The Neuroplastic Narrative and Neuro‐Ecological Diversity: Non‐Pathologizing Biological Foundations for Trauma‐Informed Medical and Mental Health Nursing

ABSTRACT

Following the Adverse Childhood Experiences study (1998), a wealth of similar studies has strongly associated experiences of trauma and adversity in childhood with increased risk of poor physical and mental health and undesirable social outcomes in adulthood. The medical model interprets this data through a pathologizing lens which assumes that trauma and adversity are harmful and lead to impairment and pathology. Trauma‐informed and Adverse Childhood Experience aware approaches can perpetuate this pathologizing framing, despite prioritising asking “What's happened to you?” over “What's wrong with you?” In this paper, we draw on The Neuroplastic Narrative, a novel, non‐pathologizing biological theory which foregrounds people's adaptation to their ecological niche. This narrative offers a compelling reinterpretation of data that associates early trauma and adversity with poor adult health and social outcomes. We introduce an evolutionary perspective, Life History Theory, to reframe the Adverse Childhood Experiences (ACEs) study through an evolutionary lens, yielding the insight that populations with ACEs strategically adapt to their environment. We evidence the perspective that the human species' capacity to adapt to a diverse range of environments during development is strategic and not of itself pathological. Adapting to diverse ecologies produces commensurately diverse brains and physiologies. We term the diversity across brains and physiologies resulting from adapting to experiences: Neuro‐ecological diversity An ecological framing that privileges experiences and considers how and why people adapt to traumatising relationships and adverse environments both physiologically and behaviourally calls for novel formulations and responses from practitioners and ultimately for a non‐pathologizing foundation for trauma‐informed nursing. This less shaming response also orientates our attention towards issues of inequity and social justice. The aim of this position paper is to articulate a trauma‐informed framework for nursing that does not focus on pathology but rather on adaptation, offering nurses a new way to understand, formulate and respond to distress and suffering associated with trauma and adversity. We will demonstrate that trauma‐informed nursing needs a foundation that is not premised in pathology but honours experience; offer the Neuroplastic Narrative as a biological, non‐pathologizing (less shaming) foundation for trauma informed nursing, and introduce the concept of Neuro‐Ecological Diversity to support nurses' understandings of, and responses to, different consumer presentations.

1. Introduction

This paper arises from the authors' study of neuroscience and evolutionary biology and is informed by personal and professional engagements with mental health services, psychiatry, consumer accounts and mental health activist narratives.

Where there is emotional and psychological suffering in the wake of trauma and adversity, medical model explanations assume pathology and validate this suffering with a diagnosis of mental illness (Allsopp et al. 2019; Read et al. 2016). The need for a genuinely alternative paradigm is called for by many, such as mental health survivor activist Jasna Russo, “So, given that the foundations of the biomedical model remain missing, we have two options: we can use the numerous opportunities to assist in proving and amending this model on the basis that the ultimate proof of ‘mental illness’ will one day be discovered. Or we can go in a very different direction: we can turn our gaze completely away from individual pathologies and outwards to the world we live in; we can join forces far more firmly and outspokenly in order to forge a whole new paradigm” (p64) (Russo 2016). Here, we ask readers to step outside of medical model framing of health and sickness and consider that suffering may not imply pathology; that suffering can be validated and alleviated without recourse to diagnosis; and that an alternative ecological narrative of adaptation is less shaming and more empowering for those of us with histories of complex trauma and adversity and/or transgenerational trauma.

The paradigm shift we articulate is away from the pathological and towards the ecological. An ecological niche comprises all the relationships and environmental factors that influence a species (National_Geographic 2025). We think of our individual ecology as being made up of all the relational, social and environmental factors that have influenced us. We recognise that experiences—of all kinds, some highly desirable and others highly undesirable—have shaped our brains and physiologies, adapting each of us for survival and reproduction in the environment that we have encountered. The diversity of experiences sculpts commensurately diverse brains and physiologies. Recognising that diverse experiences are embedded via neuroplastic mechanisms creating diverse brains and physiologies, we will introduce the term Neuro‐ecological diversity. This term de‐pathologizes the suffering that frequently accompanies adaptation to the highly undesirable experiences of trauma and adversity but crucially does not invalidate the impact of traumatic and adverse experiences as causes of suffering and distress. This shift foregrounds the imperative to prevent such suffering by addressing traumatising environments and adverse experiences through public health and social justice efforts.

The Neuroplastic Narrative and the concept of Neuro‐Ecological diversity offer a viable biological, non‐pathologizing, strengths‐based explanation for emotional and psychological distress and empowers nurses to collaborate with service users in offering a choice of how to frame and formulate their emotional and psychological distress; through the lens of pathology (medical model) or adaptation (Neuroplastic Narrative) Choice is empowering and this is aligned with the trauma‐informed principle ‘Empowerment voice and choice’ (SAMHSA 2014). We hold that the person's view of themselves (rather than the professional's view of them) is of paramount importance and we offer this alternative narrative in that spirit.

2. The Assumption of Pathology in Trauma‐Informed Models

As a society we are becoming increasingly aware of the role that childhood relationships and experiences play in our lives. The observed association between childhood experiences of adversity, and maltreatment with poor outcomes in adulthood strongly indicates that early life experiences shape life trajectories (Gilbert et al. 2009; Hughes et al. 2017; Macpherson et al. 2021). The language varies across academic and clinical fields and by people with trauma histories, but however they are termed, experiences of complex trauma, childhood maltreatment and Adverse Childhood Experiences all involve: repeated interpersonal or relational abuses, betrayals and/or neglect, and occur before the age of 18 (Felitti et al. 1998; NCTSN 2021; WHO 2019).

