By Nadine Burke Harris, M.D.
Houghton Mifflin Harcourt, 2018, ISBN: 978-0-544-82870-4, 273 pages, $27
“The Deepest Well” is the first book by Dr. Nadine Burke Harris, a pediatrician who has become a leader in the movement to change the way our society, especially the medical community, responds to early childhood adversity.
This book presents compelling research and moving personal accounts that demonstrate how adverse childhood experiences (ACEs) can change a young person’s stress response, leading to health problems during childhood and negative health outcomes later in life. While this book contains a fair amount of complex scientific research, Harris makes it more digestible by linking it with the stories of children she has treated and the story of her own growth and development as a doctor, advocate and parent.
Early in the book, Harris opened a clinic in one of San Francisco’s poorest neighborhoods, Bayview-Hunters Point, because she knew the families needed more attention and care. While most people know that poverty is associated with poor health outcomes, a recent body of research has helped to explain why that is.
ACEs research, first released in 1998, shows that early childhood trauma can cause lifelong negative health impacts. Poverty is often a root cause of factors that lead to trauma, but it is also important to recognize that people from all walks of life and income brackets undergo trauma. ACEs include suffering physical, or emotional abuse, neglect, experiencing a divorce, or living with someone who has abused substances.
At Harris’ clinic in Bayview-Hunters Point, children were suffering from physical ailments such as asthma and eczema as well as behavioral issues such as irritability and difficulty paying attention in class. By talking with their parents, she learns that some of these children have been abused or are witnessing violence at home. She begins working in tandem with a therapist who hands her an article about the 1998 study on ACEs, which examined the health outcomes of 17,421 people who had taken an ACEs test reporting on their own childhood trauma.
It found that 67 percent of the population had at least one ACE, and 12.6 percent had four or more ACEs. And a person with four or more ACEs was twice as likely to develop heart disease and cancer and three and a half times as likely to develop chronic obstructive pulmonary disease as a person with zero ACEs, the study found. Learning about the study led Harris to start asking each of her patients and their caregivers about their ACEs.
In many cases, as she writes in this book, explaining ACE science has helped the caregivers visiting Harris’ clinic to take actions to improve the lives and health of their children. One mother, for example, could not bring herself to leave her abusive partner until she realized that the violence and instability in their home was severely damaging the physical health of her child.
Foster parents have the difficult and important task of caring for children who have experienced ACEs. The lessons shared in this book can help foster parents understand trauma. Harris points to therapy, exercise, and developing positive and nurturing relationships as a few ways she guides her patients toward healing. But there are still many unknowns, so Harris is trying to research effective responses to trauma through a nonprofit she founded, the Center for Youth Wellness.
“I believe that we can rewrite the story of adversity and break the intergenerational cycle of toxic stress,” Harris writes toward the end of the book. “I wrote this book for all the parents, step parents, foster parents, grandparents, and caregivers of all stripes who are trying to figure out how to give the little people in their care the best shot in this world despite the difficulties life throws in their way and, often, despite their own histories of adversity.”
While most of the book deals with Harris’ work as a doctor and advocate, her experience with parenting and a tragic event in her life brings her message home.
— Reviewed by Holden Slattery