my having an ACE score of seven. I experienced domestic violence. My mother died of suicide. There was drug use in the home. I was displaced and homeless. I went through a lot of things where I should have been protected as a child, and these adverse experiences that I went through—you know, child abuse, physical abuse, neglect—it was just something that I shouldn't have gone through as a child. But it happened, and it was adverse, and those are my experiences.

ACEs have impacted me in my life. The way that I learned at a very young age to internalize the pain, the experiences that I was going through, I was very aware. I remember a lot of things from my early childhood, and I'm talking as early as two years old. I remember the things that happened in my house. I remember the beatings. I remember the drug use. I remember the violence, vividly, very vividly. They came to me a lot throughout my life, in dreams. I would have these vivid dreams about what happened, and then I had documented proof of it actually happening, because some people in my family said that I was too young to remember a lot of these things, and it's not true.

As an adult, it's like a teakettle with this pressure, that's how I see my body, how my body has betrayed me over the years. It is the pressure of holding it in. Once I started to release it, I've been so much better, but it's holding it in and not having understanding, like I just wanted my questions answered. I just want it to be validated. As a child, I didn't understand the concept of punishment, or consequences to this negative behavior. All I knew is that I had experienced something as a child, and I wanted to know that people understood that I saw something. I needed people to know that there were things that were happening in my life as a young child, that I didn't understand. And I needed somebody to stop telling me to not talk about it. I needed them to stop telling me that. “Get out of grown folks’ conversation. You shouldn't be in this room right now.” I needed somebody to see me.

Giving voice to the harmed: Shifting from individual responsibility to provider-based screening and coordinated treatment

Q: Thinking back to whether it was childhood experiences, young adult experiences, or later in adulthood, were there ever any turning points where you were connected to services and helped by other support systems?

As far as support services, that was just not readily available. The doctors ran tests, but didn't talk about childhood. They said, “keep the stress level down,” but it didn't directly relate it to my childhood or any type of trauma. The conversation was not about trauma. It was never “This is what you have. This is what you need to do. And we have a treatment protocol for you.” I literally had to research on my own. It’s only because of my field that I was able to identify that this may be directly connected to my childhood experiences. I found and took the ACE screen myself, realized this is a direct correlation, and then sought out the services for myself. A health practitioner had not identified that for me and had not said anything to me to lead me in that direction to even start thinking about how what I had gone through as a child could potentially be affecting my health now as an adult.

Q: It sounded like the lack of provider awareness of ACE screening and coordinated treatment placed individual responsibility upon you, as the person harmed.

With that in mind, and recalling the research that you've done, what do you wish your healthcare provider would have shared with you in terms of supportive services?

I wish my healthcare team would have provided a proper assessment to include ACEs. I wish that was a part of their regular workup, like, as they're doing your blood pressure and checking your temperature and breathing. There needs to be a more formalized assessment. And I know that's available now, but making it a part of the regular clinical practice, just like you fill out the form with all of your identifying information and all of the things that talk about your family health history, and just being more trauma informed and having those scores to be able to say, “You know, here's what you may consider.” And then, do a direct correlation to say, “Is something showing up in your physical exam that could be connected to your childhood adversities?” and putting me in touch with that. It has to be a complete picture of mental and physical symptoms, and I wish all health practitioners would consider that.

A trauma-informed approach to healing interventions: Let kids talk about their adversities to be seen, heard, and healed

Thinking from a pediatric standpoint, my heart goes out to the little ones because they scream the loudest, with no sound. Kids are saying so much, but as adults, we don't listen.  

I'm emotional about that because when I got ready to deal with the trauma of losing my mother to suicide, I tried every way that I knew as a nurse and as a mental health practitioner to process that loss, I tried everything. I decided to become an author. I just felt like writing was so cathartic for me. I was going to write from an adult perspective about my trauma, but I couldn't get the words out as an adult. I couldn't process it as an adult. I had to process it as that four-year-old child and what I experienced. And so, I have the only children's book that is directly related to suicide loss. Nobody talks about that. And it's written in a way that’s very cartoonish where it's friendly for the kids to see, but it's meant as a conversation starter for adults to help children process loss.