The association between early trauma and adversity and poor mental and physical health was reported in the landmark 1998 Adverse Childhood Experiences (ACE) Study, and child maltreatment (including physical, sexual, emotional abuses and neglect) has been identified as the most significant preventable risk factor for mental illness and substance misuse (Teicher et al. 2022; Teicher et al. 2016). Increasing acceptance of the association between complex trauma and early adversity with poor physical and mental health outcomes in adulthood has led to a widespread motivation for professionals and services to become ‘trauma‐informed’. However, without a clear conceptual basis from which to understand how and why our early experiences manifest in poor health outcomes in later life, there is a simplistic assumption that adversity and trauma cause pathology. This pathologizing assumption forecloses our understanding of what is being preserved at the expense of health and troublingly leads to (potentially stigmatising and shaming) judgements and categorisations in the form of diagnoses that misdirect our attention and effort away from addressing the antecedent conditions from which these adaptations arise.

2.1. Adverse Childhood Experiences as the Knowledge Base

The Adverse Childhood Experiences (ACE) Study examined the long‐term correlates of cumulative categories of adverse experiences, (see Table 1) (Felitti et al. 1998). The study analysed 9508 responses to a questionnaire on adversity in childhood and found that of the one in eight people who had experienced four or more categories of adversity, the risk for heart disease, cancer, stroke or lung disease was doubled and the risk for depression, substance misuse, alcoholism and suicide more than quadrupled (see Table 2) (Felitti et al. 1998). More recently a systematic review of 37 international studies published in the Lancet similarly found that of the one in eight people who had four or more ACEs, their risks for cancer, heart disease, lung disease, mental illness and to smoke or drink heavily increased two to six‐fold (Hughes et al. 2017).

TABLE 1.

Categories of adverse experience defined by the ACE study (Felitti et al. 1998).

Categories of Adverse Experience occurring prior to 18 years old (note that the legal age for sexual consent in some states and countries is 16 years old)

Psychological abuse: Living in fear of being hurt/being put down, sworn at or insulted

Physical abuse: Being pushed grabbed shoved or slapped/being injured or marked

Sexual abuse: Being touched or fondled/having to touch or fondle/attempted or actual oral, anal or vaginal intercourse

Substance abuse: Member of the household using street drugs/or was a problem drinker or alcoholic

Mental illness: Member of the household depressed/mentally ill/suicidal

Mother treated violently: Mother or stepmother pushed grabbed slapped or had something thrown at her/kicked bitten or hit/repeatedly hit over a few minutes/threatened or hurt with a knife or gun

Criminal behaviour: Member of the household ever sent to prison

TABLE 2.

The increased risk of various outcomes carried by the 1 in 8 people who had experienced four or more categories of adversity (defined in Table 1) (Felitti et al. 1998).

Outcome—behaviour/health problem	Risk factor increase (ranked)
Being severely obese (BMI ≥ 35)	1.6
Diabetes	1.6
Ever had a skeletal fracture	1.6
Any form of cancer	1.9
Being a current smoker	2.2
Ischemic heart disease	2.2
Fair or poor self‐rated health	2.2
Stroke	2.4
Ever had hepatitis or jaundice	2.4
Ever had a sexually transmitted disease	2.5
Have had 50 or more partners for sexual intercourse	3.2
Chronic bronchitis or emphysema	3.9
Depressed mood for more than 2 weeks in the past year	4.6
Ever used illicit drugs	4.7
Considers oneself to be an alcoholic	7.4
Ever injected drugs	10.3
Ever attempted suicide	12.2

Three years after the Adverse Childhood Experiences Study, Harris and Fallot suggested that people accessing mental health or addiction services could be offered a ‘trauma‐informed approach’ by services, an inherently validating response, as most had histories of abuse and trauma (Harris and Fallot 2001). They recommended services and programs become ‘trauma‐informed’ by operationalising five core values of safety, trustworthiness, choice, collaboration, and empowerment. They aimed to mitigate the impact of trauma and prevent the re‐traumatisation that happens in services (Fallot 2009). This idea was developed by the US state agency Substance Use and Mental Health Service Administration (SAMHSA) which published guidance on trauma‐informed approaches and whose guidance now forms the basis for most other available guides to becoming trauma‐informed (SAMHSA 2014). Contemporary nursing advocates for trauma‐informed patient care across all settings (Dowdell and Speck 2022; Fleishman et al. 2019; Liu et al. 2024; Oral et al. 2016; Reeves 2015).

2.2. Diathesis‐Stress Explanation

The ACE study poses the question, “Exactly how are adverse childhood experiences linked to health risk behaviours and adult diseases?” (p252) (Felitti et al. 1998). Trauma‐informed ACE aware approaches commonly interpret the data gathered by the ACEs and similar studies from a diathesis (vulnerability) stress perspective (Zubin and Spring 1977; Zuckerman 1999). This assumes that childhood experiences of adversity and trauma breach a threshold, disrupting what would otherwise be normal, healthy developmental trajectories, leading to mental and physical disorders. In this way, the diathesis stress perspective is already subsumed within the medical model. Experiences of trauma and adversity disruption are viewed as impairing or distorting neurological and physiological regulatory systems in ways that initiate and perpetuate damage and dysfunction, eventuating in pathology that shortens health and lifespans (Anda et al. 2006; Ellis and del Giudice 2019; Lupien et al. 2009; McEwen 1993; Nelson et al. 2020; Nemerhoff 2016; Nusslock and Miller 2016). Trauma‐informed nursing discourse can exhibit the same interpretations, suggesting that trauma and adversity lead to ‘deficits’, ‘impairments’ (Muskett 2014) and ‘toxic stress’ (Dowdell and Speck 2022).

