Vincent Felliti, who led the study on adverse childhood experiences (ACE’s), writes that it is only in recent decades that the size of the problem of developmentally damaged people has begun to be recognised. It has become evident that traumatic experiences during childhood and adolescence are far more common that is usually recognised. Early traumatic experience is linked with outcomes later in life that are of concern to public health and the social fabric. Early adverse experiences have been shown to have a large impact on neuroregulatory systems mediating illness as well as social behaviour. We often focus our attention on tertiary consequences far downstream while primary causes are protected by time, taboo and social convention.

The ‘hidden epidemic’ of early trauma is not just a problem for mental health fields and medicine but for all of society. There is a need to create interventions for primary prevention of many physical and mental illnesses. Parenting skills is likely to be a core feature of primary prevention in the future of medicine and psychiatry. The influence of childhood experience, as outlined by Freud, including often unrecognised traumatic experience, is as powerful as Freud and other early pioneers described it. Chronic life stress in early development is generally underappreciated as an etiological mechanism underlying many biomedical illnesses.

There are signs that various aspects of the human condition are under severe stress and this is being expressed in an increase in emotional disorders in childhood and adulthood, according to Allan Schore.  The roots of psychopathology lie in traumatic attachment experiences. There is a need to focus psychotherapeutically on the precursors to disorders in childhood not just their manifestations in adulthood. Dysregulated affect (particularly unconscious affect) plays a primary role in not just psychopathogensis but all illness and disease.

Most mental illness begins far earlier in life that was previously believed. A scientific consensus is emerging that the origins of adult disease is found among developmental and biological disruptions occurring in the early years of life. In utero and immediate postnatal environments and dyadic relations between child and caregivers in the early years have an enduring impact on brain development and behaviour. There is compelling evidence that developmental and biological disruptions in early life are increasing and that emotional disorders in childhood and adolescence are on the rise. The declining mental health of children is playing a prominent role in the emergence of physical problems. Psychosomatic and psychosocial disorders have a long-lasting impact on children’s lives and society. There is thus a need to focus more on prevention and early intervention in mental disorders.