The Deepest Well: Healing the Long-Term Effects of Childhood Trauma and Adversity—A Transformative Guide to Understanding Childhood Trauma and Health

by Nadine Burke Harris

If they can get a safe, stable, and nurturing environment at an early age, the biology says that this sets them up to develop a healthy stress-response system in adulthood.

Blackburn and Epel looked at how food, exercise, and even mental focus affected the health of telomeres. But to me, the most interesting part of what they found was that stress had a major impact on the length and health of telomeres, and that in turn had a major impact on the risk of disease.

showing us the lasting imprint that early stress has on cellular aging and disease processes.

They found that while lifetime cumulative adversity significantly predicted telomere shortening, that shortening was due mostly to the adversity experienced in childhood;

you can still slow decline by increasing your telomerase with things like meditation and exercise.

there’s no discounting the impact of the DNA that comes from the good old egg and sperm. As we know, it’s all about nature and nurture. You are handing down to your kids both your genome and your epigenome and they both count in determining health.

Not only that, but we could also possibly prevent future illness by treating the underlying problem—a damaged stress-response system.

We found that a focus on the underlying biology of toxic stress and the factors that helped balance the dysregulated pathways—sleep, integrated mental-health services, and healthy relationships—made a big difference for our patients.

The program’s success showed us that addressing ACEs as part of a weight-reduction program was essential.

But in an interesting twist, we found that if our goal had been simply to address ACEs instead of obesity, exercise and nutrition would still have been an important part of that.

we were pleasantly surprised to see how much the kids improved when we added healthy diet and exercise incentives to therapy.

the research is piling up in exciting new directions, showing us that moving our bodies builds our brains as well as our muscles.

Eating foods that are high in omega-3 fatty acids, antioxidants, and the fiber from fruits, vegetables, and whole grains helps fight inflammation and bring the immune system back into balance. By contrast, a diet high in refined sugar, starches, and saturated fats can promote further inflammation and imbalance.

At that point, my staff and I had some strong strategies for specifically targeting and healing the dysregulated stress response: sleep, mental health, healthy relationships, exercise, and nutrition.

Remarkably, the biometric results demonstrated that at the end of the study, the patients in the meditation group were able to exercise on the treadmill 12 percent harder and 15 percent longer before experiencing chest pain. Even more interesting, during the treadmill test, the meditation group experienced an 18 percent delay in the onset of EKG changes that indicated stress on the heart,

While stress activates the fight-or-flight system (also called the sympathetic nervous system), meditation activates the resting-and-digesting system

How much damage could be done while you were waiting for the right questions to be asked, the right tests to be run? Guthrie knew. His sister-in-law knew. They saw what happened when PKU was not tested across the board, when the opportunity for early intervention was lost. That is why an ounce of screening is better than a pound of cure.

The prenatal and early childhood periods offer special windows of opportunity because they represent “critical and sensitive periods” of development. A critical period is a time in development when the presence or absence of an experience results in irreversible changes.

We know that early adversity activates the brain pathways that are associated with vigilance, poor impulse control, increased fear, and inhibition of executive functioning. But if we can identify kids who are at high risk for toxic stress early enough, we can intervene in time to take advantage of high levels of both synaptic and cellular

plasticity. The most effective way to rewire the brain is to implement early interventions that help to prevent the stress response from becoming dysregulated and that support practices that buffer the stress response (as with child-parent psychotherapy).

More good news—there are things that you can actually do yourself to boost your synaptic plasticity; sleep, exercise, nutrition, and meditation all enhance the process. That being said, a little more patience and consistent practice is required for adults,

Informed by these insights, we reworked our screening tool to include other factors that we believe may also increase the risk for toxic stress. Community violence Homelessness Discrimination Foster care Bullying Repeated medical procedures or life-threatening illness Death of caregiver Loss of caregiver due to deportation or migration In our teen screener, we also include the following: Verbal or physical violence from a romantic partner Youth incarceration

Unfortunately, sometimes what makes sense doesn’t always align with the reality of medical practice.

But what made her sit on the edge of her seat and her hands go numb was what the video had to say about verbal and emotional abuse. It was just as bad for kids, and in some ways, worse.

actually said it that she ever contemplated that what had happened could be considered emotional abuse. The yelling, the intimidation, and the controlling behavior—all of a sudden, she could see it for what it was.

But ironically, the things that seemed to make the biggest difference for Karl were the changes she made for herself.

“Honestly, it sounds like Karl was experiencing toxic stress,” I said. “It makes perfect sense that he did so much better because exactly what you did is the treatment for toxic stress. Number one, reduce the dose of adversity; number two, strengthen the ability of the caregiver to be a healthy buffer. Your getting healthy was actually an incredibly important part of the equation. It’s like when a flight attendant tells you to put your own oxygen mask on before putting it on your child. That’s no joke. Your stress response was dysregulated, which made it impossible to help him regulate his. That’s the mechanism that is so critical to understand. You getting out and taking care of yourself wasn’t selfish—it was the exact right thing to do for Karl.”