However, the diathesis stress explanation used in this way forecloses exploration of the possibility that stressful experiences might have multifarious and potentially adaptive effects. Although trauma and adversity are generally undesirable experiences, the assumption that any and all downstream effects are pathological is a false inference that risks overlooking adaptive modifications. A classic example of this occurring in the trauma‐informed field has led to the widespread use of the term ‘toxic stress’. In 1992 researchers discovered that subjecting rats to chronic restraint stress led to atrophying (shrinkage) of the apical dendrites of their hippocampal neurons (Watanabe et al. 1992). A high‐profile review reported that this effect was mediated through the rodent stress hormone, corticosterone and resulted in cognitive impairment (McEwen 1999). Subsequently the term ‘toxic stress’ was coined and continues to be widely used (Shonkoff et al. 2012). However, a much less publicised finding suggests a different interpretation of the results. A 2002 study, using the same protocol of subjecting rats to chronic restraint stress, not only replicated the atrophy (shrinkage) seen in the hippocampal neurons but also found the contrasting effects of hypertrophy (growth) and increased dendritic arborisation (more branches) in the basolateral amygdala, see Figure 1 (Vyas et al. 2002).

FIGURE 1.

Contrasting effects of Chronic immobilisation stress (CIS) on neurons of the hippocampus and amygdala. (A) CIS decreased dendritic length and branching in the CA3 pyramidal neurons of rats. (B) The same protocol CIS increased dendritic length and branching in the basolateral amygdala pyramidal neurons of rats. Camera lucida drawings of representative Golgi‐impregnated hippocampal CA3 pyramidal neurons (A) and basolateral amygdala pyramidal neurons (B) from control and CIS‐treated animals. Scale bar, 50 μm. Adapted from (Vyas et al. 2002).

Rather than the stressful experience of chronic immobilisation stress causing widespread damage as assumed by the toxic stress narrative, the contrasting patterns of neuronal hypertrophy in the amygdala and neuronal atrophy in the hippocampus following the stressful experience may indicate adaptive modifications. The assumption that implicitly underpins diathesis‐stress and medical model perspectives—that stress leads to general damage—forecloses curiosity, thus preventing our discovery of novel adaptive effects to unique stressors. Given that stress of many kinds has been present throughout human evolution and yet humankind endures to this day, we have evidently adapted to survive and reproduce in even highly stressful environments (Teicher et al. 2016).

Trauma‐informed approaches do not yet articulate how our experiences embed into and shape our brains and physiology. Nor do they assist with an organising or sense‐making principle to explain why our brains and physiology are shaped by experiences in the way that they are, and with what benefits? Contemporary models of trauma‐informed nursing need a biological, non‐pathologizing theory that orients us away from the pathologizing question of “What's wrong with you?” to embrace the multilayered question of “What happened to you?” (Bloom 1995) a narrative that includes the person's experiences and how those experiences have been adapted to at the cellular level, at the level of physiological systems and also behaviourally and psychologically. This richer picture can explain both how and why childhood experiences of trauma and adversity are so strongly associated with poor health and social outcomes. The Neuroplastic Narrative offers this explanation and brings a strengths‐based perspective to even the physiological level of trauma‐informed care.

3. The Neuroplastic Narrative

The Neuroplastic Narrative is an ecological theory that weaves together the mechanics of how our experiences shape our brains and physiologies (neuroplastic mechanisms) with an evolutionary perspective (Life History Theory) (Stearns 2000) to explain why we are shaped by early experiences in the way that we are, elucidating the end goal that is served by these adaptive changes. The Neuroplastic Narrative describes mechanisms we have evolved that help us to adapt to the ecological niche we experience during development to give us the best chance of surviving long enough to successfully reproduce within the same or a similar environment (Peckham 2023).

3.1. Neuroplastic Mechanisms: Embedding Experiences ‘Under the Skin’

Animal studies reveal that experience profoundly impacts brain structure and physiology. Changes in the brains of rats following experiences of enrichment and deprivation were reported in 1964, establishing that ‘the brain is responsive to environmental pressure’ p610 (Bennett et al. 1964). Experiences of maternal care calibrate the hypothalamic pituitary adrenal axis (HPAA) of rat pups for their lifetime, through an epigenetic mechanism (Weaver et al. 2004). In mice, experience of enriched environments delays the onset of Huntington's (van Dellen et al. 2000) and even rescues genetic memory defects of offspring that did not directly experience enrichment (Arai et al. 2009). Many such studies exemplify that genes and experiences in the environment interact in complex ways to shape physiological systems and brain structure and function, both within and beyond the lifetime of the individual.

Many mechanisms have evolved to turn our lived experience into adaptive biological changes, showing that adaptation to experiences is survival positive. These mechanisms embed lived experiences into brains and physiology, enabling individuals to biologically adapt to what has happened, to better anticipate and therefore biologically prepare for what may happen next. They include epigenetics, neurogenesis, synaptic plasticity, and white matter plasticity. All are mechanisms of neuroplasticity, broadly defined, and are active during development. By detailing these mechanisms, this paper supports nurses to reconsider the impacts of trauma, moving away from the notion of damage to adaptation.

3.2. Mechanisms of Neuroplasticity

Epigenetics has been described as the “quintessential gene‐environment interaction” (Lester et al. 2016) because experiences in the environment are transduced into changes that alter gene expression without changing the genome. The changes may be transient or persistent, lasting a lifetime or maintained into the next generation. Neurogenesis is the process by which new neurons are generated and integrated into the existing network and is responsive to novelty and environmental experience, positioning it for its role in learning and memory, which is incompletely understood. Synaptic plasticity refers to the malleability of neural pathways where synapses are strengthened, so that “cells [neurons] that fire together wire together” (p64) (Shatz 1992) or weakened. Critically, for a cellular model of learning and memory, synaptic plasticity is responsive to experience in the environment (Nicoll 2017). Finally, white matter or adaptive plasticity builds on synaptic plasticity through a process of activity‐dependent myelination, whereby repeated activity along neural pathways triggers myelination of the pathway, making transmission faster and more efficient (Fields 2015; Sampaio‐Baptista and Johansen‐Berg 2017). If synaptic plasticity is about new experiences of learning or associations, white matter plasticity is about repetition or rehearsal of particular experiences, so responses become habitual or automatic. Non‐invasive imaging techniques identify changes in white matter following experiences of learning to juggle, practicing playing piano, and working memory, amongst many others (Bengtsson et al. 2005; Scholz et al. 2009; Takeuchi et al. 2010). For more detailed explanations of neuroplastic mechanisms see (Peckham 2023).

