The Impact of Adverse Childhood Experiences on the Life Course:
A Case Study Using
"The Haunting of Hill House" (2018)

By Alexandra N. Farris, MPH, CPH and Stacey B. Griner, PhD, MPH, CPH

Citation

Farris A, Griner S. The impact of adverse childhood experiences on the life course: a case study using “The Haunting of Hill House” (2018). HPHR. 2024;78. https://doi.org/10.54111/0001/ZZZ3

The Impact of Adverse Childhood Experiences on the Life Course: A Case Study Using "The Haunting of Hill House" (2018)

Abstract

Purpose of Review

Life course theory posits that early-life experiences that take place during sensitive developmental time periods can influence health behaviors into adulthood. Children who have been exposed to adverse childhood experiences (ACEs) are often predisposed to many health issues across their lifespan. With the power to impact brain development as well as lifelong health and function, ACEs can fundamentally alter the adults they grow up to be, likely leading them down paths they would not have taken otherwise. Almost 40% of children have experienced at least one ACE, and multiple studies have confirmed the link between ACEs and future chronic health issues, mental health conditions, alcohol and substance use disorders, increased health risk behaviors, and premature death. Using a life course perspective lens, this case study sought to explore the impact of ACEs on the life course by analyzing a popular psychological horror series, The Haunting of Hill House (2018).

Recent Findings

Alternating between flashbacks and present-day life, themes and concepts aligned with life course theory are presented throughout the series to further illustrate how early-life traumatic experiences can make children vulnerable to negative health outcomes in the future. This includes examples of life course constructs such as developmental risk and protection, linked lives, trajectories, transitions, and major life events.

Summary

This paper uses a case study to apply and provide examples of life course theory concepts, which are often abstract and difficult to understand. Aside from telling a compelling story about the impacts of trauma and grief on health, The Haunting of Hill House (2018) is the epitome of how early-life experiences and presence of a reliable support system can impact one’s path towards adulthood, further reinforcing how necessary it is to protect, nurture, and advocate for children during such sensitive developmental periods in the life course.

Introduction

To interrupt the cycle of childhood adversity and ensure that all children are positioned to achieve health equity, it is imperative to understand the impact of early adversity across the life course.¹ The purpose of this case study is to provide an overview of life course theory and delve deeper into the effects of adverse childhood experiences on adulthood by presenting a case study application of life course theory to a television series, The Haunting of Hill House (2018). Specific examples of concepts, themes, and experiences aligned with life course theory and adverse childhood experiences are highlighted below.

Life Course Theory

The life course theory seeks to understand how early-life experiences that often take place during sensitive developmental time periods can influence health behaviors that carry over into adulthood.² Recognizing the linkages between childhood and adolescent experiences and their impact on later experiences in adulthood, the life course perspective relates time and human behaviors by analyzing how chronological age, life transitions, and social change can shape people’s lives.³ A life course perspective can be utilized as a theoretical orientation, or an interdisciplinary concept rooted in multiple fields of study.⁴ Research utilizing both approaches have been published for over forty years, but for the purposes of this paper, life course will be presented as a theory with discrete constructs.⁴ Life course theory includes the basic concepts of transitions, trajectories, life events, and turning points that occur across the life course as well as interrelated themes such as linked or interdependent lives and developmental risk and protection.³ Further explanation of these components will be explored later, but overall, life course theory posits that early-life circumstances (those occurring in childhood) may impact adult circumstances and therefore health conditions and outcomes.⁴

Adverse Childhood Experiences

One early-life circumstance that is important to consider is adverse childhood experiences (ACEs), defined as stressful or potentially traumatic events that occur during infancy, childhood, and/ or adolescence.⁵ These are considered non-medical drivers of health that can affect early brain development as well as lifelong health and function.6 Common examples of ACEs include physical, emotional, or sexual abuse; witnessing violence; losing a family member to suicide; and living with family members who struggle with substance abuse, mental health conditions, or instability stemming from parental separation, divorce, or incarceration.⁷ Given the ability to induce prolonged toxic stress, ACEs can impact the body’s normal stress response and impair emotional processing and regulation.⁸ Exposure to ACEs during sensitive developmental periods in childhood and adolescence can enhance the sensitivity and likelihood of the toxic stress response into regulatory biological processes, permanently altering the body’s metabolic and epigenetic functioning.⁵ Using a biopsychosocial model, an example of how early adversity can lead to biological changes is shown in Figure 1.⁹ ACEs are also directly linked to negative health outcomes in adulthood such as chronic health issues, mental health conditions, alcohol and substance use disorders, increased health risk behaviors, and premature death.^5,10 As of 2022, almost 40% of children in the United States have experienced one or more ACE.¹¹ Socially marginalized groups, including children who reside in foster care or child welfare systems; belong to Black, Indigenous, and People of Color (BIPOC) communities; are part of the Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+) community; and/or are involved with the justice system historically report significantly higher ACEs prevalence rates.^12,13 There is also an intersection between social identities, socioeconomic status, and ACEs, and due to structural racism and societal inequity, Black children are also more likely to live in low-income communities compared to White children.^13,14 This is an important factor to note as poverty increases the likelihood of ACEs exposure, and children from low-income households often experience more ACEs compared to those from higher-income households.^13,15 Life course concepts and ACEs are often described broadly when discussed in public health, and specific life course theory constructs can be difficult to conceptualize. However, given their direct connection to other serious public health issues, ACEs must be prioritized if health equity is to be achieved.6 Using a popular psychological horror series on the streaming platform Netflix, the impact of ACEs throughout the life course is showcased below, recounting the trauma the children endured and the paths they later followed into adulthood.

