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

Twenty years of medical research has shown that childhood adversity literally gets under our skin, changing people in ways that can endure in their bodies for decades. It can tip a child’s developmental trajectory and affect physiology. It can trigger chronic inflammation and hormonal changes that can last a lifetime. It can alter the way DNA is read and how cells replicate, and it can dramatically increase the risk for heart disease, stroke, cancer, diabetes—even Alzheimer’s.

One way the report grouped people was by their zip code. The leading cause of early death in seventeen out of twenty-one zip codes in San Francisco was ischemic heart disease, which is the number-one killer in the United States. In three zip codes it was HIV/AIDS. But Bayview Hunters Point was the only zip code where the number one cause of early death was violence.

What they showed me was that if you were a parent raising your baby in the Bayview zip code, your child was two and a half times as likely to develop pneumonia than a child in the Marina district. Your child was also six times as likely to develop asthma. And once that baby grew up, he or she was twelve times as likely to develop uncontrolled diabetes.

But I also took away a larger lesson: If one hundred people all drink from the same well and ninety-eight of them develop diarrhea, I can write prescription after prescription for antibiotics, or I can stop and ask, “What the hell is in this well?”

If you have the right amount of each hormone, they all work together to keep the body functioning normally, but if you change one of those levels, the delicate interplay gets thrown off. This kind of hormonal imbalance can have direct and indirect effects. For instance, an increase in corticosteroids can directly affect blood pressure, but it can also indirectly affect growth and development by altering how other hormones do their jobs.

Cortisol also helps maintain normal blood pressure by regulating the body’s water and salt levels. And it inhibits growth and reproduction, because if you are living through a food crisis, it’s not a good time to be doing any optimistic long-term family planning; it makes more sense to divert all available energy to the problem at hand.

It made biological sense that a high dose of stress hormones at the wrong developmental stage could have an outsize impact on my patients’ downstream health.

First, they discovered that ACEs were astonishingly common—67 percent of the population had at least one category of ACE and 12.6 percent had four or more categories of ACEs.