3.3. An Evolutionary Perspective

Neuroplastic mechanisms are survival positive because they allow the organism to deploy open genetic programs that have evolved over many lifetimes to adapt to local conditions in the environment within its lifetime (Davis and Wund 2016). Genes carry generic information encoding broad, as yet unspecified, capacities (such as the capacity to learn language) that have been reliably preserved over evolutionary time because those capacities are survival positive. The environment provides specifying information acquired through experiences during developmental time (such as hearing the language spoken) that fit the general capacity to the specific environment, thereby supporting the individual's survival and reproduction within it (Cosmides and Tooby 1999; Draper and Harpending 1982). This is perhaps most obvious in terms of Attachment theory. “Unless there are powerful built‐in responses which ensure that the infant evokes maternal care and remains in close proximity to his mother… he will die” (p20) (Bowlby 1958). Bowlby conceived of the infant having a general repertoire of instinctual behaviours that evoke responses from their specific caregiver, allowing the infant to refine its attachment behaviours into a strategy or pattern that promotes proximity to the caregiver, thus serving the infant's survival.

Draper and Harpending linked experiences during development with life trajectories that had evolutionary implications. They suggested that children's perception of ‘father absence’ during a sensitive learning period (1–5 years) established a ‘developmental track’ which shaped their reproductive strategy in adulthood (Draper and Harpending 1982). Belsky et al. subsequently proposed a sociobiological framework of ‘conditional adaptation’. This adapted the developing individual's reproductive strategy for success within similar conditions of environmental stress as those that were mediated to them via parental behaviours in the context of caregiving; in short: “rearing context shapes life history” (p649) (Belsky et al. 1991). More or less stressful environmental conditions were understood to impact parental behaviours, shaping the infant's experience and inducing either a secure or insecure attachment pattern and setting the infant on one of two “divergent developmental pathways” (p647) (Belsky 2019). At one extreme conditions of high stress mediated through parental behaviours adapt the infant/child's development for early maturation, precocious sexuality, short term pair bonding and greater mating than parenting effort. This is a coherent and successful strategy in a harsh, unpredictable environment. Conversely, conditions of low stress would adapt the infant in the opposite way, this being a coherent and successful strategy in a predictable low stress environment (Belsky 2019).

The Neuroplastic Narrative describes how generic information (general strategies that support survival and reproduction) gathered over evolutionary time combines with specifying information (experiences being embedded by neuroplastic mechanisms during developmental time) to shepherd an individual onto the life strategy likely to be successful for the ecological niche they have encountered during development. This process of shaping the general to the specific allows the individual to develop a range of traits and behaviours, including reproductive behaviours, that support survival to maturity and reproduction in the ecological niche encountered. The Neuroplastic Narrative draws on the evolutionary lens of Life History Theory to enrich our understanding of development through life courses, including traumatic life courses. See Figure 2.

FIGURE 2.

Shapes of time (Peckham 2023). Neuroplastic mechanisms embed experiences into our biology which shepherd us towards faster or slower life strategies. Adaptation occurs over evolutionary time as generic (genetic) programs are honed by natural selection, and within developmental time as these generic programs are specified by experiences in the local environment. Evolved neuroplastic mechanisms (A–D) transduce experiences into biology, specifying adaptations to the local environment. Harsh and unpredictable ecologies, dysregulating relationships and few experiences of agency and control are likely to specify a fast life history commencing with accelerated development. Benevolent and predictable ecologies, regulating relationships and many experiences of agency and control are likely to specify a slow life history commencing with protracted development. Many aspects of the individuals' traits, values and behaviours are adapted by their experiences of the environment including their orientation to time (shown as time horizon), their strategy for resource acquisition and the ultimate adaptation which all others serve—the strategy for reproductive success. At the extremes, fast life strategists are present‐focused, opportunistic, risk takers energetically disposed towards mating effort, and slow life strategists are future‐focused, steady acquisitors energetically disposed towards parenting effort. Deferring to the future benefits the reproductive strategy of the slow life strategist in a benevolent predictable environment. Discounting the future benefits the reproductive strategy of the fast life strategist in a harsh unpredictable environment but shortens healthspan and lifespan. (A) httpsupload.wikimedia.orgwikipediacommonsthumbdd1Dna‐163466.jpg512px‐Dna‐163466.jpg (B) Jason Snyder Doublecortin and Hoescht Creative Commons https://www.flickr.com/photos/functionalneurogenesis/4191317925 (C) Else if then. https://commons.wikimedia.org/wiki/File:R%C3%A9seau_de_neurones.jpg (D) Thomas Schulz https://en.wikipedia.org/wiki/Tractography#/media/File:DTI‐sagittal‐fibers.jpg.

4. Life History Theory: Living Slow and Easy or Fast and Furious?

Surviving long enough to reproduce and then reproducing successfully is the way an ancestral line continues. This is the process of natural selection which refines a population to fit ¹ their particular environment (Scott‐Phillips et al. 2011). Perhaps counterintuitively, natural selection does not shape organisms for happiness, health and longevity, or pro‐social behaviours, but for reproductive success (Wells et al. 2017). Goals of health and reproduction can be in conflict, such as when processes that preserve reproduction may incur costs to health; therefore the task of defining a process as disease or pathology is not straightforward (Cosmides and Tooby 1999; Nesse 2001).

