Salus Health Care Forum July 2, 2025

Jack

Craig, thank you for sharing the original story of ACEs with us. I really appreciate that. I think others have said it was a great introduction to this connection. It provided us a place to bring together this dichotomy of mind-body. 100 years ago (or 1,000 years ago) mind and body had been separated by scientists and philosophers and theologians. You have provided a great opportunity to bring those back in with a biologic plausibility. And as important and necessary as ACE is, it is not adequate. And, Craig, I think you’ve sort of said that. It didn’t include moderators. It didn’t include mitigators. It didn’t include positive events. And so it may be time for us to think about redoing it. It’s 30 years old. Walt talked about the 70s and 80s. Divorce was a big deal in the 60s and 70s. It’s not anymore. Gay couples were a big deal in the 60s and 70s. They’re not anymore. I think many other things are going on.

Bill B, to your question about rural. We’ve been doing a lot of work on how do you develop community. How do you help a community become more integrated? And there was a sociologist, Alexander Layton, who did a big study in Nova Scotia over 20 years. Called the Sterling County study, it was found that those small towns that were less integrated or more disintegrated had higher rates of both what we would call common mental health illnesses, depression, and anxiety. These less integrated communities also had a higher incidence of what we used to call Axis One, schizophrenia, and bipolar. And the communities with higher integration had less of that. Layton proposed the concept of generalized stress. When a community functions at such a level that there’s a high level of generalized stress, then everybody suffers. When there is one episode or one additional stressful happening, you cross the threshold into overt expression of a mental, emotional, and behavioral issue. Whereas with that same event in another community that is well integrated, you wouldn’t hit the overt stage. There’s even an impact with some of the Axis One mental illnesses that we think are biological and untreatable. This was in the 40s and 50s, and it was a radical proposition that you could actually prevent mental, emotional and behavioral health by having a community that was more integrated. So, that’s the work I’ve been doing in rural Colorado. We have a project called Comet (Changing Our Mental Emotional Trajectory). I won’t say moving back to the good old days. And it’s really trying to teach people how to find a way for members of their community to behave like a community rather than a thousand isolated people.