I believe honestly that I would have done so much better in life as far as emotionally, and in carrying this trauma, if somebody would've just talked to me as a child, if somebody would've asked me, “What did I see through my eyes? How was I processing that?” and then giving me ways to help process it. And so that's the purpose of the children's book, to sit down with a kid, and read this book with them. The whole point is to open up the dialogue, let them start to say what they see around them.

I'm 47 now, but I was 40 when I went and got my mother's coroner's report, because everything that I had seen, everything that I had dreamt, no one would validate me. They kept telling me there's no way I could have remembered that, there's no way. And I'm like, “Did this happen? Is this the color of the house? Is this the room? Is, this how the room looked in the house? Is this how it was set up? Is this true?” And nobody would validate me. No one would validate me. And when I got the coroner’s report, the police had done a detailed report of the house and of my mother. Everything—from the positioning that they found her in—it was everything that I had seen. It was so detailed. The person that was there with my mother had given my mother heroin. I didn't know it was heroin at the time. I knew that she stuck her in the arm, and I knew it was her left arm. I knew it. I saw them. I saw the lady, I was looking through the door, and I always peeked through the door. So, I was looking for the door and I saw her, she tied something on her arm. She stuck her in her arm. She laid her down. So, I told my family, but everybody's told me to stop talking. Like, you don't know what you're talking about. And I kept asking that question. Did they find something? Did they find something that showed my mom was a drug addict? I remember praying to God and asking God to remove that thought, because if it's not true, then I don't want to think that, I don't want to keep seeing this. I want that to be gone. And I got the coroner's report.

It's shows a diagram of her, and it shows one needle mark on her arm, and that was it. It doesn't say anything else about it. It just shows that detail. And I am saying it validated everything. I remember crying for days after, because I was saying to my family, if you had just heard me… I think it was just for me, God's way of saying, “Pay attention to the children.  Have parents and clinicians ask them what they are experiencing and how they are doing.” I also think therapy should happen young, very, very young with children, to allow them in their own way to process trauma. And then I think it'll help to mitigate some of the stressors that we deal with later on in life. I think the earlier you start helping kids process trauma, the better they’ll be as adults.

Q: If you could be the provider treating your younger self, what would you prescribe now?

I would ask the necessary questions. I would allow them to talk about their experiences in the way that they have experienced it, without judgment, without questioning, and just allow the same way we allow kids to be creative in drawing when they have gone through experiences, allow them to articulate that and then help them to put some of that in context to manage the pain.

One of my biggest struggles that I dealt with in suicide loss is this feeling of worthiness. I'm hoping as I continue after all these years of therapy, to be my best self. I'm hoping that I'll really start to celebrate. I've never been able to celebrate because the celebrations are short-lived because of worthiness. She made a choice. Suicide in my eyes was a choice. And how I internalize it was that I wasn't her choice, that what she was experiencing was greater than me, her little person, that she had the responsibility to care for. So, I often wonder, did I do something wrong? Could I have done something better? Was I a good little girl? Was I a bad little girl? Was that the reason why she chose to die?

That's how I saw it. Four year old self. I saw sadness greater than me. Am I not making you happy? And so, in my life, how it showed up later is that I'm always seeking validation, as I say, from a ghost. So, I'll succeed in life. And then it's like, would this have made you proud enough to live? She was a nurse. When I graduated nursing school, I didn't even go to my graduation because I wondered would that have been enough to save my family. You're just trying to be just like your mother, but I'm like, so is that a bad thing? Is that a bad thing? Is there something that I could have done that would have made a difference that she would have chosen me over her own sadness? Would she have fought harder to get the help that she needed? If there is something that I could have done?