Life History Theory describes how organisms allocate resources to survival and reproduction, according to the survival pressures they face in their ‘ecological niche’ (Stearns 2000). An ecological niche consists of all the environmental factors and interspecies relationships that influence the species (National_Geographic 2025). Elements of a niche can be: harsh (or dangerous) versus safe, predictable versus unpredictable, with features the organism can control, or not. Thus, the optimal strategy for surviving long enough to successfully reproduce in any niche depends on the pressures of the niche, the capacity the organism has to control their niche and the resources available to the organism. The organism allocates its limited resources coherently, to favour either maintenance or growth; current or future reproduction; quantity or quality of offspring, and mating or parenting effort (Ellis et al. 2009). Across many species the pressures of harsh and unpredictable environments tend to reduce birth size but increase the number of births; increase growth rate but reduce age and size at reproductive maturity, and increase mating effort resulting in more births, but reduce parenting effort resulting in a greater number of less competitive offspring (Hertler et al. 2018). Essentially, the implicit question, posed by natural selection and answered by the life history strategy of the organism is: ‘Given the risks and opportunities afforded by this ecological context is it a better reproductive strategy to grow now and reproduce later, or would it be better to reproduce now in case it is not possible to later?’

The dimension of time is critical, intersecting with survival pressure to speed up maturity and reproduction as necessary. “Some organisms rush through life, investing in quantity of offspring and intergenerational turnover, whereas other organisms mature, mate and age slowly investing in bodily maintenance and quality of offspring” (p4) (Hertler et al. 2018). Accordingly, life history strategies are ‘coherent bundles of traits’ (p3) (Hertler et al. 2021) organised along a continuum of fast to slow that serve reproductive success in environments that can also be arrayed on a parallel continuum from harsh (dangerous) and unpredictable to safe and predictable respectively. Both fast and slow life strategies are specified by experiences, creating a diverse range of adaptive profiles. “From the perspective of evolution, neither the fast nor slow reproductive pattern is better than the other, neither is ‘biologically normal’ or ‘evolutionarily adaptive’; what is normal and adaptive depends on the environment” (p171) (Chisholm 2015).

Species with fast life histories, such as the rabbit, are often prey animals with uncertain lives. Unable to predict or control their environment, they are subject to intense survival pressure to which they have strategically adapted by speeding up their reproductive strategies, mitigating the risk of extinction of their line in their unpredictable, uncontrollable, dangerous environments. Rabbits, for example, mature swiftly, mate indiscriminately and breed frequently and prolifically, producing litters to which they offer minimal parenting effort before the offspring mature and repeat the cycle. Rabbits may live fast and die young, as they are susceptible to predators and other environmental threats, but they are famed for their capacity to leave descendants. Contrast rabbits with elephants, a species typifying a slow life history strategy, which have high birth weight, long lifespan, slow growth rate to maturity, and usually bear a single calf approximately every 4 years, that nurses for 3 years and is the recipient of care and guidance from multiple familial adult females for decades (ElephantVoices 2022; Hertler et al. 2018). These are across species differences but differences in life history strategies are observed both across and within species, including homo sapiens . Additionally, in humans, the time frame over which relationships and the environment can be reliably predicted is an important variable that shapes individuals' experiences of their own agency. Relationships and an environment that is stable or slow to change foster a sense of predictability therefore agency over the longer term whereas instability in relationships and the environment foster an imperative of impulsivity, of carpe diem, seizing the day or the moment, before the opportunity is lost. Accordingly, traits most likely to impact on life history strategy carry temporal imperatives, such as being opportunistic or impulsive or considered and risk averse (Hertler et al. 2021). See Figure 2.

Amongst people, the slow life strategists' dominant experience from childhood is of a safe environment that is predictable over the long term; an environment that can be learned and controlled and where there is no imperative to rush or need to become opportunistic. Planning works in this environment because it is predictable. Material resources, social and financial capital can be reliably accrued with effort, and reproduction can be delayed in favour of growth and seeking a quality mate for the long term. The slow life multi‐level planning positions people to invest in the parenting, enculturation and education of their (likely) few children so that, at maturity, those children will become highly competitive in a resource limited environment. Accordingly, traits that generate long term gains are associated with slow life strategists: co‐operation, empathy, the capacity to play, intelligence, planning, consequential thinking, risk‐aversion, secure attachment and conscientiousness (Chisholm 2015; Figueredo et al. 2006; Hertler 2016; Hertler et al. 2021; Szepsenwol and Simpson 2019). We can contrast this slow life course and associated strategies with those of fast life course.

A slow life strategy which capitalises on predictability fails in a chaotic or unpredictable environment. A fast life strategy, which capitalises on opportunity in the moment, is adaptive in a dangerous or harsh environment that is unpredictable or only predictable in the very short term. Hastening reproductive decisions and maximising the number of offspring is adaptive because it mitigates the risk of death or disability that could prevent descendants being left at all (Ellis et al. 2009). The human predicament of how to live and raise a family is shaped by the harshness and unpredictability or short‐term predictability of their environment. Experience shapes the fast life strategists' sense of agency. In the immediate and short term their agency is effective but over the longer term their plans and efforts to acquire resources are thwarted or limited by an unpredictable or predatory environment (powerful bad actors, institutions and other drivers of structural inequities) that are beyond the strategist's prediction and/or control. Accordingly, traits that provide short‐term gains are fast life history associated traits: impulsivity, risk‐taking, sensation‐seeking, an orientation to the present, insecure attachment, precocious sexuality, and engaging with multiple uncommitted partners (del Giudice and Haltigan 2021; Szepsenwol and Simpson 2019). See Figure 2.