Summary: The Haunting of Hill House

The Haunting of Hill House (2018), inspired by Shirley Jackson’s 1959 gothic horror novel of the same name, tells the fictional story of a happy young family that suffers adverse psychological trauma after temporarily moving into “the most haunted house in America” during the summer of 1992.^16,17 Parents Olivia and Hugh Crain bought the one-hundred-year-old house with the intention of flipping it, or simply fixing the house to resell it, to eventually build their own “forever house.” Ranging from ages six to twelve, their five children, Steven, Shirley, Theodora (Theo), and twins Luke and Eleanor (Nellie), immediately begin to experience inexplicable events but are unable to confide in their parents, whose main priority is fixing the extremely broken Hill House.

Matriarch Olivia eventually becomes paranoid after having vivid hallucinations of the deaths of the twins, and attempts to poison them to prevent them from experiencing all the sadness, heartbreak, and death that occurs out in the real world. Although Hugh rescues all five children from suffering at the hands of their mother’s mental health crisis, he ends up leaving Olivia behind as he drives them away from Hill House. Hugh returns to discover Olivia died by suicide, and he is left to pick up the pieces of their deeply traumatized children who are sent to live with their Aunt Janet following police investigation of the suspicious circumstances surrounding Olivia’s death. The show alternates between flashbacks and present-day life to exemplify how these collective traumatic experiences influenced the Crain children’s transitions into adulthood, negatively impacted their relationships with each other and their future spouses, and ultimately haunted them for the rest of their lives.

An Application of Life Course Theory to The Haunting of Hill House (2018)

Using a life course perspective lens specifically towards mental health and grief processing, the traumatic psychological experiences that tormented the Crain children affected each of them differently in adulthood.

Theme of Developmental Risk and Protection

The theme of developmental risk and protection posits that early deprivations and traumas do not automatically lead people down a trajectory of failure but can potentially lead to an accumulation of disadvantage without intervention that reverses the trajectory.³ The oldest child, Steven, was a successful writer that was in denial about what happened at Hill House and instead placed blame on mental health issues that he convinced himself were genetic, specifically in his mother and younger sister Nellie. As a result, he decided to undergo a vasectomy after college to ensure that no mental illnesses would be passed down to any potential offspring. Shirley was the second oldest child who pursued a career as a mortician and operated her own funeral home business alongside her husband. She was inspired by the mortician who not only “fixed” her mother’s body, but also helped calm her down enough to walk her to the open casket at her mother’s funeral. Despite the appearance of a seemingly picture-perfect family, their funeral home business was secretly suffering financially, and Shirley was plagued with guilt after recently cheating on her husband. Theo was the impassive middle child who, despite becoming a clinical child psychologist and providing therapy for at-risk children, depended on alcohol and one-night stands to fill the void occupied by grief and loneliness.

Theme of Linked Lives

The theme of linked lives suggests that interdependent lives and social networks in which we belong have the power to shape health over generations.⁴ This is best exemplified through the twins Luke and Nellie, who felt the weight of Hill House and their mother’s absence the most since they were there in her final moments.¹⁸ Luke developed a heroin addiction and was caught frequently lying and stealing money from his family to replenish his stash to “get well,” spending a lot of time in rehab centers but never fully adhering to treatment. Nellie suffered from severe depression, vivid hallucinations that followed her well into adulthood, and frequent sleep paralysis episodes that started the very first night after moving into Hill House. Her siblings were always hesitant to believe her whenever she reached out to tell them that she was struggling, which made her feel as though no one ever truly listened to her over the course of her entire life. While she attempted treatment by seeing a psychologist and taking prescription medications, she eventually stopped, and following in her late mother’s footsteps, Nellie also tragically dies by suicide at Hill House at the age of thirty-two. It is later revealed that the horrific hallucination that terrorized her since she was a child foreshadowed her own heartbreaking demise. The twins, who were only six years old when their worlds began to unravel, undoubtedly suffered worse health outcomes compared to their older siblings. As the show progresses, life course concepts of trajectories, transitions, and numerous major life events are seen throughout the Crain children’s lives.

