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

was tremendously important for kids to go to a school where they felt physically and emotionally safe. Check. It was also really important for kids to develop their readiness for learning, because the exposure to adversity affected the skills that were involved in learning readiness. Check, we have to do that too.

when it comes to student success, teaching things like resilience and grit can be as important as teaching math and science.

before kids could learn grit and resilience, or math and science, for that matter, they needed a basic foundation in healthy attachment, stress management, and self-regulation.

families often faced overwhelming challenges in providing safety and security for their children.

Turnaround embraces an approach that simply identifies where a student is on the developmental trajectory and uses the science of toxic stress to help get that child back on track.

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.

Toxic stress affects how we learn, how we parent, how we react at home and at work, and what we create in our communities. It affects our children, our earning potential, and the very ideas we have about what we’re capable of. What starts out in the wiring of one brain cell to another ultimately affects all of the cells of our society, from our families to our schools to our workplaces to our jails.

these women were on the vanguard of the movement, slowly but surely bringing ACE-informed approaches to scale.

The agenda of the Precision Public Health Summit was to bring everyone together to discuss how precision medicine could be used in the public-health arena to level the playing field in the critical first one thousand days of a child’s life.

big theme throughout was the importance of partnerships between scientists and the communities they are trying to help.

One of the speakers from the community partner side of things was Jenee Johnson, the director of the Black Infant Heal...

Her voice rose with pain and anger as she talked about how science was failing the people she worked with by not putting them at the center of the work.

both white and a successful CEO. He sits on the top of the socioeconomic food chain.

The stress-response mechanism is hardwired into all of us. Threat equals reaction,

the same biological mechanism is triggered.

What I felt Jenee wasn’t seeing was that while my kids and hers might have stress-response-triggering experiences because of their race, poor white kids living in Appalachia also have triggering experiences.

Think about it like this: We all live in a forest with different kinds of bears. There is a large group of bears that populate a part of the forest called Poverty, and if you live there, you’re going to see a whole lot of bears. There’s also a part of the forest called Race, where a different cluster of bears hang out. And there is another bear neighborhood called Violence. If you live near any of these bear dens, your stress-response system is go...

But there are also a lot of bears that live in the neighborhoods of Parental Mental Illness and Divorce and Addiction, which is why I reacted

so strongly to the last part of Jenee’s statement. Some of “the people that this impacts” were in the room.

I stood up, trembling.

Why were people so resistant to the science of adversity and to giving a basic fact of our biology a name and a number? Because when you bring it down to the level of cells, the level of biological mechanisms, then it is about all of us. We are all equally susceptible and equally in need of help when adversity strikes.

In rural white communities, the story is about loss of living-wage work and the fallout from rampant drug use. In immigrant communities, it is about discrimination and the fear of forever being separated from loved ones at a moment’s notice. In African American communities, it’s about the legacy of centuries of inhuman treatment that persist to this day—it’s about boys being at risk when they are playing on a bench or walking home from the store wearing a hoodie. In Native American communities, it is about the obliteration of land and culture and the legacy of dislocation. But everyone is really saying the same thing: I am suffering.

that’s exactly the mentality that is killing black people, white people, and all people. It perpetuates the problem by framing it in terms of us versus them.

this very human instinct toward tribalism was why we needed science.

Because the science shows us that it is not us against them. In fact, we all share a common enemy, and that common enemy is childhood

adver...

It’s the same fundamental approach to treatment for us all. If we begin to understand that, then maybe we will stop being so Balkanized in our response to the problem and be able to come up with solutions that work for everyone.

He wanted to be the unconditionally accepting caregiver that her real family wasn’t. So he started going over to her house every day after school to hang out, but it was a rough place to be. Diego didn’t want to be there, but he couldn’t leave her alone either. Soon, the yelling and the drama took him back to a familiar, dark place.

Diego had gone through periods of suicidality.

Fearing for his mother, Diego called 911. The police came and arrested his dad. Because he was undocumented, his fa...

Diego felt horrib...

Diego and his mom and little sister moved into a smaller apartment to save money, but they still went hungry sometimes.

Then his dad’s letters stopped coming.

months later, Rosa heard from one of her cousins. Diego’s dad was a desaparecido—one of the many who vanished after resisting the Mexican drug cartels.

Rosa got a call at work from San Francisco’s child-crisis response team. Diego had somehow gotten himself onto the roof of his school building and was standing near the edge, crying so hard his whole body shook, saying he didn’t want to live anymore.

Over the next weeks, our team worked with Diego to assess how he was doing in the six critical areas of sleep, exercise, nutrition, mindfulness, mental health, and healthy relationships.

Months later, when I saw him for a follow-up appointment, I felt a deep sense of satisfaction at the progress he had made. The system was working exactly as it should. Diego was back on track.

“About two weeks ago, I knew something was wrong. I could see he was about to fall into depression,

say, Mi amor, I see you. You are just sleeping, you don’t want to bathe yourself, you are not eating. I can see that you are suffering. Tell me, has something happened?

Son, are you depressed? I will stay here with you. But he told me, No, Mama, estoy bien, you can go.

Mama, forgive me for what I am about to do.

went into a panic. I imagined getting home in forty-five minutes and finding my son dead.

When I got home I was trembling.

He will have to try to keep his head about him to the degree that he can, recognize what’s going on biologically, and marshal his resources.

That’s the reason we created CYW in the first place. It’s what we can do.

we can use what we know about his biology to mitigate the impacts of the toxic stress that will forever be a part of his world.

Compared to what we know about the mechanism of toxic stress, what we do is still rather primitive. I wished we had better diagnostic tests to figure out exactly which pathways were being most disrupted so we could target our treatments more effec

POG stands for Pediatric Oncology Group. It was one of four pediatric clinical-trial groups dedicated to treating childhood cancers;

At COG institutions, multidisciplinary teams consisting of physicians, basic scientists, nurses, psychologists, pharmacists, and other specialists use their skills in the investigation, diagnosis, and management of childhood cancer.

wasn’t the development of a single pill that made the difference. It was the spirit and practice of collaboration across the United States and, indeed, the world.