To summarise, fast life history strategists are necessarily orientated to the present, because they are evolutionarily disposed towards trying to survive and reproduce today, in case they cannot tomorrow. Such is life in a harsh, unpredictable and uncontrollable environment. Consequential thinking, delayed gratification, steady resource acquisition and investing in the future are functional for slow life strategists, effective only if they occur in a predictable environment over which they have a degree of control and resources to buffer uncertainty. See Table 3 which arrays traits and behaviours along a continuum of fast and slow.

TABLE 3.

Variations in traits and behaviours along the continuum of fast and slow life strategists. Adapted from (Ellis et al. 2012).

5. Reframing the Data From the ACE Study Through a Life History Lens

Life History Theory comprehensively accounts for the data gathered in the ACE study (Hertler et al. 2021). Life History Theory predicts that a fast life strategy would likely follow the harsh and unpredictable experiences of maltreatment, trauma and adversity in childhood (Hertler et al. 2021). Resources that could be allocated to growth would be routed into hastening reproductive effort. Earlier puberty, menarche, sexual debut and pregnancy may occur, compromising long‐term health. Mating effort would supersede parenting effort; there may be more children from multiple partners, compromising the available capacity for parenting. Ultimately, the life lived faster may be shorter. Additionally, the dysregulating impact of a traumatising and adverse (harsh and unpredictable) childhood engenders an enduring need for emotional and physiological regulation and distraction. This heightens the stopgap appeal of substances and activities, paving the way to substance and process addictions. Desperation and pain (emotional or physical) are present orienting states and if experienced repeatedly, organise the emergence of traits and habitual behaviours that serve immediate and short‐term gratification. Such traits include impulsivity, risk taking, sensation seeking, opportunism and the exploitation of others. Amongst other outcomes, these traits militate against ‘slow life’ proprieties and protections for sexual activity, potentially resulting in an increase in sexually transmitted diseases and unplanned pregnancies.

Data collected by the Adverse Childhood Experience study accords with predictions arising from the evolutionary perspective of Life History Theory. If we consider that experiencing four or more categories of abuse or household dysfunction in childhood as defined in Table 1 equates to a harsh and unpredictable developmental period, through the lens of life history theory we would anticipate a tendency towards a fast life strategy predicting: a shorter health span and lifespan; discounting of future consequences in favour of short term gains and immediate gratification; consumption rather than conservation of resources; impulsivity, and a higher number of sexual partners (see Table 3). The study showed that experiencing four or more categories of abuse or household dysfunction doubled the risks for heart and lung disease, cancers, and stroke; doubled the likelihood of acquiring a sexually transmitted disease; and trebled the likelihood of having 50 or more sexual partners (Felitti et al. 1998). This is consistent with a fast life history interpretation of a reallocation of energy resources to reproduction, at the cost of health. Experiencing four or more categories of adversity also increased the risks of becoming an alcoholic and of using illicit drugs (Felitti et al. 1998). This too is consistent with a fast life history interpretation of individuals who have become more orientated to the present, more impulsive, and more likely to seek out short term gratification and relief whilst discounting future consequences. All are processes that may provide immediate relief or distraction but potentially lead to substance or process addictions over the longer term, adding to suffering and increasing the risk for undesirable outcomes. Table 4 links data from the ACE study with a fast life strategy revealing that reproductive effort is prioritised at the expense of health (see italicised text) and the long‐term consequences of this ‘faster’ strategy.

TABLE 4.

Data from the ACE study (Felitti et al. 1998) is comprehensively accounted for from a life history theory perspective. In a harsh unpredictable environment—such as experiencing 4 or more categories of adversity, reproduction is spared at the expense of health (see italicised text). Poorer health outcomes may arise from the health costs of increased reproductive effort and attempts to distract from, numb, or regulate emotions or memories associated with trauma and adversity.

Concern for people with 4 or more categories of adversity	Risk factor increase	Link to fast life strategy
Being severely obese (BMI ≥ 35)	1.6	Emotional regulation/distraction with food Possible long‐term outcome of short‐term best available coping strategy
Diabetes	1.6	Possible long‐term outcome of short‐term best available coping strategy
Ever had a skeletal fracture	1.6	Emotional regulation/reward/risk behaviours
Any form of cancer	1.9	Possible long‐term outcome of short‐term best available coping strategies
Being a current smoker	2.2	Emotional regulation/distraction/reward
Ischemic heart disease	2.2	Possible long‐term outcome of short‐term best available coping strategies
Stroke	2.4	Possible long‐term outcome of short‐term best available coping strategies
Ever had hepatitis or jaundice	2.4	Possible long‐term outcome of short‐term best available coping strategies
Ever had a sexually transmitted disease	2.5	Increased mating effort Emotional regulation/distraction/reward Possible long‐term consequence of short‐term best available coping strategies
Have had 50 or more partners for sexual intercourse	3.2	Increased mating effort Emotional regulation/distraction/reward Possible long‐term consequence of short‐term best available coping strategies
Chronic bronchitis or emphysema	3.9	Possible long‐term consequence of short‐term best available coping strategies
Ever used illicit drugs	4.7	Emotional regulation/distraction/reward
Considers oneself to be an alcoholic	7.4	Emotional regulation/distraction/reward and Possible long‐term outcome of short‐term best available coping strategies
Ever injected drugs	10.3	Emotional regulation/distraction/reward
Ever attempted suicide	12.2	Despair/extreme emotional regulation

The ACE study suggests that having more than 50 sexual partners (with an associated risk of contracting a sexually transmitted disease) may be a coping strategy for early trauma and adversity. However, the authors allude to an alternative perspective, “incomplete understanding of the possible benefits of health risk behaviours leads them to be viewed as irrational and having solely negative traits” (p254) (Felitti et al. 1998). The alternative, articulated through the lens of Life History Theory, is that having more than 50 partners (carrying an associated risk of contracting an STD) indicates an increase in opportunistic mating effort, albeit at the expense of long term health—an evolutionarily rational response to an environment where one's opportunities to reproduce may both arise and be foreclosed unpredictably.