Examples of Trajectories

Trajectories are the continuation of long-term behavioral patterns that lead toward a specific direction.³ For example, Theo’s emotional walls that protected her since she was a child continued to isolate her as an adult when she refused to let anyone get close to her. Her turning point, or life event that results in a lasting shift in trajectory,³ was after Nellie’s funeral when she finally allowed someone to be there for her and later entered a committed relationship. Luke’s drug addiction that began when he was a teenager shifted his trajectory down a path of distrust after repeatedly lying and stealing money from his family to buy drugs. His turning point, like Theo, was also shortly after Nellie’s funeral when he finally started to take his journey to sobriety seriously.

Examples of Transitions

Transitions are defined as changes in trajectories that involve different roles or statuses.³ A major transition for Aunt Janet was when she became the primary caretaker for all five children following Olivia’s death. Similarly, Hugh transitioned from husband to widower, and his overwhelming grief over losing his wife also turned him into an estranged father to their children. He coped with this loss using “after-death communications”, otherwise referred to as hallucinations, which is common among those who have lost a loved one.¹⁹ In a way, the Crain children went from having two parents to simultaneously losing both post-Hill House. Later, Nellie marrying Arthur was her transition into a wife. Theo transitioned into a clinical child psychologist after graduating with her Ph.D. in psychology. Steven, who previously struggled to get his writing off the ground, became a famous author after writing a successful horror novel about Hill House based solely on his siblings’ experiences.

Examples of Major Life Events

Life events are abrupt changes that significantly impact one’s life course.³ According to the Social Readjustment Rating Scale created by psychiatrists Thomas Holmes and Richard Rahe in 1967, the most stressful events in order are the death of a spouse, divorce, marital separation, and death of a close family member,³all of which the Crain family endured except for divorce. Although Hugh rescues the children during Olivia’s mental health crisis, they ultimately witness him leaving their mother behind, and this strained the once strong relationship he had with his children. Nellie’s husband Arthur unexpectedly died from a brain aneurysm, putting her in a worsening state of emotional distress. Olivia and Nellie both died by suicide at Hill House twenty-six years apart. Steven’s wife Leigh finds out about his secret vasectomy after visiting a fertility clinic together, which later resulted in a marital separation. Theo confessed to collecting her share of the royalties from Steven’s Hill House novel after lying to Shirley about not taking them, and Shirley kicked her out of the guest house she was living in. Of these, the most impactful life event was moving into Hill House to begin with, as this derailed the Crain family’s life course entirely.

Discussion

As presented here, The Haunting of Hill House (2018) incorporates concepts and themes aligned with life course theory and presents numerous significant ACEs experienced by the children. Aside from their individual and collective anomalous experiences, the children witnessed their mother’s mental health slowly decline; were almost poisoned by their mother during her mental health crisis; watched their father consciously leave their mother behind; endured losing their mother to suicide; and dealt with the eventual estrangement of their father thereafter. These adverse experiences happened early in the children’s life courses, predisposing them to negative health outcomes over time. With little to no support in the aftermath, the lingering grief and trauma that followed took a detrimental toll on the health outcomes of all five children: from harboring years of resentment and anger towards one another, to abusing alcohol and illegal substances to help numb the pain, to suffering from debilitating depression that later resulted in another suicide in the family. These health outcomes exhibited by the Crain children are consistent with previous research directly linking ACEs to negative health outcomes in adulthood.⁵^,¹⁰ The strong family unit the Crains displayed before moving into Hill House was shattered within a short time, yet the aftereffects reverberated throughout the rest of their lives.

ACEs will continue to threaten health equity without a strategic, coordinated public health approach to address them as early as possible.⁶ Life course intervention research is an emerging discipline that seeks to improve health trajectories by shifting critical developmental processes to prevent or reduce the impact of adverse outcomes early in life.²⁰ Different from traditional medical interventions, which focus exclusively on disease management, illness prevention, and health promotion, life course interventions focus on health development through acquisition of developmental capabilities that aim to equip children and adolescents with the tools to thrive in adulthood.²⁰ This area of intervention science encourages researchers to consider the biological, psychological, genetic, epigenetic, and environmental processes that occur across the life span to better understand how they influence health development.²⁰ It is crucial that life course interventions are health equity focused and consider the varying circumstances and lived experiences of the populations they aim to serve.¹⁵ Very few life course interventions have been implemented, but emerging evidence suggests that life course approaches may be suitable for providing holistic, contextually responsive interventions among young populations.²¹ The Crain children likely could have benefitted from this type of intervention with a special emphasis on grief processing and trauma recovery.