I spent that time, year after year, wondering. And so, people would celebrate, we would have balloons and things, and we're all celebrating it. And it would last literally for a second, and then the next moment would be internalizing this feeling, this battle of worthiness. If somebody could have talked to me when I was younger, that could have helped me understand that it had nothing to do with me, that this is where she was, and that we are individuals and things happened in her life apart from me. It had nothing to do with me. I didn't learn that. It wasn’t until I was fully grown, fully grown with full grown children, that I realized it wasn't about me. That it wasn't me. I didn't know.

On systemic racism and discrimination:

Q: Thank you for shining a light on the need to pay attention to our young ones by carefully listening to them, screening for ACEs, and thoughtfully connecting them to treatment and community supports. I deeply appreciate your discussion around the need for buffering supports like therapeutic interventions, expressive healing arts (like drawing and writing), and supportive adults to help children process and heal from their trauma.

Shifting now to a systems perspective, what have you learned from the systems you have experienced?

What I have learned from the systems that I have experienced is that there's a lot of people, and a lot of systems that are in place, that are really not designed to heal. It's a lot of bureaucracy, it's a lot of politics, a lot of policies that are in place in the healthcare industry, in the social service and child welfare industry, and in the school systems, that are not designed to incorporate or to consider that a child has something else going on, or that an adult has something going on. The police system—the policing in America—denies that there is something more happening.

What we see in America right now with racism and the senseless killings, whether it is same race crimes or interactions with police, there is something more. My husband says it all the time. Everybody has a backstory, and if we can just take the time to get to know what is happening with a person… If you just stop for a second…

I can think of incidences all the time with my young moms who go to the doctor. They get up to the counter and you have a person who's behind the desk who is just insensitive, and not realizing that you can be a trauma trigger, that they could be dealing with things at home. It's almost like a lack of humanity. It's just this rush, instead of taking the time to look at a mom and understand that she doesn't know, she doesn't know why [she’s facing the obstacles in her life]. Yet people understand that teen moms most likely come from environments that are of lower socio-economic statuses and poverty-stricken environments. It's documented and well-researched. So, if you're coming from environments like that, there is a lack of education, and there are so many factors that bring them to this point. And if you don't consider that as they come to your counter and you get ready to have an engagement with them, you could be the person that becomes the barrier for services, because once you turn them off—or as the teens would say, get an attitude with me—they're not coming back for prenatal care.

So now you have run the risk of this kid not having prenatal care the entire pregnancy, running the risk of this kid having a premature baby or fetal mortality, which then impacts the systems. The money is impacted, right? Because if you get a kid that goes into NICU and ICU, you're paying hundreds of thousands, those are million-dollar babies, right? So, you're paying that cost. All the systems are affected. I think that if we had a way to screen everybody through universal screening of ACEs, and then train everybody in ACEs to understand how trauma affects people in different environments and in different groups of people, I think that we would be… better.

Q: Thank you for your honesty. I appreciate your willingness to discuss where systems have failed in treating communities stricken by historical and systemic racism and discrimination, which is a very real kind of trauma experienced especially by Black and brown communities.  

Is there anything else you would specifically like to share about the importance of addressing intergenerational trauma and systemic inequalities?

Oh yes, intergenerational trauma is a real thing. As I mentioned before about my mother's suicide loss, well, she had gone through abuse and neglect in her life.

My grandmother was a sharecropper who lived in Mississippi, in the Mississippi Delta, and experienced abuse by the people that she served in the fields of Mississippi picking cotton. Her mother also was a sharecropper; initially, a slave, and then a sharecropper. And so, these women, while they picked cotton and served other families, gave birth to kids, and these kids inherited their story.

My generation were the first generation born outside of Mississippi. My mother was born in Mississippi. She was a sharecropper when she came to California, so we were that first generation. We didn't understand the sharecroppers mentality, but what they had gone through greatly impacted us, because their experience was true to them, and they believed that we would experience the same thing. In black families, there's a thing called colorism. It is very true that fair-skinned Black people stayed in the house and worked as maids and servants in the house, while the darker-hued African-Americans worked outside in the fields. And so, when my grandmother brought her children to California, that was in their minds.