Findings from many correlative studies based on the ACE study model also provide incidental evidence for Life History Theory. ACE researchers related an increase in the number of categories of adversity experienced in childhood to increased likelihood of early intercourse, adolescent and unintended pregnancy, sexual risk behaviours, including a higher number of partners and an increase in sexually transmitted diseases, and foetal death (Dietz 1999; Hillis 2010; Hillis et al. 2004; Hillis et al. 2001). Direct evidence linking early adversity to faster life strategy comes from evolutionary researchers such as Daly and Wilson who demonstrated a relationship between low life expectancy in dangerous neighbourhoods with earlier reproduction (Wilson and Daly 1997). Similarly, Nettle demonstrates that early life adversities associate with earlier first pregnancy in a UK cohort (Nettle et al. 2011).

Taken together, the data from the ACEs study and related studies are consistent with a Life History Theory interpretation, showing that in a harsh and unpredictable environment a fast life strategy preserves reproduction at the expense of health. In a coherent and comprehensive manner, the environment invisibly shapes the individual's traits, values, habitual behaviours and choices to enact the life history strategy that (in an evolutionary sense) is the best fit for the ecological niche, achieving evolution's ultimate aim of reproductive success even at the expense of an easier, healthier longer life. Accordingly, in a recent paper: Life History Evolution forms the foundation of the Adverse Childhood Experience pyramid, Hertler et al. conclude that “…a life history perspective casts the parenting behaviours associated with ACEs, as well as resultant effects on offspring, as strategic variation as opposed to acquired dysfunction” (p10) (Hertler et al. 2021). So, rather than being markers of dysfunction and pathology, the social, emotional, cognitive and health effects associated with ACEs are framed as ‘integrated adaptations to ecologies’ (p3) (Hertler et al. 2021). From the perspective of life history, the adaptations related to ACEs preserve reproduction and are an evolutionary success story, albeit one associated with distress and suffering which is likely to culminate in ill‐health, but these adaptations are not of themselves impairments or pathologies.

This section has reframed findings from the ACEs study from the perspective of Life History Theory. It supports the perspective that the putative effects of early trauma and adversity, measured in terms of addictions, sexual behaviours and poor physical and mental health, are evidence of adaptations to a fast life history strategy. Re‐casting the impairments and dysfunctions identified in the Adverse Childhood Experiences study as adaptations within life history theory is rationally de‐pathologizing and non‐blaming and shifts focus away from the pathologisation of individuals to call for a social justice response to the ecologies which individuals are adapting to.

6. Pathology and Suffering

From an evolutionary perspective, ‘pathological’ means ‘does not serve inclusive fitness’ or could mean a contributing (proximate) mechanism instantiating a trait or process that ultimately serves fitness is not functioning as it should (del Giudice 2018). The neuroplastic mechanisms which link early adverse experiences with adaptations that produce faster life history trajectories are functioning as they evolved to, adapting a developing child for reproductive success in a similar ecological niche at maturity. There is also no ultimate pathology in the fast life trajectory itself, which also functions as it evolved to, preserving reproductive success in a harsh unpredictable ecological niche, albeit at a cost. From this perspective there is no ultimate pathology or ‘harmful dysfunction’ (Wakefield 1992) in the fast life strategy per se. In evolutionary terms, fast life strategies ward off the ultimate threat of extinction, so the emotional and psychological suffering, the health costs and the shortened life expectancy associated with it are worth the reproductive dividends. To say this is to describe it, not justify it. Natural selection is a powerful force, not a moral agent.

Following this evolutionary logic, there is a potential here to misconstrue the implications for nurses, so let us be clear: even though we rationally de‐pathologize trauma responses with the evolutionary explanation, we know that suffering is still suffering. So, nurses and all clinicians are called to assist people presenting with distress and suffering that has its origins in trauma. We suggest that rationally de‐pathologizing fast life trajectories calls for wider recognition of the following:

• Slow and fast life strategies lie on a ‘continuum of normal’, their diversity reflecting the diversity of the ecologies of development which shaped them. None are pathological or laudable. In a society that values health and longevity, the slow life trajectory is culturally more desirable.

• People who have been shaped by and for life in a faster ecology accrue stressors and responses that culminate in poorer health (identified by ACE studies), which may be screened for to enable early detection and prompt treatment.

• These same people have been exposed to an environmental threat that can be understood and responded to as a public health issue and appropriately alleviated through social justice.

• That our brains and physiology adapt to what has typically happened and form an anticipation of what is likely to happen. Thus, the emotional and psychological suffering associated with early experiences of trauma and adversity can be validated and understood as a person's adaptation to and anticipation of experiences that were typical in their unique ecology of development. This suffering is a meaningful response to that person's experiences and not ‘maladaptive’ or necessarily symptomatic of mental illness.

These points matter because the assumption of pathology where there is suffering can be disempowering. The framing of the suffering is important. Filson remarks “A doctor once pointed out to me – in the face of what he considered to be my obvious denial – all the behavioural indicators associated with my particular brand of madness. To him, my self‐injury was a ‘symptom’; My panic was a ‘symptom’; My hearing voices and seeing people who were not there were all ‘symptoms’. When he proclaimed, not without disgust, you have a mental illness, I'd responded, ‘I thought I had stories to tell’…. In the context of the medical model the story we learn to say is that we are ill. We begin to see ourselves as ill. We tell stories of illness, and the psychiatric system and, by extension, society accepts illness as the story of our distress…. In part, healing happens in the re‐storying of our lives” (p20–23) (Filson 2016). Reflecting on this testimony and the evolutionary perspective of the Neuroplastic Narrative, mental health clinicians and psychiatrists may redefine their role around the insight that adapting to survive trauma and adversity, which involves anticipating it, leads to distress and suffering that warrants care for the individual as well as advocacy and action to address the structural violence that creates and maintains generations of adverse and traumatising ecologies which individuals evolved to adapt to. For example, the impact of trauma and adversity could be explicitly validated and medications prescribed from a drug‐centred rather than disease‐centred perspective (Moncrieff 2019).