Similarly, the trauma experienced by the Crain children could have been addressed through resiliency practices that instill ways to cope with stress and negativity by fostering healthy coping strategies, confidence, and creation of dependable support systems.²² Successful ACE prevention strategies have resulted in higher academic achievement as well as reductions in depression, suicidal behaviors, incarceration rates, and substance use.²³ Examples of evidence-based prevention strategies include early childhood home visitation programs, such as the Nurse Family Partnership program, that is associated with reductions in child abuse and neglect as well as improvements in the parental life course;^24,25 after-school programs, such as After School Matters, that has improved graduation rates and decreased the likelihood of drug or gang involvement;^24,26and skill-based learning programs, such as Life Skills Training and Promoting Alternative Thinking Strategies (PATHS), that teach youth how to manage stress, resolve conflicts, and manage their emotions and behaviors, further contributing to reductions in depression and anxiety, alcohol and drug use, and suicidal thoughts and attempts.^24,27,28 Legislative policies can also aid primary prevention efforts by focusing on reducing ACE risk factors (such as housing insecurity, food insecurity, and domestic violence and neglect) as well as supporting ACE protective factors (such as earned income tax credit, paid family leave, Medicaid expansion, early home visitation programs, and parental education).^13,24 Figure 2 highlights how the presence of these risk factors in the community can directly influence ACEs exposure.²⁹ State and territorial health agencies have the power to directly and indirectly shape public health policy, and creating policies based on public health expertise can help to decrease ACEs prevalence within their respective communities.³⁰

Intervention post-exposure to ACEs typically involves victim-centered services and trauma-informed care tailored for children, adolescents, and adults.²³ Evidence-based, child-focused treatment approaches include child-parent psychotherapy for young children up to age 6 that have experienced a wide range of trauma; attachment, self-regulation, and competency (ARC) framework for children, adolescents, and young adults up to age 21 who have experienced chronic traumatic stress or ongoing exposure to adverse experiences; and trauma-focused cognitive behavioral therapy (TF-CBT) for youth up to age 21 who have experienced abuse or trauma.³¹ The ARC method likely would have been an effective treatment method for the Crain children as research has shown reduction in posttraumatic stress symptoms, improvements in mental health, and increases in adaptive and social skills.³¹ More recently, preliminary research findings support the application of the ARC method to emerging adults with previous ACEs exposure.³² Sadly, the Crain children mostly suffered in silence as they received little to no emotional support or closure following their mother’s unexpected death and father’s estrangement, resulting in the formation of unhealthy coping strategies and lack of a strong, dependable support system.

Several limitations exist within this case study. Firstly, it is important to acknowledge that the children experienced frequent anomalous events that may or may not represent realistic scenarios; however, this paper ultimately sought to address the long-term impact of those events on their individual life courses, further emphasizing how childhood adversity has the power to fundamentally alter the adults they grow up to be. Secondly, the flashbacks alternated between childhood and adulthood, leaving out a key developmental period within the life course: adolescence. Not only did this make it difficult to understand how the children were raised and cared for by their aunt, but it also made it impossible to pinpoint exactly when the negative health outcomes started manifesting, and whether early intervention could have prevented them from suffering as much as they did in adulthood.

Conclusion

All members of the Crain family suffered through many psychological, stressful, and emotional events that greatly impacted their individual life courses. However, exposure to such experiences made the children especially vulnerable to negative health outcomes that may not have emerged otherwise, with the two youngest suffering the worst health outcomes in adulthood. Unable to fully understand and heal from what happened at Hill House, the Crain children developed unhealthy coping mechanisms in adulthood that included relying on both material and emotional crutches to help counteract the pain. Aside from telling a compelling story about the impacts of trauma and grief on health, The Haunting of Hill House (2018) is the epitome of how early-life experiences and presence of a reliable support system can impact one’s path towards adulthood, further reinforcing how necessary it is to protect, nurture, and advocate for children during such sensitive developmental periods in the life course.

Figures

Figure 1: Biopsychosocial model highlighting the biological impacts of early childhood adversity.

Figure 2: The Pair of ACEs Tree

Disclosure Statement

The authors have no relevant financial disclosures or conflicts of interest.

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About the Author

Alexandra N. Farris, MPH, CPH

Alexandra Farris is a Project Coordinator in the School of Public Health at the University of North Texas Health Science Center.

Stacey B. Griner, PhD, MPH, CPH

Dr. Stacey Griner is an Assistant Professor in the School of Public Health at the University of North Texas Health Science Center.