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

The truth is that despite all their hard work, people like Evan who have had adverse childhood experiences are still at greater risk for developing chronic illnesses, like cardiovascular disease, and cancer.

He, as a doctor, had perceived a patient’s weight to be the problem. What if it was actually a solution? What if his patient’s weight was a psychological and emotional barrier, something protecting her from harm? That

adverse childhood experiences in and of themselves are a risk factor for many of the most common and serious diseases in the United States (and worldwide), regardless of income or race or access to care.

turned out that “bad behavior” accounted for only about 50 percent of increased likelihood for disease. In a way that’s good news, because it means that if a person is exposed to ACEs and he is careful to avoid smoking, physical inactivity, and other health-damaging behaviors, he can protect himself from about 50 percent of the health risk. But it also means that even if he doesn’t engage in any health-damaging behaviors, he’s still more likely to develop heart or liver disease.

patients with four or more ACEs were twice as likely to be overweight or obese and 32.6 times as likely to have been diagnosed with learning and behavioral problems. When

The hippocampi are two cute little seahorse-shaped parts of the brain responsible for creating and maintaining memory. When the amygdala gets activated during a major stress event, it sends signals to the hippocampus that disrupt its ability to knit together neurons, essentially making it more difficult for the brain to create both short-term and long-term memories.

stress response can affect everything from menstrual cycles to libidos to waistlines.

chronic stress increases your cravings for high-sugar, high-fat foods, and elevated cortisol makes it harder for your body to metabolize sugars and easier for your body to store fat. But cortisol isn’t the only bad guy here; the hormones leptin and ghrelin are also increased with activation of the stress response. Together they intensify appetite and work with cortisol to do their worst for your waistline.

both environment and genetic code shape both biology and behavior. Considering

Instead of waiting around for the generations-long process of genetic adaptation to change the offspring’s DNA, this environmental information gets passed on to the rat pup quickly through a change in the epigenome. To

The study found that the pups’ DNA methylation took on the pattern of their foster moms’, not their genetic moms’. So did their behavior—if a rat pup born to a high-licker mom was fostered by a low licker, she grew up to be an anxious adult rat with high levels of stress hormones who was a low licker herself when she had her own pups. Meany

key to keeping a tolerable stress response from tipping over into the toxic stress zone is the presence of a buffering adult to adequately mitigate the impact of the stressor. In the case of the rat pups, it’s the mom’s licking and

household adversities, such as abuse or having a parent who used alcohol or drugs, were a stronger predictor of telomere shortening than household financial stress.

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

child-parent psychotherapy (CPP).

CPP

This type of therapy focuses on children from from birth to five years old and is built on the notion that to help young kids experiencing adversity, you have to treat the parent and child like a team.

Dr. Lieberman debunked the long-held myth that young children and babies don’t need treatment for trauma because they somehow don’t understand or remember the chaotic experiences they faced. Her work is built on research that shows that early adversity often has an outsize effect on infants and young children, just like it did on Dr. Hayes’s tadpoles. After years as a clinician, Dr. Lieberman came to understand that children’s need to create a story or narrative out of confusing events is actually very normal. Children are compelled to give meaning to what is happening to them. When there is no clear explanation, they make one up; the intersection of trauma and the developmentally appropriate egocentrism of childhood often leads a little kid to think, I made it happen.

targeting and healing the dysregulated stress response: sleep, mental health, healthy relationships, exercise, and nutrition. Not surprisingly, these are the same things that, as Elizabeth Blackburn and Elissa Epel’s research showed, boost levels of telomerase (the enzyme that helps to rebuild shortened telomeres).

Sleep, mental health, healthy relationships, exercise, nutrition, and mindfulness—we saw in our patients that these six things were critical for healing. As important, the literature provided evidence of why these things were effective. Fundamentally, they all targeted the underlying biological mechanism—a dysregulated stress-response system and the neurologic, endocrine, and immune disruptions that ensued. I got to

childhood adversity is associated with a variety of diseases and conditions in children that can be observed as early as infancy. In babies, exposure to ACEs is associated with growth delay, cognitive delay, and sleep disruption.

the data suggests that if a child grows up in a stressful community environment but has a well-supported and healthy caregiver, he or she is much more likely to stay in the tolerable stress zone as opposed to the toxic stress zone.

toxic stress in children as long-term changes to brains and bodies in the absence of a buffering caregiver.

screening for ACEs, doctors are acknowledging that they exist. By being open about ACEs with friends and family, people are normalizing adversity as a part of the human story and toxic stress as a part of our biology that we can do something about. Toxic stress is a result

Pamela Cantor. Her organization Turnaround for Children was leading the charge to bring the science of ACEs and toxic stress into schools.

greatest groupings of trauma symptoms corresponded strikingly with the communities of deepest poverty. The next page of the map revealed that the areas that were most affected were also the communities that had the fewest resources.

The communities near Ground Zero were equipped with more resources, which meant adults were far more able to act as effective buffers, keeping the kids’ stress out of the toxic zone and into the realm of tolerable. Whether it was a teacher, a religious leader, a grandparent, or a coach, the children closer to Ground Zero had many more sources of buffering that could help stabilize them in moments of acute trauma, even if it was severe.

a psychiatrist, she recognized the symptoms of trauma all around her. It wasn’t one or two kids, it was the entire school.

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.

ACEs weren’t just at the root of a public-health crisis in America, they were at the root of our public-education crisis as well.

“We need to make dat argument! We mus’ hexplain to ev’ry person dat if dey are in Appalachia, if dey are living in Middle Americah, if dey are living in Kentucky and dey believe dat dey have it hard—we mus’ mek sure dat ev’ry single person knows dat dey cyan get strong solu-shons—for poor white folks and for de peer-ent who brought her child and her syuitcases to you—dat we are in a united struggle about de effects of adversity on de developing brains and bodies of children. And when we all get behind dat, den we will have solu-shons that will lif’ ev’rybody up!”

We are all equally susceptible and equally in need of help when adversity strikes. And that is what a lot of folks don’t want to hear. Some want to stand back and pretend that this is just a poor-person problem. Others take fierce ownership of the problem and say, “This is killing my community,” but what they also mean is It’s killing my people more than yours.

that the long-term impacts of childhood adversity are not all suffering. In some people, adversity can foster perseverance, deepen empathy, strengthen the resolve to protect, and spark mini-superpowers, but in all people, it gets under our skin and into our DNA, and it becomes an important part of who we are. I don’t think people who grew up with ACEs have to “overcome” their childhoods. I don’t think forgetting about adversity or blaming it is useful. The first step is taking its measure and looking clearly at the impact and risk as neither a tragedy nor a fairy tale but a meaningful reality in between. Once you understand how your body and brain are primed to react in certain situations, you can start to be proactive about how you approach things. You can identify triggers and know how to support yourself and those you love.

This is about understanding how adversity disrupts the delicate ecosystems of family and overwhelm us. It’s about recognizing that when it inevitably does happen, we can use what we’ve learned from science to do a better job helping ourselves and one another so we can better protect our children.