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

unbeknownst to Sarah, Evan, and even Evan’s doctors, he did have a risk factor. A mighty big one.

Evan was more than twice as likely to have a stroke as a person without this risk factor.

for decades, an invisible biological process had been at work, one involving Evan’s cardiovascular, i...

The risk factor and its potential impact never came up in all of the regular checkups Ev...

something so common it’s hiding in plain sight.

what is it? Lead? Asbestos? Some toxic packing material? It’s childhood adversity.

they take on moral overtones, provoking feelings of shame and hopelessness in those who struggle with the lifelong impacts of childhood adversity.

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.

tip a child’s developmental trajectory and af...

can trigger chronic inflammation and hormonal changes that c...

can alter the way DNA is read and how cells replicate, and it can dramatically increase the risk for heart disease, stroke,...

years later, after having “transcended” adversity in amazing ways, even bootstrap heroes find themselves pulled up short by their biology.

They overcame adversity and went on to build successful lives—and then they got sick. They had strokes. Or got lung cancer, or developed heart disease, or sank into depression.

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.

As with Diego’s, most of my patients’ ADHD symptoms didn’t just come out of the blue. They seemed to occur at the highest rates in patients who were struggling with some type of life disruption or trauma,

The diagnostic criteria for ADHD told me I had to rule out other explanations for ADHD symptoms (such as pervasive developmental disorders, schizophrenia, or other psychotic disorders) before I could diagnose ADHD.

“Well, her asthma does seem to get worse whenever her dad punches a hole in the wall.

Day after day I saw infants who were listless and had strange rashes.

kids weren’t even growing.

story after story of heart-wrenching trauma.

I was doing my best to care for these kids, but it wasn’t nearly enough.

There was an underlying sickness in Bayview that I couldn’t put my finger on,

the problem in putting the pieces together was that they would emerge from situations occurring months or sometimes years apart.

difficult to see the story behind the story.

like a soap-opera wife whose husband was stepping out with the nanny, I would understand it only in hindsight.

lived in that state of not-quite-getting-it for years because I was doing my job the way I had been trained to do it.

The dominant view is that health disparities in populations like Bayview occur because these folks have poor access to health care, poor quality of care, and poor options when it comes to things like healthy, affordable food and safe housing.

Every day I see families and communities that lovingly support each other through some of the toughest experiences imaginable.

opened my practice there because I wasn’t okay with pretending the people of Bayview didn’t exist.

These babies came into the world no different than the ones born in Laurel Heights,

Probably Not actually true if uterine epigenetics and trauma are accounted for 2/22/22

it was easy to miss the forest for the trees. But the best scientists didn’t.

used their excitement and enthusiasm as a bridge from the mundane to the revelatory.

But most of us don’t like to think about the sad, upsetting things that have happened in the past.

It’s possible that we marginalize the impact of trauma on health because it does apply to us.

making available what you need most: blood, oxygen, energy, and chutzpah.

A good example of positive stress is one that many athletes can relate to: pregame jitters.

the increase in adrenaline is doing important work.

Despite the fact that these kids were no longer experiencing trauma, the parts of their brains responsible for learning and memory were still shrinking,

!!!!!!! 2/24/21

32.6 times as likely to have been diagnosed with learning and behavioral problems.

being told that they had ADHD or a “behavior problem” when these problems were directly correlated with toxic doses of adversity.

Currently, ADHD is a diagnosis based entirely on symptoms. If you remember, the criteria include inattention, impulsiveness, and hyperactivity, but the Diagnostic and Statistical Manual of Mental Disorders doesn’t say a word about the underlying biology.

the prognosis of toxic stress, the long-term risks that my patients faced, looked very different from run-of-the-mill ADHD.

unlike ADHD, the diagnosis of toxic stress doesn’t yet exist in the medical literature.

the telomeres of people with PTSD with the telomeres of people in good mental health.

those with PTSD had shorter telomeres than those in the control group.

If we put the right protocols into place in pediatric offices across the city, country, and world, we could intervene in time to walk back epigenetic damage and change long-term health outcomes for the roughly 67 percent of the population with ACEs and their children.

toxic stress is an unseen epidemic affecting every single community.

between 55 and 62 percent of the population have experienced at least one category of ACE, and between 13 and 17 percent of the population have an ACE score of four or more.

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.

work is built on research that shows that early adversity often has an outsize effect on infants and young children,