Book review: “The Deepest Well: Healing the Long-Term Effects of Childhood Adversity” by Dr. Nadine Burke Harris

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Dr. Nadine Burke Harris debuted her book, The Deepest Well: Healing the Long-Term Effects of Childhood Adversity, at the Philadelphia Free Library this evening in a talk and book signing.

This first stop in an ambitious book tour that crisscrosses the country reflects a mission that Burke Harris has pursued for nearly a decade: to spread the knowledge about the science of adverse childhood experiences, and about how people can use this knowledge to help solve our most intractable problems. (Her TED Talk has nearly 3.5 million page views.)

The story that the pioneering pediatrician and CEO of the Center for Youth Wellnessrelates is hers. It begins when, as a young pediatrician, Burke Harris struggles to define what was happening to her young patients at the Bayview Child Health Center in the Bayview Hunters Point community in San Francisco, CA.

I believed, ever since we’d opened the clinic in 2007, that something medical was happening with my patients that I couldn’t quite understand. It started with the glut of ADHD cases that were referred to me.…most of my patients’ ADHD symptoms didn’t just come out of the blue. They seemed to occur at the highest rates in patients who were struggling with some type of life disruption or trauma….what if there was a more nuanced answer? What if the cause of these symptoms — the poor impulse control, inability to focus difficulty sitting still — was not a mental disorder, exactly, but a biological process that worked on the brain to disrupt normal functioning?

And thus begins something akin to a gripping medical detective saga. Burke Harris began her career as any other pediatrician, trained as pediatricians have been trained in medical schools for decades: to treat the symptoms in front of her. She paid little attention to the story behind the story, but those background stories would pop up time and again, practically yelling at her: “Pay attention! There’s something going on here!!”

I lived in that state of not-quite-getting-it for years because I was doing my job the way I had been trained to do it. I knew that my gut feeling about this biological connection between adversity and health was just a hunch. As a scientist, I couldn’t accept these kinds of associations without some serious evidence.

Pieces of evidence appeared as she pursued understanding the effects of stress hormones on kids’ development. But the turning point came when a co-worker handed her an article that had been published in 1998 in the American Journal of Preventative Medicine: “Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: the Adverse Childhood Experiences Study,” by Dr. Vincent Felitti, Dr. Robert Anda, and six of their colleagues.

When I finished reading the study, my excitement hadn’t diminished. I felt like Neo at the end of the movie The Matrix when suddenly the world was dripping with green numbers. Not only was I seeing the full reality of what was all around me, but I understood it….At the time, I knew that this moment, this understanding, was going to profoundly change my practice, but I had no idea how much it would change my life.

In other words, at that moment, Burke Harris was woke!

The book examines the five major parts of ACEs science in an understandable, engaging way:

  • the epidemiology of ACEs….the CDC-Kaiser Permanente ACE Study that blew her mind;
  • the neurobiology of toxic stress caused by ACEs, especially on children’s developing brains;
  • the short- and long-term health consequences;
  • the epigenetic consequences of toxic stress from ACEs;
  • and — the good news — resilience research that shows how pediatricians and educators can help children and families heal themselves.

Burke Harris goes on to explain how she founded the Center for Youth Wellness to start down the very long road to encourage the pediatric profession to integrate practices and policies based on ACEs science. She began screening for ACEs, and expanded the questions from the original 10 (physical, emotional, and sexual abuse; physical and emotional neglect; growing up in a household where a family member is mentally ill, alcoholic or dependent on other substances, incarcerated; where there’s parental separation or divorce, or where a mother is being abused) to include community violence, homelessness, discrimination, foster care, bullying, repeated medical procedures or life-threatening illness, death of a caregiver, loss of a caregiver to deportation or migration, and, for youth, verbal or physical violence from a romantic partner and youth incarceration. She and her team began figuring out what resources they needed to support children and parents with high ACE scores, which, in turn, changed their approach to medical care from a doctor-patient approach to a team approach that includes mental health; community resources, including housing, transportation, food, exercise; and personal health practices, including sleep and mindfulness.

Last year, she and her team at the Center for Youth Wellness lay the foundation for the National Pediatric Practice Community on Adverse Childhood Experiences(NPPC), a three-year initiative that launches this year with a goal of supporting 1,000 pediatricians to integrate ACEs screening.

One important aspect of the book is how Burke Harris relates how she found others who’d also been as affected by the ACE Study as she had, including Jeannette Pai-Espinosa, CEO of the Crittenton Foundation, which is educating all of the teens and youth they serve about ACEs science; Nancy Mannix, chair of the Palix Foundation, which created the Alberta Family Wellness Initiative in Canada, which has a fabulous online tutorial on brain science; Dr. Denise Dowd, a pediatrician at Children’s Mercy Hospital in Kansas City, MO, who has done pioneering work in integrating practices based on ACEs science in a Head Start program; and Dr. Pamela Cantor, founder of Turnaround for Children, one of a handful of organizations that are taking a whole-school approach to integrating practices based on ACEs science.

I hope that people who are new to ACEs science don’t come away from reading the book with the impression that ACEs are a problem only of inner-city communities such as Bayview Hunters Point. Burke Harris has worked hard to disabuse people of that notion. As she said today in an interview with Cory Turner on NPR.org: “This is not a poverty problem. This is not a race problem. This is a function of human biology. It is the way all of our bodies are wired. And now we can use this science to improve outcomes for everyone.”

The Deepest Well is definitely worth reading; kudos to Burke Harris for persevering to produce it, and for including some of her own story and her family’s story. The personal part of her story is poignant and pertinent, and I won’t say more because I don’t want to spoil it for people who read the book.

I think the book will inspire the tens of thousands of people (including the nearly 20,000 members of ACEs Connection, the companion social network to ACEsTooHigh) who are in this community of early adopters of which Burke Harris is one of many leaders across sectors (including healthcare, education, justice, faith-based, business, social services, legislators, etc.), to inspire more tens of thousands, who will inspire more tens of thousands, etc., etc., to spread the word about ACEs science. That’s how revolutions happen.

As Burke Harris writes:

The revolution is in the creative application of knowledge to mitigate harm wherever it pops up. Because when you know the mechanism, you can use that understanding in countless ways to drastically improve the human condition. That is how you spark a revolution. You shift the frame, you change the lens, and all at once the world is revealed, and nothing is the same.

6 responses

  1. Pingback: Childhood Memories: The Assault on Health – M.Autera: If It's Science, It's Life

  2. The free library of Philadelphia, has podcasts of all of their talks! Terry Gross of Fresh Air often piggy backs on those speakers for her interviews too! So maybe we can catch that talk, or interview.

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  3. Has anyone studied the effects of adult child abuse? Leaving an abusive husband has left me so impoverished I am stuck living with my abusive mother and my health has seriously declined over the past six months.

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  4. In support of the ACEs movement, the Ardicare Foundation is hosting a screening of the Resilience documentary this Wednesday evening at the Landmark Theater Opera Plaza in San Francisco. Dr. Burke Harris will be signing her book at Books Inc. Opera Plaza the previous evening. Join us for the screening, a discussion of the documentary, and hear about the community program we offer. http://www.turningthetideoftrauma.org/events/

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  5. It is a crime how long it takes new, peer-reviewed facts, to change professional practice and policy. Denial, avoidance and dissociation are the default of the human brain. “Progress happens one funeral at a time.” and with extreme right wing hate-based politicians taking over the national and most state governments…the kids suffer…

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