It’s obvious why screening every child is a must, but what do you do if you’re an adult and you had ACEs as a kid? Is there treatment for that? Honestly, I am thinking about my husband, Josh, right now.”

“Absolutely,” I said. “It’s never too late to start rewiring your stress response.” “The impact of interventions for toxic stress may not be quite as dramatic in adults as it is in our kids, but it still can make a big difference. This might sound simple, but I cannot overstate this: The single most important thing is recognizing what the problem is in the first place.”

I went on to explain that for toxic stress, the six things that I recommend for my patients—sleep, exercise, nutrition, mindfulness, mental health, and healthy relationships—were just as important for adults.

The other important piece I mentioned was that adults with high ACEs were at increased risk of health problems, which was why it was important for them to ask their doctors if they had heard of the ACE Study. A doctor can help you understand how your ACE score and your family history affect your risk for certain illnesses, and then the two of you can work together to create a plan for prevention and early detection. The great news is that there is now a field, called integrative medicine, that is dedicated to looking at the whole person and using the latest science to improve health and well-being. The cool thing about integrative medicine is that it’s interdisciplinary, just like our team at CYW.

Ideally, you want to maximize all six of those things, especially for adults, because our brains aren’t as plastic as they were when we were kids. But the general idea is, the more of the six things you do, the more you’ll reduce stress hormones, reduce inflammation, enhance neuroplasticity, and delay cellular aging.

“Of course, it’s also a good idea to cut out the stuff that accelerates inflammation and cellular aging, like cigarettes, and to minimize neurotoxins like alcohol,”

Sometimes I think folks out there are waiting for a fancy pill to show up and they’re missing the point that we, as humans, have a profound power to heal ourselves and one another.

for us adults. We can damage each other’s health by repeatedly activating the stress response, but we also have the power to heal ourselves and others biologically. Let me give you an example—any of y’all get the drug Pitocin when you were having your babies?” Heads nod. “Well, that same drug, oxytocin, is actually naturally produced by our bodies.

And oxytocin isn’t released only during childbirth; it’s also released during sex and with hugs and snuggles and healthy relationships. And it buffers the stress response by actually

Plus, it has been shown to have antidepressant effects.

ACEs and toxic stress thrive on secrecy and shame, both at the individual level and at the societal level.

We can’t treat what we refuse to see.

from primary-care clinics and asking about ACEs as well as health status and mental-health measures. Much like the original ACE Study, the population was 83 percent Caucasian and 82 percent college-educated. What the researchers found was that the numbers fell within a few percentage points of Felitti and Anda’s results—demonstrating that Alberta was as affected by ACEs as anywhere else. People with high ACEs were (again) shown to be at much higher risk for depression and anxiety and also to have a greater risk of asthma, autoimmune disease, food allergies, cardiac disease, chronic obstructive pulmonary disease (COPD), migraines, fibromyalgia, reflux disease, chronic bronchitis, stomach ulcers—and the list goes on. People were astounded to see the profound effects of ACEs that had previously been unrecognized in their communities.

Turnaround was building on decades of neuroscience telling us that it’s not enough to “step on the gas” by providing enriched environments to support learning for children. You also have to release the “brake” (the inhibitory effect of the amygdala on cognitive function) by supporting attachment, stress management, and self-regulation. In doing so, Turnaround may finally be able to crack the notoriously difficult test-scores problem for kids living with adversity. Their partner schools in the Bronx are beginning to see net gains in scores in math and language arts that outpace the gains of other schools in the district.

Threat equals reaction, and it doesn’t matter if the threat is in the form of a Confederate flag tattoo or a strapping grizzly; the same biological mechanism is triggered.

But everyone is really saying the same thing: I am suffering.

Some triggering event will expose Diego to a level of stress that trips his already sensitive stress-response

response system. Even with all the progress he’s made, it will likely send him flying.

But when it was bad . . . well, it was pretty darn bad. The

problem was that we never knew which mother we were going to get. Every day after school it was a guessing game—are we coming home to happy Mom or scary Mom? Needless to say, it created an environment of repeated and unpredictable stress that marked us in different ways, both negative and positive.

Looking back, I can see now how I adapted to our mom’s illness by becoming more attuned to those around me.

For me, quickly figuring out which mom I was coming home to was the key to navigating our household.

There isn’t a day that goes by that I don’t think about the son that we lost. And despite my tendency toward optimism, I have struggled to find meaning in his passing. But I do recognize that we were lucky. In the moment that I was brought to my knees, I had folks I could lean on to help me get back up. That’s something that I am profoundly grateful for. Sitting in my car, crying in front of Starbucks, I caught a glimpse of what it might be like to lose the ability to be the parent we all want to be. My mother didn’t have the network of support that Arno and I enjoy.