They would use a term of “free” all the time. Like, “We are free.” They were free physically, but mentally, they were not. And so, they then pushed what they had gone through—and I'm sure they carried it in the womb, of course—because it just passed down. So, it affected us not only in our environments, but in the experiences that we had in our environment. The beatings that we experienced were not because we were so bad, per se, right? The beatings that we experienced were my grandmother's terms, all the time, so that the white man or the police won't kill you outside: I have to do it in here so that it won't happen out there. If I teach you discipline here, with these levels of beatings, then they won't do it. I’d rather do it here than to let a police officer do it. I would rather do it here than to let a white person outside do it. That was her mentality and all that is passed down from generation to generation.

And so, there's a level of all of that trauma that you carry in your body, that had nothing to do with you. You weren't even born. And now you are experiencing this fear, this paranoia, that something's going to happen. Some of it is taught, and some of it is just encapsulated into your body because this is the fear that's carried down. It's almost like everybody's living in a fight or flight type of state of mind, and then you find out some is true and some is not. I was trained and taught to stay in the house, that my place was in the house, and this was how I was supposed to be. And my brother, who was a darker hue, had to go out early in the morning. It didn't matter that you wanted to go play with your friends, to go outside. You had to get outside of the house early in the morning. That's intergenerational. That's the trauma that she experienced. She passed it down to my mother. My mother then passed it down to us, and I have done the work to not pass that down to my own children.

And it's been a lot of work, but I've done my best to not do that.

I try to live life with an understanding that I came through the womb of my mother. She was the vehicle that brought me into existence, but I was already tagged and labeled and identified with purpose, before even getting here. And so, I keep that in my mind at all times.

Thank you for bravely sharing your difficult story to illustrate a greater point about how trauma is inherited and handed down the generations. It sounds like this experience might feel like something that has gone unvalidated for a long time. The good news is that the science can now back up the impact your ancestors’ experiences have had on your health.

Your story reminds me of how California’s Surgeon General, Dr. Nadine Burke Harris, discusses the Intergenerational Transmission of Adversity in her report Roadmap for Resilience: The California Surgeon General’s Report on Adverse childhood Experiences, Toxic Stress, and Health. The novel concepts are the linkages between parental and caregiver ACEs and toxic stress with the health and well-being of their children:

Intergenerational transmission of toxic stress occurs when adverse experiences alter parental biology or behavior in ways that affect the development and health of their children. This includes changes to parental and child neuro-endocrine-immune-metabolic and genetic/genetic regulatory function, in ways that matter for pre-conception health, and also influence pregnancy, birth, infant, and child health outcomes. Parenting behaviors, positive experiences, societal factors, and historical traumas also influence the way that health risks are passed on from parent to child.

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Hopefully this brings a bit of validation to your experiences, honors what you already know, and points you (and others who experienced harm) toward healing supports.

Q: As we reflect upon trauma-informed practices, what do you want people to know that could help others heal or impact change?

I want others to know that healing is possible. You don't have to live in the hurt. Your experience can become your testimony to then help others.

And then if you do the work… well, first, you have to identify it, right? So that's where the assessment comes in. And once you recognize it, if you do the work, healing is possible, it is possible to be a better person. It is possible to live beyond the pain. That's not to say that triggers won't happen, but once you have the tools, you're able to manage, and that's what I tell people all the time.

I'm not completely where I can say that I am trauma free… but I am definitely in a better place when I'm having my moments and I'm triggered by certain things, or by memories, or just things that happen in life, I'm able to manage because I have the tools.

And so, the work is done daily sometimes, hourly… sometimes it's minute by minute. But you take those moments, and you do the work, you remember the tools that you have, you put them into play.

We can stop the cycle. We can stop this. We're at the generation now, especially with the introduction of ACEs and learning so much more about it, where we can help the generation after us, and the generations after that, because now we know we're not in a place of darkness. We know what is possible.

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