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 body of research sparked by the ACE Study makes it clear 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.

Toxic stress response can occur when a child experiences strong, frequent, and/or prolonged adversity—such as physical or emotional abuse, neglect, caregiver substance abuse or mental illness, exposure to violence, and/or the accumulated burdens of family economic hardship—without adequate adult support. This kind of prolonged activation of the stress-response systems can disrupt the development of brain architecture and other organ systems, and increase the risk for stress-related disease and cognitive impairment, well into the adult years.

IF YOU WANT TO understand how a child’s stress response is working, try walking into the examination room with a tray full of needles and telling him it’s time for shots. By now, it seemed like I could almost guess the ACE score of a patient by the amount of commotion that took place when my nurse went in to give the vaccinations. We’d seen it all: screaming, kicking, biting, kids literally trying to climb the walls to get away from the needles. One patient got so upset he vomited on my white coat. Another ran out of the exam room and made it all the way down the block before we caught her. These extreme displays of fear were not your ordinary needle-phobic reactions; they were full-blown bear-in-the-woods reactions. Coincidentally, this natural stress-response provocation challenge gave us an opportunity to test the second, equally important ingredient for toxic stress—the caregiver’s ability to act as a buffer. The kids who had the worst responses were also the ones whose caregivers were the least likely to hug, kiss, sing to, or otherwise soothe their child. We heard a lot of “Hold him down!” and “I don’t have time for this, I have to be back at work in a half hour.”

the term kriegs-Basedow (kriegs means “war,” so kriegs-Basedow is “hyperthyroidism of war”) was coined following the observation of an increased incidence of hyperthyroidism during major wars.

more of the good stuff to feel the same amount of pleasure. The biological changes in the VTA that lead people to crave dopamine stimulators like high-sugar, high-fat foods also lead to an increase in risky behavior. The ACE Study shows that there is a dose-response relationship between ACE exposure and engaging in many activities and substances that activate the VTA. A person with four or more ACEs is two and a half times as likely to smoke, five and a half times as likely to be dependent on alcohol, and ten times as likely to use intravenous drugs as a person with zero ACEs.

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.

FOR MOST PEOPLE, the name Dr. Robert Guthrie doesn’t set their hearts aflutter, but as my brothers like to remind me, I might be a special case. In my mind, Dr. Guthrie is right up there with JFK Jr. and Idris Elba. Definitely on my short list for the “name any person, dead or alive, you most want to have dinner with” game. I don’t know if People magazine was around in 1961, but if it was, the development of newborn screening should have earned Dr. Guthrie a spot on the cover of the “Sexiest Man Alive” issue.

Over 60 percent of newborns develop some amount of jaundice. The signature yellow skin lets pediatricians know that there is a buildup of a chemical called bilirubin in the baby’s system. Bilirubin is created when the body breaks down old red blood cells. It is naturally processed by the liver and excreted by the body (which is actually why your pee is yellow).

Caroline’s bearing is what I find remarkable about her. She may be the most analytical person I have ever met. Her brain is like a computer. No matter what the question is, when Caroline responds, you get the sense that she has calculated all of the options and is responding with the solution that has at least a 99.4 percent likelihood of success.

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.