The widespread tendency to pathologize a fast life trajectory emerges if we conflate what life course is ‘desirable’ with what is ‘normal’. What is normal and adaptive depends on the environment. The undesirable experiences of adversity and trauma during development are normal within fast life history niches. Adapting to survive and reproduce within such niches generates “vicious, self‐perpetuating, intergenerational cycles of risk and uncertainty” and causes such physical and emotional suffering that we intuit there must be a pathology (p171) (Chisholm 2015). Conversely, it is only within the relative privilege of slow life history niches that development usually occurs in the absence of trauma and adversity, which is desirable and can also, in this limited context, be considered ‘normal’. Eschewing value‐laden intuitions of ‘normality’ and ‘pathology’ and accepting that different life history strategies have evolved to preserve reproductive success across disparate environments invites the value‐neutral language of difference into discussions of individual development. Hertler draws attention to this, remarking that life history strategies often thought to begin with neurodevelopment that is ‘disrupted’ are “more properly [conceptualised as] different” (p10) (Hertler et al. 2021).

The tendency to pathologize the traits and behaviours of the fast life strategist is widespread and pernicious (Daly and Wilson 2005). Without intent, a situation emerges whereby slow life strategists, experts in the construction and expansion of the niches they thrive in, become not only the diagnosing practitioners, but the rule makers and arbiters of social norms and values, including those that determine what is deemed pathological (Hertler 2016). An alternative narrative that may better serve patients, nurses and society in general maintains a descriptive stance and refrains from making value judgements about states is a narrative of diversity.

7. Neuro‐Ecological Diversity

The term ‘neurodiversity’ was coined by Judy Singer to name a social change in the context of The Autistic Self‐Advocacy Movement (Singer 1999). Neurodiversity “simply names an indisputable fact about our planet, that no two human minds are exactly alike, and uses it to name a paradigm for social change” (Singer 1999). Following Singer, Blume asserted that the social change sought is away from the default pathologisation of people who have unusual constellations of social, emotional and cognitive abilities, towards their inclusion, acceptance and accommodation, and the valuing of their variation. “Neurodiversity may be every bit as crucial for the human race as biodiversity is for life in general. Who can say what form of wiring will prove best at any given moment” (Blume 1998). A similar conceptual and social change to that sought by the neurodiversity movement might work well here. We encourage a move away from the default pathologisation of fast life history adaptations including the emotional and psychological suffering associated with early experiences of trauma and adversity in favour of recognising a diverse array of adaptations arising from an equally diverse array of developmental ecologies. This diversity arises through our adapting to experiences via evolved mechanisms of neuroplasticity which manifest in differences in brain structure and function, in the calibration of physiological systems, and in certain values, traits, responses and behaviours. Here, we propose the term ‘Neuro‐ecological diversity’ to refer to the differences that arise between individuals as a result of neuroplastic mechanisms biologically embedding experiences from infancy, childhood and adolescence. Thus, fast and slow life strategies exemplify neuro‐ecological diversity; one is not better or more adapted than the other and neither are pathological, merely reflective of the ecologies from which they emerge. In our culture many people would prefer a slow life strategy because fast life strategy is a hard way to live, but we do not choose the ecological niche we grow up in. Where we have resources to do so, we may seek out the kinds of experiences and communities that will help us mitigate a fast life trajectory, slowing down our decision‐making and looking at long term consequences as well as short term gains.

We anticipate that people with histories of trauma and adversity who find the pathologization of their distress and suffering oppressive may prefer to identify as neuro‐ecologically diverse rather than mentally ill.

8. Conclusion

The Neuroplastic Narrative and Neuro‐Ecological Diversity provide a non‐pathologizing, biological foundation for trauma‐informed nursing that privileges experience and offers a coherent, non‐shaming alternative to the medical model. These insights offer mental health nurses an opportunity to revolutionise current theory and practice and to formulate collaboratively with consumers from a perspective that is independent of psychiatry and the Diagnostic and Statistical Manual of Mental Disorders. Instead of accepting narratives of pathology and associated diagnoses, nurses are empowered to privilege and validate the impact of people adapting to experiences, to survive as best they can, their lived experiences of trauma and adversity and/or a lack of control over circumstances, the hallmark of social inequity, that attends the lives of many seeking help from mental health services.

This paper is a beginning; future work is needed for formulating from an adaptive stance that recognizes how past trauma informs present situations and how new experiences can reform future trajectories.

9. Relevance to Clinical Practice

This research contributes to nursing knowledge and practice by offering nurses an alternative explanatory framework to the medical model and the premise of pathology. We introduce a neuroscientifically and evolutionarily informed explanatory model which shows how and why our brains and physiologies adapt to, and are calibrated by, our earliest experiences. The Neuroplastic Narrative and Neuro‐Ecological Diversity provide a non‐pathologizing, biological foundation for trauma‐informed nursing that privileges experience and offers a coherent, non‐shaming alternative to the medical model.

Author Contributions

Haley Peckham: conceptualization, writing – original draft, writing – review and editing. Bridget Hamilton: writing – review and editing.

Funding

The authors have nothing to report.

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

Data sharing not applicable to this article as no datasets were generated or analysed during the current study.